Diabetes Epidemiology

In 2000 the worldwide estimate by the International Diabetes Federation (IDF) was 151 million adults (20-79 years) with type 2 diabetes. This is an increase from 30 million in 1985 and 135 million in 1995. There is a projected global estimate of 300 million people in 2025 (IDF,

2001). Because higher energy intakes and lower energy expenditures are having differential impacts on developed and developing countries, the prevalence of type 2 diabetes in developing countries is expected to increase by 170% compared with a rise of 41% in developed countries between 1995 and 2025 (IDF, 2001). Approximately half this increase will be Asian and Pacific Islander populations. China is predicted to have a prevalence increase of 68%, followed by India (59%) and other Asian countries and the Pacific Islands (41%) (Joslin Diabetes Center,

2002). By comparison, the worldwide estimate for type 1 diabetes was 4.9 million in 2000 and is not expected to show a major increase in prevalence.

The Diabetes Atlas 2000 (IDF, 2001) contains estimates of diabetes prevalence in 130 countries including more than 5.5 billion people within the seven regions of the IDF. Lowest regional rates are in Sub-Sahara Africa and the highest rates in the Western Pacific. Countries with a prevalence of diabetes between 1.5% and 3.9% include Chile, China, the Philippines, Ireland, Brazil, Argentina, the United Kingdom, Peru, Thailand, Norway, South Africa, Columbia, and Venezuela. Countries with a prevalence of diabetes between 4% and 8% include Turkey, Indonesia, Portugal, Finland, Poland, India, Greece, Korea, Melanesia, Hungary, Israel, Japan, the United States (6.2%), and New Zealand. Countries between 8% and 12% include Egypt, Cuba, and Singapore. A number of Caribbean and South Pacific Island countries, Mexico, Papua New Guinea, Bahrain, Hong Kong, Pakistan, and the Czech Republic range from 12% to 15% (Table 1) (IDF, 2001).

The three tiers of prevalence represent countries from all parts of the world demonstrating genetic and ethnic diversity. Because most of these countries are small, the top 10 countries in terms of numbers of individuals with diabetes is very different. In descending order theses are: India, China, the United States, Pakistan, Japan,

Indonesia, Mexico, Egypt, Brazil, and Italy (Table 2) (IDF, 2001). In the United States the adult prevalence rates vary widely among and within ethnic groups. These are: 15.1% of American Indians and Alaska Natives, 13% non-Hispanic "Blacks," 10.2% Hispanic/Latino Americans, and 7.8% non-Hispanic "Whites" (Harris, 1995).

The most comprehensive epidemiological data exist for Native Americans. Among Native Americans one of every five is affected with diabetes (Indian Health Service, 2000). Age-adjusted rates of diagnosed diabetes in the Indian Health Service Areas for fiscal year 1995 are highest (115/1,000) for the Pima and Papago of Arizona

Table 1. Prevalence of Diabetes (20-79 Age Group) in the Top 10 Countries


Prevalence (%)

Papua New Guinea








Trinidad and Tobago






British Virgin Islands

Cayman Islands



Hong Kong

St. Kitts and Nevis



Czech Republic




Table 2. People with Diabetes (20-79 Age Group) in the Top 10 Countries

Number of people







United States
















and lowest (26/1,000) for Alaskan populations (Gohdes & Acton, 2000). These rates have increased dramatically over the last two decades. Approximately 50% of Pima adults aged 35 and older have diabetes (Knowler, Pettitt, Bennett, & Williams, 1983). Other dramatic increases have been reported for the Navajo Indians (Glass, 1996), Cree and Ojibwas Indians in Canada (Young & Harris,

1994), and Alaskan Natives (Gohdes et al., 1996). Most prevalence studies indicated that females have higher rates of diabetes than males (Lee, Howard, & Savage,

1995). In addition, rates of diabetes are higher with increasing Indian heritage (Lee et al., 1995). Genetic studies have determined that there is a genetic propensity for diabetes among the Pima (Baier, Bogardus, & Sacchettini, 1996; Farook et al., 2002).

Starting in the 1990s there has been a rapid increase in the number of Native American children with type 2 diabetes. The primary factor is obesity (Salbe et al., 2002) associated with centrally distributed fat (Goran, & Gower, 1999) and high fasting insulin levels or insulin resistance (Pettitt, Moll, & Bennett, 1993). Many of these children were exposed to high circulating glucose levels in mothers with type 2 diabetes or with gestational diabetes (Ghodes & Acton, 2000), therefore there is an inter-generational affect of diabetes during pregnancy.

Latinos are the fastest growing minority group in the United States: Mexican American (60%), Puerto Rican (12%), and Cuban (6%) with smaller numbers of Central American and South Americans. Puerto Ricans live primarily in the North East corridor, Cuban Americans primarily, in Florida, and Mexican Americans in the Southwest. By age 45, 20% of Latino Americans have diabetes and by age 65 diabetes has been diagnosed in more than 33% of Latinos regardless of their country of origin (Davidson, Seltzer, & Bressler, 1994; Harris, 1991; Weller et al., 1999). Sixty percent of the increase in diabetes prevalence in the United States in the 1990s is attributed to Latino populations (ADA, 1994). Heredity is an important factor and Latinos with a higher percentage of Native American admixture are at greater risk for diabetes (Stern et al., 1992).

The prevalence of type 2 diabetes in second-and third-generation Japanese Americans, particularly males, in the Seattle area is twice as high as the prevalence for the population with European ancestry and four times greater than the non-migrant population in Japan (Fujimoto, Leonetti, Kinyoun, Newell-Morris, & Shuman, 1987).

Diabetes is a costly disease. The economic burden of diabetes is estimated in direct healthcare costs to patients and the additional costs of lost wages, disability, and premature death. In the United States this was $98 billion in 1997 (approximately $12,000/patient) (Diabetes Public Health Resource, www.cdc.gov/diabetes/pubs/ estimates.htm, May/2002). Per patient costs for other countries in U.S. dollars are estimated to be over $3,000 for Belgium, Germany, and France with slightly lower levels for other European countries and the United Kingdom ($2,000) (IDF, 2001). The rising incidence and prevalence of type 2 diabetes will present a tremendous economic burden for many countries.

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