Diabetes and associated disorders in Cambodia: two epidemiological surveys.

BACKGROUND: The Asia-Pacific region is thought to be severely affected by diabetes. However, reliable, standardised data on prevalence and characteristics of glucose intolerance in Asian populations remain sparse. We describe the results of two field surveys undertaken in Cambodia in 2004. METHODS: 2246 randomly selected adults aged 25 years and older were examined in two communities, one rural (Siemreap) and one semi-urban (Kampong Cham). The diagnosis of diabetes and impaired glucose tolerance was based on 2-h blood glucose estimation using criteria recommended by the latest report of a WHO Expert Group. Blood pressure, anthropometry, habitual diet, and other relevant characteristics were also recorded. FINDINGS: Prevalence of diabetes was 5% in Siemreap and 11% in Kampong Cham. Prevalence of impaired glucose tolerance was 10% in Siemreap and 15% in Kampong Cham. About two-thirds of all cases of diabetes were undiagnosed before the survey. Prevalence of hypertension was 12% at Siemreap and 25% at Kampong Cham. People in Kampong Cham had higher estimates of central obesity than those in Siemreap. INTERPRETATION: Diabetes and hypertension are not uncommon in Cambodia. A quarter of all adults in the chosen suburban community had some degree of glucose intolerance. Since Cambodian society is relatively poor, and lifestyle is fairly traditional by international standards, these findings are unexpected.

The burden of mortality attributable to diabetes: realistic estimates for the year 2000.

OBJECTIVE: To estimate the global number of excess deaths due to diabetes in the year 2000. RESEARCH DESIGN AND METHODS: We used a computerized generic formal disease model (DisMod II), used by the World Health Organization to assess disease burden through modeling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, age- and sex-specific estimates of diabetes prevalence, and available published estimates of relative risk of death for people with diabetes compared with people without diabetes. The results were validated with population-based observations and independent estimates of relative risk of death. RESULTS: The excess global mortality attributable to diabetes in the year 2000 was estimated to be 2.9 million deaths, equivalent to 5.2% of all deaths. Excess mortality attributable to diabetes accounted for 2-3% of deaths in poorest countries and over 8% in the U.S., Canada, and the Middle East. In people 35-64 years old, 6-27% of deaths were attributable to diabetes. CONCLUSIONS: These are the first global estimates of mortality attributable to diabetes. Globally, diabetes is likely to be the fifth leading cause of death.

Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.

OBJECTIVE: The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030. RESEARCH DESIGN AND METHODS: Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations' population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries. RESULTS: The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age. CONCLUSIONS: These findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.

Global policy: aspects of diabetes in India.

Diabetes has already been described as an epidemic, but predictions for future increases in prevalence, especially in developing countries, point to a major healthcare crisis for the future. Very little is known about the economic impact of diabetes in the developing world where predicted increases in prevalence are greatest. This paper discusses the implications of a recent study of the economic aspects of diabetes in India. The study aims were to estimate the costs of diabetes care and to assess the awareness of patients and healthcare professionals about the prevention and treatment of diabetes. The findings confirm reports from earlier studies of the high costs of treatment amongst all socio-economic patient groups resulting in a serious burden on both patients and state resources alike. Both patients and medical practitioners displayed a lack of comprehension of the need for constant disease monitoring and consistent approaches to tight glycaemic control. The long term economic implications are worrying. With the Indian diabetic population predicted to rise to >80.9 million by the year 2030, immediate health policy restructuring and investment will be needed if the best use is to be made of the scarce healthcare resources.

Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP).

OBJECTIVES: To investigate for the first time the prevalence of diabetes and impaired glucose tolerance (IGT) nationwide in Turkey; to assess regional variations and relationships between glucose intolerance and lifestyle and physical risk factors. RESEARCH DESIGN AND METHODS: The Turkish Diabetes Epidemiology Study (TURDEP) is a cross-sectional, population-based survey that included 24,788 subjects (age > or =20 years, women 55%, response 85%). Glucose tolerance was classified according to World Health Organization recommendations on the basis of 2-h blood glucose values. RESULTS: Crude prevalence of diabetes was 7.2% (previously undiagnosed, 2.3%) and of IGT, 6.7% (age-standardized to world and European populations, 7.9 and 7.0%). Both were more frequent in women than men (P < 0.0001) and in those living in urban rather than rural communities (P < 0.001). Prevalence rates of hypertension and obesity were 29 and 22%, respectively. Both were more common among women than men (P < 0.0001). Prevalence of diabetes and IGT increased with rising BMI, waist-to-hip ratio (WHR), and waist girth (P < 0.0001). Multiple logistic regression analysis revealed that age, BMI, WHR, familial diabetes, and hypertension were independently associated with diabetes, age, BMI, WHR, familial diabetes, and hypertension with IGT (except for familial diabetes in women with IGT). Education was related to diabetes in men but was protective for diabetes and IGT in women. Socioeconomic status appeared to decrease the risk of IGT in men while it increased the risk in women. Smoking had a protective effect for IGT in both sexes. CONCLUSIONS: Diabetes and IGT are moderately common in Turkey by international standards. Associations with obesity and hypertension have been confirmed. Other lifestyle factors had a variable relationship with glucose tolerance.

Prevención de la diabetes mellitus: una perspectiva global de la salud pública

El rápido desarrollo a nivel mundial de la epidemia de diabetes, con sus efecto más marcados en los países en desarrollo, requiere de una respuesta global. La Organización Mundial de la Salud, en asociación con la Federación Internacional de Diabetes, otras organizaciones no gubernamentales y el sector privado, tiene que desempeñar un papel preponderante. Las acciones apropiadas incluyen la vigilancia epidemiológica, la formulación de políticas, el desarrollo de potencial humano disponible, la preparación de normas y la promoción. Todas estas medidas están destinadas a respaldar a los Estados Miembr de la O.M.S. con el establecimiento o el acrecentamiento de sus programas nacionales para la prevención y el control de la diabetes. (AU)