June 29, 2011

June 28, 2011 (Boston, Massachusetts and London, United Kingdom) — The incidence of hyperglycemia is rising at an alarming rate, with the number of adults with diabetes worldwide having more than doubled over the past three decades, a new study suggests [1].

The study, published online in the Lancet on June 25, 2011, was conducted by a group led by Drs Goodarz Danaei and Mariel Finucane (Harvard School of Public Health, Boston, MA), and Dr Majid Ezzati (Imperial College London, UK)

Ezzati commented to heartwire : "Raised glucose is one of the most important risk factors for coronary heart disease and stroke, and the increased prevalence of diabetes will offset the gains we are making in preventing these conditions through reducing smoking, blood pressure, and cholesterol. The problem with diabetes is that if prevention fails and people develop the condition, the treatments available are not that effective and have many side effects. It is not like blood pressure and cholesterol, where there are lots of effective drugs." He added: "Unless we develop better programs for detecting people with elevated blood sugar and helping them to improve their diet and physical activity and control their weight, diabetes will inevitably continue to impose a major burden on health systems around the world."

Noting that the driving factor is obesity, which is rising fast as a direct result of the worsening diet of the population, Ezzati called for urgent action by governments to prevent this from continuing. "There are many tools they can use to affect what people eat and drink, such as taxing unhealthy food and subsidizing healthy food. And they also need to do more to encourage physical activity. We should be seriously restricting the availability of sugar-laden food and drinks and providing low-cost healthier alternatives. People will choose to snack on fresh fruit if it is made available at the right price, but at present it is much easier and cheaper to eat sugar-loaded rubbish. That should not be the case."

350 Million Now Estimated to Have Diabetes

For the study, the researchers analyzed fasting plasma glucose data from 2.7 million people aged 25 and over across the world, obtaining data from health examination surveys and epidemiological studies. They found that the number of adults with diabetes increased from 153 million in 1980 to 347 million in 2008. The number of men with diabetes worldwide rose from 8.3% to 9.8% (an 18% rise) over the 30-year period, while the number of diabetic women increased from 7.5% to 9.2% (a 23% increase).

While about 70% of the increase is attributed to population growth and aging, rising adiposity rates are believed to account for much of the remaining 30% of the increase. Age-standardized mean fasting plasma glucose has been rising by 0.07 mmol/L per decade for men and by 0.09 mmol/L per decade for women, and by 2008 had reached 5.50 mmol/L for men and 5.42 mmol/L for women.

At present it is much easier and cheaper to eat sugar-loaded rubbish.

Among high-income countries, fasting plasma glucose levels rose in the US at more than the twice the rate of Western Europe over the three decades. In wealthy nations, diabetes and glucose levels were highest in the US, Greenland, Malta, New Zealand, and Spain and lowest in the Netherlands, Austria, and France. Despite its obesity epidemic, the UK's diabetes prevalence was lower than that of most other high-income countries.

Oceania had the largest rise and the highest mean fasting glucose levels and diabetes prevalence. Glucose levels and diabetes were also particularly high in South Asia, Latin America, the Caribbean, Central Asia, North Africa, and the Middle East.

In a commentary [2], Dr Martin Tobias (Ministry of Health, Wellington, New Zealand), describes the current findings as "stark" and notes that the situation is probably even worse than suggested here, as data from other studies have shown that less than half of diabetes cases are diagnosed globally, and, of this subset, less than half have glycated hemoglobin (HbA1c) concentrations below 7% (indicative of tight control). He calls for continued country-level surveillance of raised sugar levels and diabetes, the results of which need to be regarded as "information for action."


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