About Diabetes: Epidemiology of diabetes in Mediterranean
A global perspective
Diabetes is one of the most common non-communicable diseases (NCDs). It is the fourth or fifth leading cause of death in most high-income countries and there is substantial evidence that it is epidemic in many economically developing and newly industrialized countries. Without effective prevention and management programs, the burden will continue to increase worldwide. In most countries diabetes has increased alongside rapid cultural and social changes: ageing populations, increasing urbanization, dietary changes, reduced physical activity and unhealthy behaviours.
Type 2 diabetes accounts for 85% to 95% of all diabetes in high-income countries and may account for an even higher percentage in low and middle income countries. Type 2 diabetes is a common condition and a serious global health problem.
Type 1 diabetes, although less common than type 2 diabetes, is increasing each year in both rich and poor countries. In most high-income countries, the majority of diabetes in children and adolescents is type 1 diabetes.
Gestational diabetes is common and, like obesity and type 2 diabetes, is increasing throughout the world. The risk of developing type 2 diabetes is high in women who have had gestational diabetes. The reported prevalence of gestational
diabetes varies widely among different populations around the world.
Some 382 million people worldwide, or 8.3% of adults, are estimated to have diabetes. About 80% live in low and middle-income countries. If these trends continue, by 2035, some 592 million people, or one adult in 10, will have diabetes. This equates to approximately three new cases every 10 seconds or almost 10 million per year. The largest increases will take place in the regions where developing economies are predominant. Age distribution Almost half of all adults with diabetes are between the ages of 40 and 59 years. More than 80% of the 184 million people with diabetes in this age group live in low and middle-income countries. This age group will continue to comprise the greatest number of people with diabetes in the coming years. By 2035, it is expected that the number will increase to 264 million. Again, more than 86% will be living in low and middle-income countries.
The majority of people with diabetes live in the economically less-developed regions of the world. Even in Africa, the Region with the lowest prevalence, it is estimated that around 522,600 people died due to diabetes in 2013. The disparities in the world’s response to the epidemic are huge: although 80% of people with diabetes live in low and middle-income countries, only 20% of global health expenditure on the disease was made in those countries.
A staggering 138 million people are living with diabetes in the Western Pacific, more than in any other region. With 19.8 million people affected, Africa has the smallest diabetes population compared with the other Regions although this is projected to more than double by 2035. In terms of the prevalence of adults with diabetes, the Middle East and North Africa Region has the highest, at 10.9%. The Middle East and North Africa Region is followed closely by the 9.6% rate found in the North America and Caribbean Region while 8.2% of adults in the South and Central America Region have diabetes. The picture is similar for IGT. The Western Pacific Region is estimated to have the greatest number of people with IGT and consequently at greatly increased risk for developing type 2 diabetes, with some 110 million; although the North America and Caribbean Region has the highest comparative prevalence, with 12.1% of the adult population affected. Worldwide, the prevalence (%) of IGT is lower than that of diabetes but there is a high risk that, if not treated
early, these people will progress to diabetes.
Prevalence*(%) estimates of diabetes (20-79 years), Mediterannea Area, 2013
The number of people with diabetes in Europe is estimated to be 56.3 million – 8.5% of the adult population. Turkey has the highest prevalence (14.8%) and the Russian Federation has the greatest number of people with diabetes (10.9 million). After Turkey, the countries with the highest prevalence are Montenegro (10.1%), Macedonia (10.0%), Serbia (9.9%), and Bosnia and Herzegovina (9.7%). The countries with the highest number of people with diabetes are for the
most part in Western Europe, including Germany, Spain, Italy, France, and the UK.
Age is an important risk factor for type 2 diabetes. In the Europe Region, 37% of the population is over 50 years of age, and this is expected to increase to over 44% by 2035. To a large degree, the high prevalence of type 2 diabetes and IGT are a consequence of the ageing of the Region’s population. Europe also has one of the highest incidence rates of type 1 diabetes in children, with 20,000 new cases per year.
One in 10 deaths in adults in the Europe Region can be attributed to diabetes – 619,000 in 2013. The large majority (90%) of these deaths were in people over the age of 50, which partly reflects the age distribution of the population, but also may be related to improved survival rates due to more responsive health systems. There are slightly more deaths due to diabetes in women compared to men (329,000 vs 289,000, respectively) in the Region.
Estimates indicate that at least USD 147 billion was spent on diabetes healthcare in the Europe Region in 2013, accounting for over one-quarter of global healthcare spending on diabetes. Just as there are wide variations in the prevalence of diabetes across the Region, the range between countries of average diabetes-related healthcare spending is also large – from USD 10,368 per person with diabetes in Norway to just USD 87 per person with diabetes in Tajikistan.
Middle East and North Africa
The Region has the highest comparative prevalence of diabetes (10.9%). Rapid economic development coupled with ageing populations has resulted in a dramatic increase in the prevalence of type 2 diabetes. Over the past three decades, major social and economic changes have transformed many of the countries in the Region. These include rapid urbanization, reduced infant mortality and increasing life expectancy. This development has brought with it a constellation of negative behavioural and lifestyle changes relating to poor-quality nutrition and reduced physical activity, giving rise to increased obesity. Smoking, a risk factor for diabetes complications, remains a serious and growing problem
According to the latest estimates, 34.6 million people, or 9.2% of the adult population, have diabetes. This number is set to almost double to 67.9 million by 2035. The explosion of diabetes in the Region is overwhelmingly due to type 2 diabetes. Worryingly, the prevalence (%) in the Region among younger age groups is substantially higher than the global average. A further 25.2 million people, or 6.7% of the population, are estimated to have IGT and therefore are at high risk of developing diabetes. This number is also expected to almost double by 2035. Saudi Arabia has 14,900 children with type 1 diabetes, by far the highest number in the Region, and approximately a quarter of the Region’s total of 64,000.
Diabetes kills more than 10% of all adults in the Region – 368,000 deaths in 2013. Nearly half of all deaths from diabetes in the Region occurred in people under 60. These early deaths may be a result of a combination of factors: the rapidly changing environments and lifestyles in the Region, late diagnoses, and health systems that are not equipped to bear the growing burden.
Delays in diagnosis and treatment deficiencies ultimately make diabetes-related complications more likely and will inevitably increase healthcare costs in the future. In 2035, health expanditure will reach 627 billion of US$.
Indeed if diabetes is not managed correctly, sufferers are likely to become progressively ill and debilitated. Over time, diabetes can damage the heart, blood vessels, kidneys, eyes and nerves.
50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke), and 10-20% of people with diabetes die of kidney failure.
Long-term accumulated damage to the small blood vessels in the eye leads to diabetic retinopathy, an important cause of blindness. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment.
In conclusion Diabetes is undoubtedly one of the most challenging health problems of the 21st century.
Actually, prevalence of diabetes is increasing among all ages in the Mediterranean Region, mostly due to increases in overweight and obesity, unhealthy diet and physical inactivity.
All types of diabetes are on the increase, type 2 diabetes in particular: the number of people with diabetes will increase by 55% by 2035.
Full details of the methods used to generate the prevalence estimates for diabetes in adults and the proportion undiagnosed, including how the data sources were evaluated and processed, can be found in the journal Diabetes Research and Clinical Practice and on the IDF Diabetes Atlas website: www.idf.org/diabetesatlas.