Hilary King

Geographic differences in the risk of insulin-dependent diabetes mellitus: the importance of registries.

There are marked geographic differences in the incidence of insulin-dependent diabetes mellitus (IDDM); for example, children in countries such as Finland are over 35 times more likely to develop IDDM than children in Japan. An understanding of the reasons for the geographic differences is likely to be important for understanding and, hopefully, preventing IDDM. There are problems, however, because of the lack of registries with adequate standardization. The major needs for the future studies include (1) to clarify the definition of IDDM for epidemiologic study, (2) to establish a standardized approach for IDDM registries, (3) to use registries to evaluate viral, immunologic, and genetic differences in order to explain differential risks across populations, and (4) to encourage the development of new population-based registries worldwide.

Pakistan National Diabetes Survey: Prevalence of Glucose Intolerance and Associated Factors in Shikarpur, Sindh Province

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and their relationship to age and obesity was estimated in the rural town of Shikarpur in Sindh Province, Pakistan by a population‐based survey in 1994. Oral glucose tolerance tests were performed in a stratified random sample of 967 adults (387 men, 580 women) aged 25 years and above. The diagnoses of diabetes and IGT were made on the basis of WHO criteria. The response rate was 71% for men and 80% for women. The prevalence of diabetes was 16.2% (9.0% known, 7.2% newly diagnosed) in men, and 11.7% (6.3% known, 5.3% newly diagnosed) in women. The prevalence rose with age to a peak of 30% and 21% in 65–74 year‐old men and women respectively. IGT was detected in 8.2% of men and 14.3% of women. Thus, total glucose intolerance (diabetes and IGT combined) was present in 25% of subjects examined. These results indicate that glucose intolerance in South Asians can no longer be regarded as a problem confined to migrant communities. Of the 72 subjects previously known to have diabetes, none was using insulin treatment, but 57 (79%) took oral hypoglycaemic agents. Central obesity and positive family history were strongly associated with diabetes, as was prevalence of hypertension. The association with central obesity was greater for women than for men, and suggests important, modifiable risk factor(s) related to lifestyle.

Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in Baluchistan province.

The prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) and their relationship to age and obesity was estimated in a population-based survey in urban and rural areas in Baluchistan province, Pakistan. Cluster sampling of 834 adults (260 men, 574 women) in the urban and 570 adults (175 men, 395 women) in the rural areas was carried out. Oral glucose tolerance tests were performed in adults aged 25 years and above. Diagnosis of diabetes and IGT was according to the World Health Organization (WHO) criteria. The overall prevalence of diabetes and IGT in both sexes was 10.8 and 11.9% (urban) versus 6.5 and 11.2% (rural), respectively. The crude prevalence of diabetes in the urban versus rural area was 11.1% in men and 10.6% in women versus 10.3% in men and 4.8% in women. As against this IGT was found in 6.5% of men and 14.3% of women in the urban area and 7.4% of men and 13.0% of women in the rural setting. The major risk factors associated with diabetes were age, positive family history (F/H) of diabetes and obesity. Central obesity was more strongly associated with diabetes in women than men.

High Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in the Sultanate of Oman: Results of the 1991 National Survey

A national survey of glucose intolerance and cardiovascular disease risk factors in Oman has demonstrated a high prevalence of diabetes (10%) and impaired glucose tolerance (IGT, 13% in females and 8% in males). Prevalence of diabetes rose with age to a maximum of over 30% in both sexes. Prevalence of total glucose intolerance (diabetes and IGT combined) exceeded 50% in the seventh (females) and eighth (males) decade of life.

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.

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.

Impact of poverty on the prevalence of diabetes and its complications in urban southern India

Aim The impact of poverty on the profile of diabetes and its complications was studied.

Non-insulin-dependent Diabetes (NIDDM) in a Newly Independent Pacific Nation: The Republic of Kiribati

A population-based survey of 2938 subjects has demonstrated a high prevalence of non-insulin-dependent diabetes (NIDDM) in the Micronesian population of Kiribati (formerly the Gilbert Islands). This finding provides further support for evidence from Nauru, Guam, and the Marshall Islands that Micronesians are particularly susceptible to NIDDM. The age-standardized prevalence was over twice as high in an urban, as compared with a rural, sample (9.1 versus 3.0 in men, 8.7 versus 3.3 in women). To test the a priori hypotheses that obesity, reduced physical activity, and a nontraditional diet are associated with NIDDM, indices of these factors were compared in rural and urban subjects. The rural population was found to be leaner, to have a higher estimate of habitual physical activity, and to have a lower percentage of daily energy intake derived from imported foods. Further analysis demonstrated that obesity alone was insufficient to explain the rural-urban difference in prevalence of NIDDM. The multiple logistic regression model demonstrated a significant association between the prevalence of NIDDM and both obesity and urbanization in men. In women, obesity, physical inactivity, and urbanization were all associated with increased prevalence of NIDDM.

Glucose Intolerance in Colombia: A population-based survey in an urban community

Objective— To determine the prevalence of diabetes and its relationship to age and obesity in an urban community in Colombia. Research Design and Methods— A cluster sample of 670 adults ≥ 30 yr of age was selected from the city of Santafè de Bogotá. Classification of diabetes and IGT was according to WHO criteria. Results— Response to the survey, conducted in 1988–1989, was 71% for men and 84% for women. Prevalence of diabetes was 7% in both sexes. Prevalence of IGT was 5% in men and 7% in women. Age-standardized prevalence of diabetes in the 30- to 64-yr age range was comparable with that reported in urban Brazilians and rural Hispanics in the U.S.. Prevalence was higher than in the white population of the U.S. but lower than in several urban U.S. Hispanic communities. Some 40% of men and 30% of women with diabetes were unaware of their condition before the survey, but all those <50 yr of age were diagnosed previously. Glucose intolerance was associated with high BMI in men and with advancing age in both sexes. Conclusions— Glucose intolerance is common in this community and will likely increase in frequency in Colombians with further urbanization and population aging.

Relationship Between Prevalence of Impaired Glucose Tolerance and NIDDM in a Population

Objective To study the relationship between the prevalence of impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) across populations of the Pacific Ocean region to assess whether variability in those two proportions followed some predictable pattern related to modernization of life-style and risk factor levels. Research Design and Methods Prevalence estimates from studies with 75-g oral glucose loads and World Health Organization criteria were age standardized. Results The linear correlation between IGT and NIDDM prevalence was poor (0.22 in men and 0.24 in women), although it was improved when the outlying data of Micronesian Nauruans and Australian Aborigines were excluded (r = 0.65, P < 0.01 in men and r = 0.54, P < 0.01 in women). However, an epidemicity index calculated as the percentage of total glucose intolerance (TGI) made up by IGT (i.e., IGT/TGI) had the strongest correlation with NIDDM prevalence (r = −0.81, P < 0.001 in men and r = −0.77, P < 0.001 in women) and also explained more of its variance, with no population having undue influence on the relationship. When IGT/TGI was plotted against NIDDM prevalence for the genetically homogeneous rural (relatively traditional) and urban (modernized) segments of five Pacific island populations, there was a clear tendency for IGT/TGI to decline as the prevalence of NIDDM increased in association with worsening risk factor levels. However, longitudinal data for the high prevalence population of Nauru demonstrated that at least in a stabilizing epidemic, changes in the prevalence of IGT and NIDDM may not be easily predictable. Conclusions The epidemicity index may be useful as an indicator of the potential for higher future NIDDM prevalence in whole populations. Populations will probably equilibrate at a certain NIDDM prevalence dependent on the strength of their genetic susceptibility to the disease and their degree of exposure to adverse environmental risk factors, including modern diet, physical inactivity, and obesity.