Jonathan E. Shaw
Baker IDI Heart and Diabetes Institute
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Diabetes Research and Clinical Practice | 2010
Jonathan E. Shaw; Richard Sicree; Paul Zimmet
AIM We estimated the number of people worldwide with diabetes for the years 2010 and 2030. METHODS Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. RESULTS The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. CONCLUSION These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries.
Diabetic Medicine | 2006
K. G. M. M. Alberti; Paul Zimmet; Jonathan E. Shaw
Aims To establish a unified working diagnostic tool for the metabolic syndrome (MetS) that is convenient to use in clinical practice and that can be used world‐wide so that data from different countries can be compared. An additional aim was to highlight areas where more research into the MetS is needed.
Diabetes Research and Clinical Practice | 2011
Katherine Ogurtsova; J. da Rocha Fernandes; Y. Huang; Ute Linnenkamp; Leonor Guariguata; Nam H. Cho; David Cavan; Jonathan E. Shaw; L.E. Makaroff
AIM To produce current estimates of the national, regional and global impact of diabetes for 2015 and 2040. METHODS A systematic literature review was conducted to identify data sources on the prevalence of diabetes from studies conducted in the period from 1990 to 2015. An analytic hierarchy process was used to select the most appropriate studies for each country, and estimates for countries without data were modelled using extrapolation from similar countries that had available data. A logistic regression model was used to generate smoothed age-specific estimates, which were applied to UN population estimates. RESULTS 540 data sources were reviewed, of which 196 sources from 111 countries were selected. In 2015 it was estimated that there were 415 million (uncertainty interval: 340-536 million) people with diabetes aged 20-79years, 5.0 million deaths attributable to diabetes, and the total global health expenditure due to diabetes was estimated at 673 billion US dollars. Three quarters (75%) of those with diabetes were living in low- and middle-income countries. The number of people with diabetes aged 20-79years was predicted to rise to 642 million (uncertainty interval: 521-829 million) by 2040. CONCLUSION Diabetes prevalence, deaths attributable to diabetes, and health expenditure due to diabetes continue to rise across the globe with important social, financial and health system implications.
Diabetes Care | 2009
David M. Nathan; B. Balkau; Enzo Bonora; Knut Borch-Johnsen; John B. Buse; Stephen Colagiuri; Mayer B. Davidson; Ralph A. DeFronzo; Saul Genuth; R R Holman; Linong Ji; Sue Kirkman; William C. Knowler; Desmond A. Schatz; Jonathan E. Shaw; Eugene Sobngwi; Michael W. Steffes; Olga Vaccaro; Nicholas J. Wareham; Bernard Zinman; Richard Kahn
Members of the International Expert Committee have recommended that diabetes should be diagnosed if A1C is ≤6.5%, without need to measure the plasma glucose concentration (1). We are concerned that practical limitations will lead to false positives and negatives with this approach. A given A1C instrument may identify some but not other abnormal hemoglobins (http://www.ngsp.org/prog/index2.html). How, therefore, can we be sure whether a hemoglobinopathy is causing (or preventing) diagnosis? Before diagnosis, should we not also exclude iron deficiency anemia, which may increase A1C by 1–1.5%, as well as hemolytic anemia and renal failure or chronic infections, which also lower …
The Lancet | 2006
rosiglitazone Medication Trial Investigators; Hertzel C. Gerstein; Salim Yusuf; Jackie Bosch; Janice Pogue; Patrick Sheridan; Dinccag N; Markolf Hanefeld; Byron J. Hoogwerf; Markku Laakso; Mohan; Jonathan E. Shaw; B. Zinman; R R Holman
BACKGROUND Rosiglitazone is a thiazolidinedione that reduces insulin resistance and might preserve insulin secretion. The aim of this study was to assess prospectively the drugs ability to prevent type 2 diabetes in individuals at high risk of developing the condition. METHODS 5269 adults aged 30 years or more with impaired fasting glucose or impaired glucose tolerance, or both, and no previous cardiovascular disease were recruited from 191 sites in 21 countries and randomly assigned to receive rosiglitazone (8 mg daily; n=2365) or placebo (2634) and followed for a median of 3 years. The primary outcome was a composite of incident diabetes or death. Analyses were done by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00095654. FINDINGS At the end of study, 59 individuals had dropped out from the rosiglitazone group and 46 from the placebo group. 306 (11.6%) individuals given rosiglitazone and 686 (26.0%) given placebo developed the composite primary outcome (hazard ratio 0.40, 95% CI 0.35-0.46; p<0.0001); 1330 (50.5%) individuals in the rosiglitazone group and 798 (30.3%) in the placebo group became normoglycaemic (1.71, 1.57-1.87; p<0.0001). Cardiovascular event rates were much the same in both groups, although 14 (0.5%) participants in the rosiglitazone group and two (0.1%) in the placebo group developed heart failure (p=0.01). INTERPRETATION Rosiglitazone at 8 mg daily for 3 years substantially reduces incident type 2 diabetes and increases the likelihood of regression to normoglycaemia in adults with impaired fasting glucose or impaired glucose tolerance, or both.
Diabetes Care | 2012
Joanne W.Y. Yau; Sophie Rogers; Ryo Kawasaki; Ecosse L. Lamoureux; Jonathan W. Kowalski; Toke Bek; Shuohua Chen; Jacqueline M. Dekker; Astrid E. Fletcher; Jakob Grauslund; Steven M. Haffner; Richard F. Hamman; Mohammad Kamran Ikram; Takamasa Kayama; B. E. K. Klein; Ronald Klein; S Krishnaiah; Korapat Mayurasakorn; J. P. O'Hare; T. J. Orchard; Massimo Porta; M Rema; Monique S. Roy; Tarun Sharma; Jonathan E. Shaw; Hugh R. Taylor; James M. Tielsch; Rohit Varma; Jie Jin Wang; Ningli Wang
OBJECTIVE To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years. RESULTS A total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.
Diabetes Care | 2008
Genevieve N. Healy; David W. Dunstan; Jo Salmon; Ester Cerin; Jonathan E. Shaw; Paul Zimmet; Neville Owen
OBJECTIVE—Total sedentary (absence of whole-body movement) time is associated with obesity, abnormal glucose metabolism, and the metabolic syndrome. In addition to the effects of total sedentary time, the manner in which it is accumulated may also be important. We examined the association of breaks in objectively measured sedentary time with biological markers of metabolic risk. RESEARCH DESIGN AND METHODS—Participants (n = 168, mean age 53.4 years) for this cross-sectional study were recruited from the 2004–2005 Australian Diabetes, Obesity and Lifestyle study. Sedentary time was measured by an accelerometer (counts/minute−1 < 100) worn during waking hours for seven consecutive days. Each interruption in sedentary time (counts/min ≥100) was considered a break. Fasting plasma glucose, 2-h plasma glucose, serum triglycerides, HDL cholesterol, weight, height, waist circumference, and resting blood pressure were measured. MatLab was used to derive the breaks variable; SPSS was used for the statistical analysis. RESULTS—Independent of total sedentary time and moderate-to-vigorous intensity activity time, increased breaks in sedentary time were beneficially associated with waist circumference (standardized β = −0.16, 95% CI −0.31 to −0.02, P = 0.026), BMI (β = −0.19, −0.35 to −0.02, P = 0.026), triglycerides (β = −0.18, −0.34 to −0.02, P = 0.029), and 2-h plasma glucose (β = −0.18, −0.34 to −0.02, P = 0.025). CONCLUSIONS—This study provides evidence of the importance of avoiding prolonged uninterrupted periods of sedentary (primarily sitting) time. These findings suggest new public health recommendations regarding breaking up sedentary time that are complementary to those for physical activity.
Pediatric Diabetes | 2007
Paul Zimmet; K. George M. M. Alberti; Francine R. Kaufman; Naoko Tajima; Martin Silink; Silva Arslanian; Gary Wong; Peter H. Bennett; Jonathan E. Shaw; Sonia Caprio
Zimmet P, Alberti K George MM, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S; IDF Consensus Group. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatric Diabetes 2007: 8: 299–306. Paul Zimmet, K George MM Alberti, Francine Kaufman, Naoko Tajima, Martin Silink, Silva Arslanian, Gary Wong, Peter Bennett, Jonathan Shaw and Sonia Caprio; IDF Consensus Group International Diabetes Institute, Melbourne, Victoria, Australia; Department of Endocrinology and Metabolic Medicine, St Mary’s Hospital, London, UK; Center for Diabetes, Endocrinology and Metabolism, Children’s Hospital, Los Angeles, CA, USA; Division of Diabetes, Metabolism and Endocrinology, Jikei University School of Medicine, Tokyo, Japan; Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Division of Endocrinology, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong; Phoenix Epidemiology and Clinical Research Branch, NIDDK, National Institutes of Health, Phoenix, AZ, USA; and Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
Diabetes Care | 2008
Genevieve N. Healy; Katrien Wijndaele; David W. Dunstan; Jonathan E. Shaw; Jo Salmon; Paul Zimmet; Neville Owen
OBJECTIVE—We examined the associations of objectively measured sedentary time and physical activity with continuous indexes of metabolic risk in Australian adults without known diabetes. RESEARCH DESIGN AND METHODS—An accelerometer was used to derive the percentage of monitoring time spent sedentary and in light-intensity and moderate-to-vigorous–intensity activity, as well as mean activity intensity, in 169 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) participants (mean age 53.4 years). Associations with waist circumference, triglycerides, HDL cholesterol, resting blood pressure, fasting plasma glucose, and a clustered metabolic risk score were examined. RESULTS—Independent of time spent in moderate-to-vigorous–intensity activity, there were significant associations of sedentary time, light-intensity time, and mean activity intensity with waist circumference and clustered metabolic risk. Independent of waist circumference, moderate-to-vigorous–intensity activity time was significantly beneficially associated with triglycerides. CONCLUSIONS—These findings highlight the importance of decreasing sedentary time, as well as increasing time spent in physical activity, for metabolic health.
The Lancet | 2007
Paul Zimmet; George Alberti; Francine R. Kaufman; Naoko Tajima; Martin Silink; Silva Arslanian; Gary Wong; Peter H. Bennett; Jonathan E. Shaw; Sonia Caprio
www.thelancet.com Vol 369 June 23, 2007 2059 and community mobilisation was possible for the Mitanin programme, but there were no community-level baselines or controls in the programme design to measure outcomes, and suffi cient sample sizes were neither easy nor aff ordable. At this stage, outcomes can be assessed only by use of indicators in independent surveys of national health and demographics. These surveys show that the rural infant mortality in Chhattisgarh decreased from 85 deaths per 1000 livebirths in 2002 to 65 deaths per 1000 livebirths in 2005, which is much the same as the national rural infant mortality rate (64 deaths per 1000 livebirths). However, estimation of the precise contribution of the Mitanin programme to this decrease is diffi cult. Much of the improvement in child survival in Chhattisgarh undoubtedly relates to better healthseeking behaviour and child-care practices. The initiation of breastfeeding in the fi rst 2 h after birth increased from 24% of livebirths to 71% of livebirths, and the use of oral rehydration salts in the management of diarrhoea in children younger than 3 years increased by 12% in the 2 weeks before the survey. These two interventions substantially aff ect child survival, and were highly mon i tored and eff ective Mitanin interventions. Other re corded improvements include total immunisation and ante natal care, to which Mitanins would have lent support. Community participation and the empowerment of women cause change. The many Mitanins who have since entered elected offi ce in local governance bodies, and the successful Mitanin-led community actions against deforestation, for securing of tribal liveli hoods, for early childhood-care facilities, or against alcoholism and corruption are testimonies to the so-called unintend ed positive outcomes. However, as the programme grows, these actions will pose new problems for the sus tainability of large-scale CHW programmes, and might again lay bare the tensions between the diff erent expec tations and descriptions of the CHW.