Diabetes prevalence is increasing worldwide, compounded by population growth and an ageing population.[3]NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016 Apr 6;387(10027):1513-30.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00618-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27061677?tool=bestpractice.com
In 1980, the global age-standardised diabetes prevalence was 4.3%.[3]NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016 Apr 6;387(10027):1513-30.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00618-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27061677?tool=bestpractice.com
In 2017, the global age-standardised diabetes prevalence was estimated at 8.6%.[4]International Diabetes Federation. IDF diabetes atlas - 8th edition. 2017 [internet publication].
https://www.diabetesatlas.org
Survey data of diabetes in adults does not separate type 1 and type 2 diabetes, but most cases of diabetes (around 90%) are type 2.[3]NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016 Apr 6;387(10027):1513-30.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00618-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27061677?tool=bestpractice.com
However, while the overall burden of diabetes is increasing, trends in the incidence rate of diabetes plateaued and now appear to be decreasing. Data from the US National Health Interview Survey documented that the incidence of age-adjusted, diagnosed diabetes decreased from 2007 to 2017, from 7.8 to 6.0 per 1000 adults.[5]Benoit SR, Hora I, Albright AL, et al. New directions in incidence and prevalence of diagnosed diabetes in the USA. BMJ Open Diabetes Res Care. 2019 May 28;7(1):e000657.
https://drc.bmj.com/content/7/1/e000657
http://www.ncbi.nlm.nih.gov/pubmed/31245008?tool=bestpractice.com
Incidence and prevalence of type 2 diabetes have risen steadily since 1950, driven by increasing prevalence in obesity and being overweight.[6]Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet. 2014 Mar 22;383(9922):1068-83.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226760/
http://www.ncbi.nlm.nih.gov/pubmed/24315620?tool=bestpractice.com
In the US in 2017, type 2 diabetes had a prevalence of 8.5%.[7]Xu G, Liu B, Sun Y, et al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ. 2018 Sep 4;362:k1497.
https://www.bmj.com/content/362/bmj.k1497.long
http://www.ncbi.nlm.nih.gov/pubmed/30181166?tool=bestpractice.com
In the UK, prevalence rates of type 2 diabetes increased from 3.21% in 2004 to 5.26% in 2014, and incidence rates remained stable.[8]Zghebi SS, Steinke DT, Carr MJ, et al. Examining trends in type 2 diabetes incidence, prevalence and mortality in the UK between 2004 and 2014. Diabetes Obes Metab. 2017 Nov;19(11):1537-45.
http://www.ncbi.nlm.nih.gov/pubmed/28387052?tool=bestpractice.com
Clinical onset is usually preceded by many years of insulin resistance and hyperinsulinaemia before elevated glucose levels are detectable.[1]Meigs JB, Muller DC, Nathan DM, et al. The natural history of progression from normal glucose tolerance to type 2 diabetes in the Baltimore Longitudinal Study of Aging. Diabetes. 2003 Jun;52(6):1475-84.
https://diabetes.diabetesjournals.org/content/52/6/1475.full
http://www.ncbi.nlm.nih.gov/pubmed/12765960?tool=bestpractice.com
Patients with type 2 diabetes have a very high risk of concurrent hypertension (80% to 90%), lipid disorders (70% to 80%), and overweight or obesity (60% to 70%).[9]Preis SR, Pencina MJ, Hwang SJ, et al. Trends in cardiovascular disease risk factors in individuals with and without diabetes mellitus in the Framingham Heart Study. Circulation. 2009 Jul 6;120(3):212-20.
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.108.846519
http://www.ncbi.nlm.nih.gov/pubmed/19581493?tool=bestpractice.com
When diabetes is diagnosed at age 40 years, men lose an average of 5.8 years of life, and women lose an average of 6.8 years of life, highlighting the importance of primary prevention of diabetes.[10]Gregg EW, Zhuo X, Cheng YJ, et al. Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985-2011: a modelling study. Lancet Diabetes Endocrinol. 2014 Nov;2(11):867-74.
http://www.ncbi.nlm.nih.gov/pubmed/25128274?tool=bestpractice.com
However, onset of diabetes at older ages has much less effect on life expectancy if acceptable glucose, blood pressure, and lipid control can be achieved and maintained.