Diabetes prevalence is increasing worldwide, compounded by population growth and an ageing population.[2]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
[3]Magliano DJ, Islam RM, Barr ELM, et al. Trends in incidence of total or type 2 diabetes: systematic review. BMJ. 2019 Sep 11;366:l5003.
https://www.bmj.com/content/366/bmj.l5003.long
http://www.ncbi.nlm.nih.gov/pubmed/31511236?tool=bestpractice.com
In 2000, the global diabetes prevalence in adults aged 20-79 years was estimated at 4.6%, increasing to 10.5% in 2021.[4] International Diabetes Federation. IDF diabetes atlas - 10th edition. 2021 [internet publication].
https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf
Prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries.[5]WHO. Diabetes. Sep 2022 [internet publication].
https://www.who.int/news-room/fact-sheets/detail/diabetes
Between 2000 and 2019, there was a 3% increase in age-standardised mortality rates from diabetes; in lower-middle-income countries the mortality rate due to diabetes increased by 13%.[5]WHO. Diabetes. Sep 2022 [internet publication].
https://www.who.int/news-room/fact-sheets/detail/diabetes
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.[2]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 most countries, the incidence of diagnosed diabetes rose from the 1990s to the mid-2000s, but has been plateauing since.[3]Magliano DJ, Islam RM, Barr ELM, et al. Trends in incidence of total or type 2 diabetes: systematic review. BMJ. 2019 Sep 11;366:l5003.
https://www.bmj.com/content/366/bmj.l5003.long
http://www.ncbi.nlm.nih.gov/pubmed/31511236?tool=bestpractice.com
It is thought that this trend might be owing to public health education and preventive strategies. Data are limited in developing countries and the trend in these regions might differ.[3]Magliano DJ, Islam RM, Barr ELM, et al. Trends in incidence of total or type 2 diabetes: systematic review. BMJ. 2019 Sep 11;366:l5003.
https://www.bmj.com/content/366/bmj.l5003.long
http://www.ncbi.nlm.nih.gov/pubmed/31511236?tool=bestpractice.com
Clinical onset of type 2 diabetes 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
People 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%).[6]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
Smoking prevalence among individuals with type 2 diabetes is similar to that of the general population (current smokers: 25% vs. 28%; never-smokers: 39% vs. 42%, respectively).[7]Blomster JI, Woodward M, Zoungas S, et al. The harms of smoking and benefits of smoking cessation in women compared with men with type 2 diabetes: an observational analysis of the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial. BMJ Open. 2016 Jan 8;6(1):e009668.
https://bmjopen.bmj.com/content/6/1/e009668.long
http://www.ncbi.nlm.nih.gov/pubmed/26747037?tool=bestpractice.com
The most common initial cardiovascular disease complications for those with diabetes is peripheral artery disease (16.2%) and heart failure (14.1%), followed by stable angina (11.9%), non-fatal myocardial infarction (11.5%), and stroke (10.3%).[8]Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023 Feb 21;147(8):e93-621.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001123?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
http://www.ncbi.nlm.nih.gov/pubmed/36695182?tool=bestpractice.com
On average, adults with type 2 diabetes are up to twice as likely to die of stroke or myocardial infarction compared with those without diabetes, and they are more than 40 times more likely to die of macrovascular than microvascular complications of diabetes.[9]Hansen MB, Jensen ML, Carstensen B. Causes of death among diabetic patients in Denmark. Diabetologia. 2012 Feb;55(2):294-302.
http://www.ncbi.nlm.nih.gov/pubmed/22127411?tool=bestpractice.com
[10]Tancredi M, Rosengren A, Svensson AM, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015 Oct 29;373(18):1720-32.
https://www.nejm.org/doi/full/10.1056/NEJMoa1504347
http://www.ncbi.nlm.nih.gov/pubmed/26510021?tool=bestpractice.com
[11]Desai JR, Vazquez-Benitez G, Xu Z, et al. Who must we target now to minimize future cardiovascular events and total mortality? Lessons from the surveillance, prevention and management of diabetes mellitus (SUPREME-DM) cohort study. Circ Cardiovasc Qual Outcomes. 2015 Sep;8(5):508-16.
http://circoutcomes.ahajournals.org/content/8/5/508.long
http://www.ncbi.nlm.nih.gov/pubmed/26307132?tool=bestpractice.com
However, data indicate that adults with type 2 diabetes who optimally manage glucose, blood pressure, lipids, smoking, and weight have a risk of major cardiovascular events that is not significantly above the risk of age and sex-matched peers without diabetes.[12]Rawshani A, Rawshani A, Franzén S, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2018 Aug 16;379(7):633-44.
https://www.nejm.org/doi/10.1056/NEJMoa1800256
http://www.ncbi.nlm.nih.gov/pubmed/30110583?tool=bestpractice.com
[13]Berkelmans GF, Gudbjörnsdottir S, Visseren FL, et al. Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500 000 patients with type 2 diabetes mellitus. Eur Heart J. 2019 Sep 7;40(34):2899-906.
http://www.ncbi.nlm.nih.gov/pubmed/30629157?tool=bestpractice.com
When diabetes is diagnosed at aged 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.[14]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. In a large systematic review and meta-analysis, age at diabetes diagnosis was found to be inversely associated with risk of all-cause mortality and macrovascular and microvascular disease.[15]Nanayakkara N, Curtis AJ, Heritier S, et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia. 2021 Feb;64(2):275-87.
https://link.springer.com/article/10.1007/s00125-020-05319-w
http://www.ncbi.nlm.nih.gov/pubmed/33313987?tool=bestpractice.com