Epidemiology

Diabetes prevalence is increasing worldwide, compounded by population growth and an aging population.[4] In 1980, the global age-standardized diabetes prevalence was 4.3%.[4] In 2019, the global age-standardized diabetes prevalence was estimated at 8.3%.[5] However, while the overall burden of diabetes is increasing, trends in the incidence rate of diabetes plateaued and now appear to be decreasing.[6] Data from the US National Health Interview Survey documented that the incidence of age-adjusted, diagnosed diabetes decreased 2007 to 2017, from 7.8 to 6.0 per 1000 adults.[7] Lifetime risk of diabetes is now 40% for both men and women in the overall US population, and is 50% in the US African-American population.[8]

Type 2 diabetes accounts for over 90% of all diabetes cases, and has a prevalence of 8.5% in the US.[9] Clinical onset is usually preceded by many years of insulin resistance and hyperinsulinemia before elevated glucose levels are detectable.[1] The prevalence of type 2 diabetes has risen steadily since 1950, driven by increasing prevalence in obesity and being overweight.[10] Improved survival of people with diabetes is also a factor as increasing numbers of people with diabetes are living longer.[6][11] 

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%).[12] 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.[13] Young-onset (<40 years) type 2 diabetes is associated with worse metabolic control and an increased risk of chronic complications and all-cause mortality.[11] 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.

The epidemiology of complications of type 2 diabetes is changing.[14] Rates of macrovascular complications (e.g., myocardial infarction, lower extremity amputation) and hyperglycemic death have declined in high-income countries due to improvements in multiple-risk factor management and diabetes care.[11][14][15] Data on trends in microvascular complications (e.g., diabetic kidney disease, diabetic retinopathy, neuropathy) are scarce and trends are less conclusive.[14]

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