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Monday, February 22, 2016

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #12: Epidemiology and Geography of Type 2 Diabetes … – Diabetes In Control

Date - 

DeFronzoCoverAge- and sex-personal prevalence of type 2 diabetes in different ethnic groups

Type 2 diabetes mellitus (T2DM) is now taking its place as one of the main threats to human healthiness in the twenty-initial century [1]. In 1921, Dr Elliot Joslin was already concerned that according to his count there had been a doubling of diabetes in three decades [2]. The impact of T2DM is increasingly felt about the world, along with its prevalence rising dramatically over recent decades. The globe healthiness Organization (WHO) estimated that there were 150 million individuals aged 20 years and older living along with diabetes in 2000, and by 2025, this will certainly have actually risen to 300 million (Figure 3.1). There will certainly be a 42% increase, from 51 to 72 million, in made countries and a 170% increase, from 84 to 228 million, in producing countries [3]. The top 10 countries along with the highest estimated number of individuals along with diabetes in 2025 are listed in Table 3.1.

Diagnostic criteria for diabetes

In the past two decades there have actually been several vital developments, which have actually had substantial impact on the definition of diabetes and thereby on the assessment of its magnitude. In 1979, the 2-h 75-g oral glucose tolerance test (OGTT) was proposed as a standard test for diagnosis of diabetes by the National Diabetes Data Group (NDDG) [4], and endorsed by That in 1980 [5]. In 1985, That earned a minor change to the diagnostic criteria [6]. This has actually developed order from the confusion in the diagnostic criteria for diabetes. Prior to that enormous variations existed in diagnostic cutoff values for fasting as well as after glucose loading. The glucose load varied between 50 and 100 g or was physique weight related. The differences in glucose assay methods, glucose load, and the time after loading earned the comparison between different studies difficult. Near-universal adoption of the That criteria has actually had a substantial influence on epidemiologic studies of diabetes.

In 1997, a revision of the diagnostic criteria was approved by the American Diabetes Association (ADA) [7] and adopted by That Consultation in 1999 [8]. The major modifications were lowering the positive cutoff value of fasting venous plasma glucose from 7.8mmol L−1 (140mg dL−1) to 7.0mmol L−1 (126mg dL−1). The positive cutoff value for 2-h plasma glucose remained unchanged, that is, 11.1mmol L−1 (200mg dL−1) and over. For epidemiologic studies and for book clinical practice, the ADA did not recommend the primary use of OGTT, yet That Consultation still retained the OGTT as the standard test procedure. The prevalence data assembled in this chapter are estimated mainly according to the That 1999 criteria [8], except for those noted otherwise.

Conversion factors for glucose concentrations

Glucose concentration can easily be measured using different blood specimens such as venous plasma glucose, capillary whole blood glucose, and venous whole blood glucose. The cutoff points for the classification of stages of glucose abnormalities from different specimens are different. Currently, there are no internationally accepted conversion factors for glucose concentrations in the literature. Recently, conversion factors for changing glucose concentrations between different blood samples were made on the basis of data from a Finnish study and applied them in the DECODE study (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) [9–11]. The equations were derived based on 294 matched samples of whole blood (capillary and serum) glucose and plasma glucose concentrations drawn from a standard 75-g OGTT in 74 people at 0, 30, 60, and 120 min at the 29 Diabetes and Genetic Epidemiology Unit, National Public healthiness Institute in Finland. The relationships between glucose concentrations as measured by the different ways used were estimated. The formulas derived are as follows:

Venous plasma glucose (mmol L−1)

= 0.558 + 1.119 × whole blood glucose (mmol L−1)

Venous plasma glucose (mmol L−1)

= 0.102 + 1.066 × capillary blood glucose (mmol L−1)

Venous plasma glucose (mmol L−1)

= −0.137 + 1.047 × serum glucose (mmol L−1)

Age- and sex-personal plasma glucose concentration

The age- and sex-personal mean fasting and 2-h plasma glucose after 75-g glucose load were estimated in general Caucasian populations in Europe, and in Chinese, Japanese, and Indians in Asia,That did not have actually prior history of diabetes.The participants are included in the DECODE and the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Asia) studies, the two largest epidemiologic studies for diabetes in Europe and Asia, along with a total of 15,606 subjects from Europe [10] and 19,845 subjects from Asia [12]. The data presented here are based on the pooled data from13 DECODE and the 11 DECODA participating cohorts. A standard OGTT was carried out in every one of populations, and subjects along with prior history of diabetes were not included in the analysis.The plasma glucose concentrations flower along with age and reached a peak at 60–69 years of age then started to decline in Indians yet continued to boost after 70 years of age in Europeans (Figure 3.2). In each age group, the mean 2-h plasma glucose was significantly greater for Indians compared to for Chinese and Japanese, and the same was likewise true for fasting plasma glucose in most of the age teams (Figure 3.2). The mean fasting and 2-h glucose concentrations did not differ between Chinese and Japanese except at 40–49 years of age where the glucose values were greater in the Japanese. The mean glucose levels were lower in Europeans compared to in Asians younger compared to 70 years, whereas they were greater in Europeans compared to in Asians 70 years or older. The mean glucose levels were similar in Asian men and women. In Europe, the mean fasting glucose concentration was greater in men compared to in women at 30–69 years of age yet after 70 years of age, it was greater in women. The 2-h glucose was greater in women compared to in men throughout the age range. Two-hour glucose increased a lot more along with age compared to did fasting glucose.

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