Best Practice & Research Clinical Endocrinology & Metabolism 30 (2016) 331e343
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Type 2 diabetes: A 21st century epidemic Lindsay M. Jaacks, PhD, Post-Doctoral Fellow a, *, Karen R. Siegel, PhD, MPH, Adjunct Assistance Professor b, 1, Unjali P. Gujral, PhD, MPH, Post-Doctoral Fellow c, 2, K.M. Venkat Narayan, MD, MSc, MBA, Ruth and O.C. Hubert Professor of Global Health and Epidemiology d, 3 a
Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Claudia Nance Rollins Building 7040-I, 1518 Clifton Road NE, Atlanta, GA 30322, USA b Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Claudia Nance Rollins Building 7040-J, 1518 Clifton Road NE, Atlanta, GA 30322, USA c Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Claudia Nance Rollins Building 7040-K, 1518 Clifton Road NE, Atlanta, GA 30322, USA d Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Claudia Nance Rollins Building 7049, 1518 Clifton Road NE, Atlanta, GA 30322, USA
a r t i c l e i n f o Article history: Available online 28 May 2016 Keywords: type 2 diabetes impaired fasting glucose impaired glucose tolerance incidence prevalence obesity
Around 415 million people around the world have diabetes (9% of adults), and the vast majority live in low- and middle-income countries. Over the next decade, this number is predicted to increase to 642 million people. Given that diabetes is a major cause of mortality, morbidity, and health care expenditures, addressing this chronic disease represents one of the greatest global health challenges of our time. The objectives of this article are three-fold: (1) to present data on the global burden of type 2 diabetes (which makes up 87e91% of the total diabetes burden), both in terms of prevalence and incidence; (2) to give an overview of the risk factors for type 2 diabetes, and to describe obesity and the developmental origins of disease risk in detail; and (3) to discuss the implications of the global burden and point out important research gaps. © 2016 Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: þ1 404 727 9976; Fax: þ1 404 727 4590. E-mail addresses:
[email protected] (L.M. Jaacks),
[email protected] (K.R. Siegel),
[email protected] (U.P. Gujral),
[email protected] (K.M.V. Narayan). 1 Tel.: þ1 404 712 1021. 2 Tel.: þ1 626 589 8512. 3 Tel.: þ1 404 727 8402. http://dx.doi.org/10.1016/j.beem.2016.05.003 1521-690X/© 2016 Elsevier Ltd. All rights reserved.
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L.M. Jaacks et al. / Best Practice & Research Clinical Endocrinology & Metabolism 30 (2016) 331e343
Introduction Nine percent of adults around the world e 415 million people e have diabetes and nearly half of them are undiagnosed [1]. By 2040, the number of individuals affected by diabetes is predicted to increase to be 642 million people, with the largest increases seen in low- and middle-income countries [1]. Diabetes, a major cause of death, morbidity, and health care expenditures, now represents one of the greatest threats to global health and development. The objectives of this article are three-fold: (1) to present data on the global burden of type 2 diabetes (which makes up 87e91% of the total diabetes burden); (2) to give an overview of the risk factors for type 2 diabetes; and (3) to discuss the implications of the global burden and point out important research gaps. Global burden of type 2 diabetes The spectrum from normal glucose tolerance (NGT) through abnormal glucose regulation to overt type 2 diabetes has two distinct, though to some extent overlapping, intermediate hyperglycemic states (Table 1): impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). IFG is primarily the result of hepatic insulin resistance and an early-phase defect in beta-cell function [2], and is diagnosed as a fasting plasma glucose 5.6 mmol/l and
