Diabetes — a common, growing, serious, costly, and potentially preventable public health problem

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Abstract

An estimated 135 million people worldwide had diagnosed diabetes in 1995, and this number is expected to rise to at least 300 million by 2025. The number of people with diabetes will increase by 42% (from 51 to 72 million) in industrialized countries between 1995 and 2025 and by 170% (from 84 to 228 million) in industrializing countries. Several potentially modifiable risk factors are related to diabetes, including insulin resistance, obesity, physical inactivity and dietary factors. Diabetes may be preventable in high-risk groups, but results of ongoing clinical trials are pending. Several efficacious and economically acceptable treatment strategies are currently available (control of glycemia, blood pressure, lipids; early detection and treatment of retinopathy, nephropathy, foot-disease; use of aspirin and ACE inhibitors) to reduce the burden of diabetes complications. Diabetes is a major public health problem and is emerging as a pandemic. While prevention of diabetes may become possible in the future, there is considerable potential now to better utilize existing treatments to reduce diabetes complications. Many countries could benefit from research aimed at better understanding the reasons why existing treatments are under-used and how this can be changed.

Introduction

As we enter the 21st century, we will see more globalization and industrialization, longer life spans, and changes in lifestyles worldwide. A consequence of these changes will be shifts in the patterns of disease, with chronic diseases such as diabetes becoming more prevalent. Among themyriad complex and interconnected issues confronting the rapidly changing global village — resources, education, equity, peace — the health of all the world's peoples will deserve special attention. The growing problems of diabetes and other chronic diseases may not readily fit the ‘classic’ and ‘dramatic’ paradigm of public health emergencies, unlike infectious diseases, which are easily perceived as threats to the public at large. However, we will be challenged to change our traditional definitions of what constitutes significant public health problems and priorities.

As discussed by Vinicor [1], diabetes is arguably an important public health problem within this context. It is equally burdensome to individuals and to society, and disproportionately affects disadvantaged people and nations. The burden of diabetes and its complications continue to rise worldwide in spite of the growing number of possibilities for ameliorating much of this and the public concern for diabetes is increasing [1], [2], [3], [4]. In this paper, we will briefly review the global burden of diabetes and assess the opportunities for preventing diabetes and its complications.

Section snippets

Diabetes is common, growing, serious, and costly

At the societal level, the burden of diabetes worldwide is great and continues to grow [2]. Overall, 90–95% of diabetes is type 2, and this form of the disease (historically considered rare in youth) is now increasingly affecting children and adolescents [3]. While it is estimated that 30–50% of diabetes cases remain undiagnosed, there were approximately 30 million people worldwide diagnosed with diabetes in 1985 [4]. By 1995 this number had increased to 135 million (4.0% of the world

Conclusion

Diabetes clearly is a global public health problem that is common, growing, serious, and costly. Several of the factors associated with diabetes are potentially modifiable, and researchers currently are investigating ways to prevent diabetes. The results of these efforts likely will become available within a few years. In the meanwhile, there already exists a large battery of treatment strategies of proven efficacy in preventing diabetes-related morbidity and mortality. However, the degree of

Acknowledgements

We thank the Technical Information and Editorial Services Branch of the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention for their valuable editorial comments.

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