Diabetes May Be Even Bigger Threat Than Feared

Canadian survey finds 2005 rates surpassed levels predicted for 2030

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HealthDay Reporter

THURSDAY, March 1, 2007 (HealthDay News) -- By last year, the number of people with diabetes in Ontario, Canada, had already surpassed the rate predicted for 2030 by the World Health Organization.

The news is bad enough for Canada, but augurs even more ill for the world, which can now expect many more people to succumb to this chronic disease than originally anticipated, researchers report.

Even so, the finding did not come as a shock to many.

"I regrettably have to confess that this did not surprise me," said Dr. Larry Deeb, president of medicine and science at the American Diabetes Association. "Every estimate I have ever seen for prevalence has been surpassed the next time you get a chance to look. It's quite frightening."

The question is how to prepare for the challenge.

"Our paper indicates that the magnitude of the problem is such that our health-care systems across the world are going to have an increasingly difficult time managing the ongoing increase in diabetes," said Dr. Lorraine Lipscombe, lead author of the study, and a research fellow at the Institute for Clinical Evaluative Sciences in Toronto. "We really have to start adopting more aggressive prevention approaches, otherwise, we will see rates continue to increase. and it will be unmanageable."

Type 2 diabetes, a condition in which the body either doesn't produce enough insulin or the cells ignore the insulin, is one of the most costly and burdensome disease of the day. Left untreated, it can result in heart disease, blindness, amputations as well as nerve and kidney damage.

According to the latest World Health Organization (WHO) estimates, the number of people worldwide with diabetes climbed from 30 million in 1985 to 171 million in 2000. Some 4 percent to 6 percent of adults aged 20 and over are now affected. Developed nations tend to have a higher prevalence, but developing nations are fast catching up.

And, according to a report released last year, the number of new cases of type 2 diabetes among middle-aged Americans has doubled over the past three decades, fueled largely by increasing rates of obesity. An estimated two-thirds of adult Americans are now overweight or obese.

For the new study, published in the March 3 issue of The Lancet, researchers used population-based data from Ontario to determine prevalence and mortality of diabetes from 1995 to 2005, and incidence from 1997 to 2003 in adults aged 20 and older.

There was a 69 percent increase -- from 5.2 percent to 8.8 percent -- in diabetes prevalence from 1995 to 2005, exceeding the WHO's estimate of a 60 percent global increase between 1995 and 2030 and a 39 percent increase between 2000 and 2030. In Canada, diabetes prevalence was supposed to grow 65 percent between 1995 and 2030.

In Ontario, a 27 percent increase took place over just five years. If this continues, more than 10 percent of the adult population of the province will be diagnosed with diabetes before 2010, the researchers said.

"The WHO predicted that, in the developed world, 8.4 percent of the population would have diabetes by 2030, but we saw in Ontario that 8.8 percent of the population already has the disease," said Lipscombe, who's also an assistant professor at the University of Toronto.

The WHO predictions were based on the assumption that obesity rates would remain constant, which hasn't happened, Lipscombe added. Obesity may be one factor driving the explosion of diabetes.

Another factor may be an influx of immigrants to Ontario from regions of the world whose populations are at high risk for the disease once they are introduced to a western diet and lifestyle, she said.

"Our database doesn't allow us to look at ethnicity, but we know that Ontario has seen a 50 percent increase in immigration from certain more at-risk nations like South Asian nations," Lipscombe said. "We also know from previous work that the distribution of diabetes cases across Ontario is not uniform and that there are higher rates in areas that have more at-risk immigrant populations, so it's possible that this is contributing."

"This is a population that includes a lot of immigrants who are coming into a place where high calorie, simple carbohydrate diets are being provided, and much, much less physical activity than in their home countries," added Dr. Stuart Weiss, clinical assistant professor of medicine at New York University School of Medicine. "If you give someone who's used to eating very few calories and doing more exercise this type of lifestyle, they're likely to gain weight and develop diabetes."

More information

To learn more, visit the American Diabetes Association.

SOURCES: Lorraine Lipscombe, M.D., research fellow, Institute for Clinical Evaluative Sciences, Toronto, and assistant professor, University of Toronto, and endocrinologist, Women's College Hospital, Toronto; Larry Deeb, M.D., president, medicine and science, American Diabetes Association; Stuart Weiss, M.D., clinical assistant professor of medicine, New York University School of Medicine, New York City; March 3, 2007, The Lancet

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