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- May 13, 2008 |
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| Presentation |
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""Prediabetes" - A Global Snapshot"Prof. Paul Zimmet (biography)
English - 2005-04-14 - 28 minutes
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Summary :
The dramatic increase in the prevalence of diabetes (mainly type 2) world-wide is a matter of enormous concern to public health authorities in both developed and developing nations and international agencies such as WHO. Perhaps of even greater concern is the simultaneous dramatic increase in numbers with IFG and IGT (prediabetes). This is occurring not only in adults but, in so far poorly quantified number, of children and adolescents.
There are at least 300 million people worldwide with IGT. Between 10% and 25% of western populations may already have IGT. For example, in the 2000 Australian Diabetes, Obesity and Lifestyle Study the overall prevalence of diabetes was 7.4%, but the combined prevalence of IFG and IGT was more than twice as high, at 16.4%. These glucose-intolerant, but non-diabetic, individuals represent a reservoir of potential new diabetes cases. Approximately 4-9% of individuals with impaired glucose tolerance go on to develop type 2 diabetes each year.
IGT and IFG are not equivalent metabolically, and it is therefore not surprising that there are differences in their prevalence and in the people categorised as having one or the other. In most populations, IGT is considerably more prevalent than IFG. Furthermore, there is limited overlap between the categories - the majority of people with IGT do not have IFG, and the majority with IFG do not have IGT. Hence the terminology of 'isolated IGT' and 'isolated IFG'. The table shows data from a variety of populations demonstrating that the highest prevalence of isolated IGT and limited overlap between IGT and IFG is found in most of them. Thus, IFG and IGT identify substantially different segments of the population with impaired glucose regulation.
In addition to differences in the overall prevalence between IGT and IFG, there is now clear evidence of differences in phenotype between the two categories. The most consistent and statistically significant difference is that IFG is commoner in men than women in virtually all age groups, typically being 1.5 to 3 times higher, but up to 7 or 8 times higher in Europeans aged 50 to 70 years. Conversely the prevalence of IGT is higher in women than men in all age groups except over the age of 60 in Asian populations and over the age of 80 in the European groups.
There are now global calls for strategies to prevent the emerging global epidemic. Several recent successful intervention studies, both lifestyle and pharmacological, targeting subjects with IGT have stimulated enthusiasm for prevention of type 2 diabetes. Lifestyle interventions were successful in over 50% of subjects in the Finnish Diabetes Prevention Study and the Diabetes Prevention Program. We now need to know whether the findings of these two studies can be applied.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Prevalence rates of prediabetes in different populations around the world
- Gender differences in abnormal glucose tolerance
- IGT and IFG as CVD risk factors
- Progression to diabetes
Bibliographic references :
Davies MJ, Raymond NT, Day JL, Hales CN, Burden AC. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics.Diabet Med. 2000 Jun;17(6):433-40.
F de Vegt, JM Dekker, CD Stehouwer, G Nijpels, LM Bouter and RJ Heine. Similar 9-year mortality risks and reproducibility for the World Health Organization and American Diabetes Association glucose tolerance categories: the Hoorn StudyDiabetes Care. 2000;23(1):40-44.
SB Harris, J Gittelsohn, A Hanley, A Barnie, TM Wolever, J Gao, A Logan and B Zinman. The prevalence of NIDDM and associated risk factors in native CanadiansDiabetes Care. 1997; 20(2):185-187.
M Tominaga, H Eguchi, H Manaka, K Igarashi, T Kato and A Sekikawa.
Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes StudyDiabetes Care. 1999; 22(6):920-924.
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