Perspectivas Epidemiológicas do Diabetes

Prévia do material em texto

ORIGINAL PAPER
Epidemiological Perspectives of Diabetes
Ziqi Tao • Aimin Shi • Jing Zhao
� Springer Science+Business Media New York 2015
Abstract The global statistics of diabetes mellitus in year
2013 indicated, about 382 million people had this disease
worldwide, with type 2 diabetes making up about 90 % of
the cases. This is equal to 8.3 % of the adult population
with equal rates in both women and men. In year 2012 and
2013 diabetes resulted in mortality of 1.5–5.1 million
people per year, making it the 8th leading cause of death in
the world. It is predicted that by year 2035 about 592
million people will die of diabetes. The economic cost of
diabetes seems to have increased worldwide. An average
age of onset of diabetes is 42.5 years and could be due to
consumption of high sugar and high-calorie diet, low
physical activity, genetic susceptibility, and lifestyle. Ap-
proximately 8 % children and about 26 % young adults
have diabetes mellitus in the world. The results of epi-
demiological study of type 1 diabetes mellitus (T1D) are
presented by demographic, geographic, biologic, cultural,
and other factors in human populations. The prevalence of
T1D has been increased by 2–5 % worldwide and its
prevalence is approximately one in 300 in US by 18 years
of age. The epidemiological studies are important to study
the role, causes, clinical care, prevention, and treatment of
type1 diabetes in pregnant women and their children before
and after birth. In this article, causes, diagnosis, symptoms,
treatment and medications, and epidemiology of diabetes
will be described.
Keywords Epidemiological perspective � Diabetes �
Diagnosis
Introduction
Diabetes or Diabetes mellitus is a metabolic disease in
which sugar levels are increased in the body for a pro-
longed period of time (World Health Organization, 2014)
[1], which produces many symptoms; frequent urination,
increased thirst, hunger, diabetic ketoacidosis (DKA), and
hyperosmolar coma [2, 3]. The long-term complications
include; kidney failure, diabetic heart disease, stroke, foot
ulcers, and damage to the vision of eyes. The diabetes is
due to not sufficient insulin produced by the pancreatic
cells or the cells of the body do not respond properly to the
insulin produced [4]. There are three main types of diabetes
mellitus [2] which are
1. Type 1 diabetes results from the body which produces
not enough insulin. This is known as ‘‘insulin-depen-
dent diabetes mellitus’’ (IDDM) or ‘‘juvenile dia-
betes.’’ The cause of this diabetes is not yet known.
2. Type 2 diabetes (T2D) begins with insulin resistance, in
which cells do not respond to insulin properly. As the
disease progresses a lack of insulin may also develop [5].
This form is known as ‘‘non insulin-dependent diabetes
mellitus’’ (NIDDM) or ‘‘adult-onset diabetes’’. The
primary cause of this diabetes is excessive body weight
and not enough physical activity.
3. Gestational diabetes, this occurs when pregnant wom-
en without a previous history of diabetes develops a
high-blood glucose level.
The prevention and treatment of diabetes involve a
healthy diet, physical exercise, no tobacco, and keeping a
Z. Tao (&) � J. Zhao
Department of Science and Education, Xuzhou Central Hospital,
No. 199 JieFang south Road, Xuzhou 221009, Jiangsu, China
e-mail: taoziqi@163.com
A. Shi
School of Public Health of Nanjing Medical University,
Nanjing 211166, Jiangsu, China
123
Cell Biochem Biophys
DOI 10.1007/s12013-015-0598-4
normal body weight. Blood pressure (BP) control and
proper diet and sugar intake are also important for people
with diabetes. Type 1 diabetes must be managed with in-
jection of insulin [2]. T2D is treated with medications with
or without insulin [5, 6]. Insulin and some oral medications
can cause low blood sugar [7]. The weight loss surgery in
people with T2D who have obesity is an effective measure
[8]. The gestational diabetes usually resolves after the birth
of the baby [9]. According to global statistics, as of year
2013, about 382 million people have diabetes worldwide,
with T2D making about 90 % of the cases [10, 11], which
is equal to 8.3 % of the adults population [11] with equal
rates in both women and men [12]. Among worldwide
population in 2012 and 2013, diabetes resulted in mortality
rate of 1.5–5.1 million people per year, making it the 8th
leading cause of death [6, 13]. The diabetes at least doubles
the risk of death in diabetic people [2]. By the year 2035, it
is predicted that 592 million people with diabetes may die
[14]. The economic cost in future will rise in the world for
the diabetes care [13, 15]. About 150 million people show
early symptoms of diabetes in China [16]. In India, an
estimate shows that about 1 million people with diabetes
may have mortality every year [17, 18], and an average age
of onset is 42.5 years. It is due to consumption of high
sugar and high-calorie diet, low activity or exercise, ge-
netic susceptibility, and lifestyle [19]. By year 2030, the
diagnosis of diabetes will increase [20]. The Public Health
Agency of Canada [21] suggested that in year 2008–2009
almost 2.4 million people (age 25–64 years) were living
with diabetes. The overall incidence of diabetes during an
11 year period from 1998 to 2009 was increased in chil-
dren of age 19 years, and in working people from age 30 to
49 years. The prediction is that about 3.7 million people
will have diabetes by year 2019. Among children (one to
nine year olds) in Canada, the diabetes type 1 rate has also
been increased from 0.1 % (or 3726 cases) in 1998–1999 to
0.2 % (or 5201 cases) in 2008–2009. More than 3000 new
cases of diabetes have been reported in Canada among
children, and 26000 cases of diabetes in young adults. The
children and youth with type 1 diabetes are at a greater risk
of this life-threatening disease because they rely on daily
doses of insulin injections.
Epidemiology of Diabetes
The epidemiology of type 1 diabetes mellitus (T1D) and its
patterns are presented by demographic, geographic, biolo-
gical, cultural, and other factors in human populations [22].
This study is to gain insight into the causes of diabetes, its
natural history, risks, and complications. It has been re-
ported that T1D has been increased by 2–5 % worldwide
and its prevalence is approximately one in 300 in USA by
18 years of age. The study of risk factors for T1D to
identify genetic and environmental triggers and clinical
data is important to improve the quality of life and to
provide care to people with diabetes. The epidemiological
study is important to understand the role, causes, clinical
care, prevention, and treatment of Type 1 diabetes in
pregnant women and their children before and after the
birth. The five aspects of epidemiological studies of dia-
betes mellitus have been reported in Canada [23]; (a) in
first group the incidence of IDDM in those under 15 years
of age, whereas the second group that participated in DERI
(diabetes epidemiology research International) study had
different incidence rates in IDDM, 25.5 per 100 in PEI
province, and 9.2 per 100 in Montreal, QC; (b) the
prevalence of self-reported diabetes mellitus in adults. The
overall prevalence of self-reported diabetes in adults
(18–74 years) was 5.1 % in the CHH (Canadian Heart
Health) Survey. There were no significant regional differ-
ences in prevalence of diabetes across Canada. The rate of
T1D prevalence increased with age; Mortality data in
people with diabetes mellitus. In PEI, 321 persons with
diabetes died between Jan. 1982 and Dec. 1984, accounting
for about 2 % of all deaths. Diabetes was the cause in
16.8 % of mortality, as a contributing cause in 41.7 %, and
not mentioned at all in 41.1 % of the mortalities. Whether
diabetes was mentioned or not, myocardial infarction and
cerebral vascular disease were the two major causes of
mortalities in these 321 patients with diabetes; (d)the
prevalence of cardio-vascular risk factors in adults with
diabetes mellitus. In Canadian Heart Health Survey, the
prevalence rates of obesity, hypertension, sedentary life-
style, and high cholesterol (hypercholesterolemia) were
higher in the groups of people with diabetes mellitus.
A hypothesis that long-term postnatal development may
be modified by metabolic experiences in utero was tested
[24]. The offspring of women with pregestational diabetes
(including both type 1 and T2D) and gestational diabetes
were included in a prospective study from years 1977 to
1983. Fetal beta-cell function was measured for amniotic
fluid insulin (AFI) concentration at 32–38 weeks of ges-
tation. Postnatally, offspring were seen yearly for neu-
ropsychological testing, measurement of anthropometrics,
and modified glucose tolerance testing. The Neuropsy-
chological control subjects were followed longitudinally.
Additional control subjects had anthropometrics measured
once, and a random subset of these subjects had a single
oral glucose challenge at 10–16 years. The rate of major
neuropsychological disturbances in cohort study did not
differ significantly from national estimates. However,
aberrant maternal metabolism was associated with low
intellectual performance and psychomotor development.
The macrosomia observed at birth in offspring of diabetic
mothers (ODM) usually resolves by 1 year of age. The
Cell Biochem Biophys
123
obesity recurs in childhood; and by 14–17 years, the mean
BMI is 24.6 ± 5.8 kg/m2 in ODM vs 20.9 ± 3.4 kg/m2 in
control subjects. Obesity in adolescence is associated with
sex, mother’s weight, and AFI concentration. The impaired
glucose tolerance (IGT) was found in 36 % of ODM and
was associated with elevated AFI in utero.
In confirmation of the hypothesis, aberrant maternal
metabolism was associated with poorer intellectual and
psychomotor development, obesity, and IGT in offspring.
The excessive insulin secretion in utero, as determined by
AFI concentration, is a predictor of both obesity and IGT in
adolescence. This study performed a long-term prospective
evaluation of the effects of maternal diabetes on pregnant
women and their offspring. The correlation between in-
dexes of maternal and fetal metabolism during pregnancy
and the offspring’s subsequent physical, metabolic, and
psychological development from birth through adolescence
were determined. It has been reported that T2D in children
has increased worldwide and children from ethnic groups
are also at a higher risk of T2D [25]. In Canada, 1.54 %
children and adolescents of over 18 years and in USA
8.1 % of age group 15–19 years have T2D [26].
Prevention of Diabetes
The breast feeding to babies has been shown to reduce the
risk of youth onset of T2D [27]. The obesity is a major risk
factor for T2D. Health Canada has recommended physical
activity and healthy nutrition for children to prevent diabetes
[28, 29]. The Metformin or Orlistat has potential for short-
term weight loss in obese children and adolescents [30].
Diagnosis of Diabetes
The diabetes can be diagnosed by the determination of
blood sugar levels which are usually high. The children
may have DKA or hyperosmolar coma. The daily deter-
mination of blood sugar levels of children with T2D is
essential for screening program to prevent acute, life-
threatening presentation, and to decrease chronic compli-
cations. The daily blood sugar level determination im-
proves Glycemic control and reduces the related short- and
long-term complications [31]. The risk factors for the de-
velopment of T2D in children include a history of T2D in a
first or second degree relative [32]. The anti-psychotic
medications are associated with significant weight gain,
insulin resistance, and impaired fasting glucose/T2D in
children [33]. The use of neuropsychiatric medications is
more common in obese children and diagnosis of T2D
compared to the general pediatric population. In Canada,
the mean age of diagnosis of T2D in youth was 13.7 years.
However, 8 % of all newly diagnosed children with T2D
were \10 years old. In children of Aboriginal, Caucasian,
and Asian origin, 11, 8.8, and 8.7 %, respectively, pre-
sented T2D at \10 years of age. Thus, consideration
should be given for screening at a younger age in high-risk
individuals. A fasting plasma glucose (FPG) is the rec-
ommended routine screening test for children with diabetes
mellitus. The oral glucose tolerance test may have a higher
detection rate in children who are very obese (body mass
index, BMI C99 % for age and gender) and who have
multiple risk factors for T2D.
Type 1 Diabetes Mellitus: Treatment & Management
The pediatric T1D treatment and management have been
reported before [34]. All children who have T1D require
insulin treatment by injections, blood glucose testing
tablets or strips, and urine ketone testing strips. The hy-
poglycemia, i.e., low blood sugar levels affects many
diabetic people for renal and ophthalmic impairments
which require daily monitoring of blood glucose levels.
The diabetic children can have symptoms of dehydration,
persistent vomiting, metabolic derangement, or severe in-
ter-current illness requires inpatient management and in-
travenous rehydration. There are several known drugs
available in the market for the diabetes care such as Thin
Lancets, Invokana, Metformin, Diastix strips, Insulin in-
jections, and other herbal medications.
Diabetes and Pregnancy
The pregnancy of a woman should be planned and man-
aged carefully to achieve healthy outcome for mother and
her infant. The preconception normalization of blood sugar
levels and vitamin folic acid supplements (at least
5 mg/day) reduces the otherwise increased risk of con-
genital heart disease and neural tube defects of babies. The
blood glucose levels must be observed every week for
pregnant woman during pregnancy to control sugar levels
to avoid hypoglycemia, which may damage the fetus, and
persistent hyperglycemia, which can lead to fetal gigan-
tism, premature delivery, and increased infant morbidity
and mortality. The DKA during pregnancy may cause fetal
injury or mortality.
Management of Diet
Proper diet is an essential component for the management
of diabetes care. The children with diabetes can be re-
stricted in carbohydrates diet and energy intake to keep
Cell Biochem Biophys
123
them healthy. The current dietary management of diabetes
emphasizes a healthy, balanced diet that is high in carbo-
hydrates and fiber and low in fat. The carbohydrates should
provide 50–55 % of daily energy intake, no more than
10 % of carbohydrates should be from sucrose or other
refined carbohydrates. The fat should provide 30–35 % of
daily energy intake, and protein should provide 10–15 % of
daily energy intake for diabetic children. A balanced diet,
with insulin dose and physical activity to keep blood glu-
cose levels closer to reference range, avoiding extremes of
hypoglycemia or hyperglycemia symptoms is necessary. It
is essential for diabetic children to receive fast-acting in-
sulin at meal times either by injection or insulin pump to
allow more precise matching of food and insulin. The
adequate intake of complex carbohydrates (e.g., cereals) is
important before bedtime to avoid nocturnal hypoglycemia,
especially for children getting twice daily injections of
mixed insulin. A diet plan for each child should be pre-
pared according to growth and lifestyle. For diet low in
carbohydrates, less insulin is required for diabetics. No
clinical trials of low-carbohydrate diets in children with
T1D have been reported so far, and such diets cannot be
recommended at present.
Medications for Diabetes
At present, there is no cure for diabetes except to determine
the glucose level in the blood every day and to control it by
insulin injections. The long-term treatments to prolong the
life of a diabetic person are, to relievethe symptoms, take
care of diabetic heart, amputation, kidney failure, control
diet, do physical exercises, and change lifestyle. In addition
to taking medication, manage to lose body weight, no to-
bacco smoking, and moderate alcohol drinking are useful
to control the diabetes mellitus. The medications, Met-
formin (Glucophage), and Biguanides are used to lower the
glucose level in blood of a diabetic person. The names of
few important drugs used for the treatment of diabetes are
Actos, Actoplus, Amary, Avandia, Byetta, Glucophage,
Glumetza, Invokana, Januvia, Levemir, Metformin, Ong-
lyza, etc. The International Diabetic Federation (IDF) re-
ports that about 181 million women have diabetes
worldwide. Therefore, care must be taken for diabetes in
women and children as well as adult population.
Conclusion
The three types of diabetes, symptoms and its prevention,
diagnosis, treatment, management of diet, diabetes in preg-
nancy, epidemiology of diabetes, and medications of dia-
betes are mentioned above. Prevalence of diabetes mellitus is
increasing in the world and more in women as compared to
men. The children are also affected with diabetes. Control-
ling sugar levels in the blood is necessary by insulin injec-
tions or by treatment with various known medications for
diabetes mellitus. The diabetic children show symptoms of
dehydration, persistent vomiting, metabolic derangement, or
serious inter-current illness which require proper manage-
ment and intravenous rehydration. There are several known
drugs available in the market for the diabetes care such as
Invokana, Metformin, Diastix strips, Insulin injections, and
other medications. The fatty diet, more sugar, no exercise,
poor lifestyle, smoking, alcoholism, and other factors are
responsible for the causes of diabetes mellitus. The blood
sugar levels must be controlled in diabetic people.
References
1. WHO. (2014). About diabetes. World Health Organization:
Retrieved April 4, 2014.
2. WHO, Diabetes Fact sheet No. 312. WHO: October 2013.
Retrieved March 25, 2014.
3. Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N.
(2009). Hyperglycemic crises in adult patients with diabetes.
Diabetes Care, 32(7), 1335–1343. doi:10.2337/dc09-9032.PMC
2699725.PMID4476.
4. Shoback, (2011). Greenspan’s basic & clinical endocrinology,
‘‘Chapter 17’’ (edited by David G. Gardner, Dolores) (9th ed.).
New York: McGraw-Hill Medical. ISBN 0-07-162243-8.
5. Tripathy B. et al. (2012) RSSDI textbook of diabetes mellitus
(Rev. 2nd ed.). New Delhi: Jaypee Brothers Medical Publishers.
(p. 235). ISBN 9789350254899.
6. Diabetes (2014) and ‘‘The top 10 causes of death Fact sheet
N�310’’. World Health Organization (Oct 2013).
7. Rippe [Irwin, R. S., & James, M. (eds.)] (2010). Manual of in-
tensive care medicine (5th ed.) (p. 549). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins. ISBN 9780781
799928.
8. Picot, J., Jones, J., Colquitt, J. L., Gospodarevskaya, E., Love-
man, E., Baxter, L., Clegg, A. J. (2009). The clinical effective-
ness and cost-effectiveness of bariatric (weight loss) surgery for
obesity: a systematic review and economic evaluation. Health
Technology Assessment (Winchester, England), 13(41), 1–190,
215–357, iii–iv. doi:10.3310/hta13410.PMID19726018
9. Cash, J. (2014). Family practice guidelines (3rd ed.) (p. 396).
New York: Springer. ISBN 9780826168757.
10. Williams text book of endocrinology (12th ed., pp. 1371–1435).
Philadelphia, PA: Elsevier/Saunders Publ. (2007). ISBN 978-1-
4377-0324-5.
11. Shi, Y., Hu, F. B. (2014). The global implications of diabetes and
cancer. The Lancet 383 (9933): 1947–8. doi:10.1016/S0140-
6736(14)60886-2.
12. Vos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C.,
Ezzati, M., et al. (2012). Years lived with disability (YLDs) for
1160 sequelae of 289 diseases and injuries 1990–2010: a systematic
analysis for the Global Burden of Disease Study (2010). Lancet,
380(9859), 2163–2196. doi:10.1016/S0140-6736(12)61729-2.
13. IDF DIABETES ATLAS. (2013). International Diabetes Fed-
eration (6th ed.). (p. 7). ISBN 2930229853.
14. IDF, DA (2014). International Diabetes Federation: Diabetes
Atlas. Retrieved April 4, 2014.
Cell Biochem Biophys
123
http://dx.doi.org/10.2337/dc09-9032.PMC2699725.PMID4476
http://dx.doi.org/10.2337/dc09-9032.PMC2699725.PMID4476
http://dx.doi.org/10.3310/hta13410.PMID19726018
http://dx.doi.org/10.1016/S0140-6736(14)60886-2
http://dx.doi.org/10.1016/S0140-6736(14)60886-2
http://dx.doi.org/10.1016/S0140-6736(12)61729-2
15. ADA. American Diabetes, Association (Apr 2013). ‘‘Economic
costs of diabetes in the U.S. in (2012).’’. Diabetes Care 36 (4):
1033–46. doi:10.2337/dc12-2625
16. China faces ‘diabetes epidemic’, research suggests. BBC, March
25, 2010. Retrieved June 8, 2012.
17. Gale, J. (2010). India’s diabetes epidemic cuts down millions
who escape poverty. Bloomberg, Retrieved June 8, 2012.
18. Diabetes can be controlled in 80 percent of Cases in India. IANS.
www.news.biharprabha.com Retrieved February 6, 2014.
19. Kleinfield, N. R. (2006). Modern ways open India’s doors to
diabetes. New York Times. Retrieved June 8, 2012.
20. Wild, S., Roglic,G., Green, A. Sicree, R., & King, H. (2014)
Global prevalence of diabetes. Diabetes Care: American Diabetes
Association. Jan 26, 2004.
21. Diabetes in Canada. (2011) Facts and figures from a public health
perspec-tive. Ottawa: The Public Health Agency of Canada.
22. Maahs, D. M., West, N. A., Lawrence, J. M., & Mayer-Davis, E.
J. (2010). Epidemiology of type 1 diabetes. Endocrinology &
Metabolism Clinics Of North America, 39(3), 481–497. doi:10.
1016/J.ecl.2010.05.011.
23. Tan, M. H., & MacLean, D. R. (1995). Epidemiology of diabetes
mellitus in Canada. Clinical & Investigative Medicine, 18(4),
240–246.
24. Silverman, B. L., Rizzo, T. A., Cho, N. H., & Metzger, B. E.
(1998). Long-term effects of the intrauterine environment. The
Northwestern University Diabetes in Pregnancy Center, Chicago,
Illinois. Diabetes Care, 21(Suppl 2), B142–B149.
25. Panagiotopoulos, C., Riddell, M. C., Sellers, E. A. C. (2013).
Type 2 diabetes in children and adolescents. CDA (Can. Diabetes
Association), Clinical Practice Expert Committee, 2013.
26. Dabelea, D., Bell, R. B., & D’Agostino, R. B, Jr. (2007). Inci-
dence of diabetes in youth in the United States. JAMA, 297,
2716–2724.
27. Taylor, J. S., Kacmar, J. E., Nothnagle, M., & Lawrence, R. A.
(2005). A systematic review of the literature associating breast-
feeding with type 2 diabetes and gestational diabetes. Journal Of
The American College Of Nutrition, 24, 320–326.
28. Can. Soc. for Exer. (2013). Physiol. Can. Physical Activity
Guidelines and Can. Sedentary Behavior Guidelines. February
25, 2013.
29. Health Canada, Ottawa, Ontario. Children- Canada’s food guide.
February 25, 2013.
30. Rogovik, A. L., Chanoine, J. P., & Goldman, R. D. (2010).
Pharmacotherapy and weight-loss supplements for treatment of
paediatric obesity. Drugs, 70, 335–346.
31. Pinhas-Hamiel, O., & Zeitler, P. (2007). Acute and chronic
complications of type 2 diabetes mellitus in children and ado-
lescents. The Lancet, 369, 1823–1831.
32. Pinhas-Hamiel, O., Dolan L. M., Daniels, S. R. (1996). Increased
incidence of non-insulin-dependent diabetes mellitus among
adolescents. The Journal of Pediatrics, 128(5 pt 1), 608–615.
33. Panagiotopoulos, C., Ronsley, R., & Davidson, J. (2009). In-
creased prevalence of obesity and glucose intolerance in youth
treated with second-generation antipsychotic medications.
Canadian Journal of Psychiatry, 54, 743–749.
34. Lamb, W. H., Kemp, S. (2014). Pediatric type 1 diabetes mellitus
treatment and management. www.pediatrictype1diabetesmellitus.
html
Cell Biochem Biophys
123
http://dx.doi.org/10.2337/dc12-2625
http://www.news.biharprabha.com
http://dx.doi.org/10.1016/J.ecl.2010.05.011
http://dx.doi.org/10.1016/J.ecl.2010.05.011
http://www.pediatrictype1diabetesmellitus.htmlhttp://www.pediatrictype1diabetesmellitus.html
	Epidemiological Perspectives of Diabetes
	Abstract
	Introduction
	Epidemiology of Diabetes
	Prevention of Diabetes
	Diagnosis of Diabetes
	Type 1 Diabetes Mellitus: Treatment & Management
	Diabetes and Pregnancy
	Management of Diet
	Medications for Diabetes
	Conclusion
	References