National, Regional, and Global Trends in Fasting Plasma Glucose and Diabetes Prevalence Since 1980: Systematic Analysis of Health Examination Surveys and Epidemiological Studies With 370 Country-Years and 2.7 Million Participants

Study Questions:

What are the trends in mean fasting plasma glucose (FPG) and diabetes prevalence for adults ages 25 years and older in 199 countries and territories?

Methods:

The investigators obtained data from health examination surveys and epidemiological studies (370 country-years and 2.7 million participants). They converted systematically between different glycemic metrics. For each sex, they used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative. FPG trends over time were modeled as a linear trend plus a smooth nonlinear trend, at all levels.

Results:

In 2008, global age-standardized mean FPG was 5.50 mmol/L (95% uncertainty interval, 5.37-5.63) for men and 5.42 mmol/L (5.29-5.54) for women, having risen by 0.07 mmol/L and 0.09 mmol/L per decade, respectively. Age-standardized adult diabetes prevalence was 9.8% (8.6-11.2) in men and 9.2% (8.0-10.5) in women in 2008, up from 8.3% (6.5-10.4) and 7.5% (5.8-9.6) in 1980. The number of people with diabetes increased from 153 (127-182) million in 1980, to 347 (314-382) million in 2008. The investigators recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6.09 mmol/L, 5.73-6.49 for men; 6.08 mmol/L, 5.72-6.46 for women) and diabetes prevalence (15.5%, 11.6-20.1 for men; and 15.9%, 12.1-20.5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Africa, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0.07 mmol/L per decade for men and 0.03 mmol/L per decade for women; North America had the largest rise, 0.18 mmol/L per decade for men and 0.14 mmol/L per decade for women.

Conclusions:

The authors concluded that glycemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences.

Perspective:

This systematic analysis shows that glycemia and diabetes are a rising global hazard, with the number of adults with diabetes having more than doubled over nearly three decades. Although population growth and ageing are important contributors to this increase, there is also an important epidemiological component, with age-standardized global mean FPG having increased by 0.07 mmol/L per decade or more. Since measures to prevent diabetes are unlikely to affect diabetes incidence in the short term, health systems in most countries will need to develop programs to improve detection and management of diabetes to slow progression to microvascular and macrovascular complications. There is an urgent need to strengthen basic surveillance of dysglycemia and diabetes, including standardized frameworks, definitions, survey methodology, tools, and reporting protocols.

Clinical Topics: Prevention, Diet

Keywords: Africa South of the Sahara, North America, Oceania, Caribbean Region, Risk Factors, Prevalence, Blood Glucose, Europe, Eastern, Latin America, Middle East, Diabetes Mellitus, Fasting


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