There has been an "inexorable and unsustainable increase in global health expenditure attributed to diabetes" over the past 20 years, including an emergence in children, adolescents and young adults, and there has been a trend in prevalence in in countries several years after severe famines, according to a review published Dec. 3 in The Lancet Diabetes & Endocrinology.

The authors note that diabetes prevention "should be given high priority," as it was recognized as an international public health challenge in the United Nations General Assembly in 2006, and recently the World Health Assembly called for a reduction of "avoidable mortality from non-communicable diseases by 25 percent by 2025."

Trends in the "diabetes apocalypse" were identified, including "major increases in type 2 diabetes which have occurred in China and Cambodia 40‐50 years after severe famines." The authors identify particular regions that could experience major epidemics of type 2 diabetes, including Africa, which is "expected to have a 110 percent increase in the number of people with diabetes within the next two decades."

"With some historical perspective, we are starting to see trends in the way environmental disasters such as famine, interact with the genes of a whole population group," said Professor Paul Zimmet, lead author and director emeritus at Baker IDI Heart and Diabetes Institute in Melbourne, Australia. "This interaction occurs during pregnancy affecting the baby's risk of chronic diseases such as type 2 diabetes, obesity and heart disease, which can show up decades later."

The authors note that moving forward, "establishing which countries will bear the brunt of diabetes in the future and making these regions a priority for prevention is critical to stemming the diabetes epidemic." Further, "an integrated approach is needed to prevent type 2 diabetes, taking into account the many origins and heterogeneity. Thus, research needs to be directed at improved understanding of the potential role of determinants such as the maternal environment and other early life factors, as well as changing trends in global demography, to help shape disease prevention programs," they add.

A separate study noted that diabetes is a more "heterogeneous disease than the present subdivision into types 1 and 2 assumes." The authors explain that "with the increasing probabilities to genetically and clinically or metabolically characterize patients with diabetes, we predict that the range of diabetic subgroups will be even more diverse in the future." They add that moving forward, they hope that "the delineation of these subgroups will assist in the development of individualized therapy."

Meanwhile, a separate study looked at the pathophysiology and treatment of type 2 diabetes and noted that "several new approaches for treatment have been developed, but more effective therapies to slow progressive loss of β-cell function are needed."

The authors add that "recent findings from clinical trials provide important information about methods to prevent and treat type 2 diabetes and some of the adverse effects of these interventions. However, additional long-term studies of drugs and bariatric surgery are needed to identify new ways to prevent and treat type 2 diabetes and thereby reduce the harmful effects of this disease."

Keywords: Starvation, Risk, Cambodia, Bariatric Surgery, Chronic Disease, Global Health, Disasters, Diabetes Mellitus, Type 2, Heart Diseases, Child, Prevalence, Public Health, China, Obesity, United Nations, Population Groups