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The epidemiology and prevention of diabetes mellitus 

The epidemiology and prevention of diabetes mellitus
Chapter:
The epidemiology and prevention of diabetes mellitus
Author(s):

Nigel Unwin

and Paul Zimmet

DOI:
10.1093/med/9780199218707.003.0063
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date: 12 December 2017

Diabetes mellitus is a heterogeneous disease characterized by raised blood glucose. The current classification recognizes two main types: Type 1, due to destruction of the insulin-producing cells of the pancreas and typically requiring exogenous insulin for survival; and type 2, representing 85–95 per cent of all diabetes, and due to a combination of resistance to the action of insulin and diminished insulin production. Currently, around 250 million people worldwide have diabetes, 6 per cent of the adult population, and this figure will increase markedly over the coming years as populations age and become increasingly overweight and sedentary, the major risk factors for type 2 diabetes. Contrary to popular perception over 70 per cent of people with diabetes live in low- or middle-income countries, and most new cases of diabetes over the coming decades will be in such countries. Diabetes reduces life expectancy by around 15 years in type 1 diabetes and 10 years in type 2 and in many populations is the major cause of lower limb amputation, visual loss and renal failure. It is a major source of expenditure in health systems the world over and also impacts upon economic productivity. It was recently estimated that in 2007 diabetes cost India 2.1 per cent of its gross domestic product. Prevention, or at least delayed onset, of type 2 diabetes through behavioural or pharmacological measures has been convincingly demonstrated in several trials. At best these trials were able to achieve a 60 per cent reduction in incidence. The prevention of type 1 diabetes remains the subject of research. Nonetheless, a substantial reduction in the incidence of complications in people with diabetes is possible, including reductions in cardiovascular disease events, visual loss, lower limb amputation and renal failure. However, achieving these reductions requires well organized and resourced health care, and good education and support to people with diabetes in managing their condition. Diabetes is one of the major public health challenges of the twenty-first century, a fact recognized in 2006 by a United Nations resolution.

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