Global Prevalence of Diabetes - WHO

1 Global Prevalence of DiabetesEstimates for the year 2000 and projections for 2030 SARAHWILD,MB BCHIR,PHD1 GOJKAROGLIC,MD2 ANDERSGREEN,MD,PHD,DR MED SCI3 RICHARDSICREE,MBBS,MPH4 HILARYKING,MD,DSC2 OBJECTIVE The goal of this study was to estimate the Prevalence of Diabetes and thenumber of people of all ages with Diabetes for years 2000 and DESIGN AND METHODS Data on Diabetes Prevalence by age and sexfrom a limited number of countries were extrapolated to all 191 World Health Organizationmember states and applied to United Nations population estimates for 2000 and 2030. Urbanand rural populations were considered separately for developing The Prevalence of Diabetes for all age-groups worldwide was estimated to in 2000 and in 2030.

2 The total number of people with Diabetes is projected to risefrom 171 million in 2000 to 366 million in 2030. The Prevalence of Diabetes is higher in menthan women, but there are more women with Diabetes than men. The urban population indeveloping countries is projected to double between 2000 and 2030. The most importantdemographic change to Diabetes Prevalence across the world appears to be the increase in theproportion of people 65 years of These findings indicate that the Diabetes epidemic will continue evenif levels of obesity remain constant. Given the increasing Prevalence of obesity, it is likely thatthese figures provide an underestimate of future Diabetes Care27:1047 1053, 2004 The number of people with diabetesis increasing due to populationgrowth, aging, urbanization, and in-creasing Prevalence of obesity and physi-cal inactivity.

3 Quantifying the prevalenceof Diabetes and the number of people af-fected by Diabetes , now and in the future,is important to allow rational planningand allocation of of current and future dia-betes Prevalence have been publishedpreviously (1 3). Since these reports ap-peared, further epidemiological data havebecome available for several countries inAfrica and the Middle East and for sources of these data are identified inTable report provides estimates of theglobal Prevalence of Diabetes in the year2000 (as used in the World Health Orga-nization [WHO] Global Burden of Dis-ease Study) and projections for 2030. Itprovides a sequel to the report describingestimates of the Global burden of diabetesin 1990 (2) using newer data and differentmethods for estimating age-specific prev-alence.

4 As before, the estimates are basedon demographic changes alone with theconservative assumption that other riskfactor levels such as obesity and physicalactivity remain constant (in developedcountries) or are accounted for by urban-ization (in less developed countries). Thecurrent estimates include all age-groups,and age-specific data are presented (on-line appendix [available at ]) to allow compari-son with previous estimates that were foradults only (2). As most data sources donot distinguish between type 1 and type 2diabetes in adults, it is not possible topresent data separately for subtypes DESIGN ANDMETHODS Diabetes prevalencedata for adults ( 20 years of age) werederived from studies meeting the follow-ing criteria: a defined, population-basedsample and diagnosis of Diabetes based onoptimal WHO criteria (a venous plasmaglucose concentration of mmol/l2 h after a 75-g glucose tolerance test).

5 The exceptions to the latter criterion werethe study in China, for which a test mealwas used (4), and the study in Tanzania(5), in which fasting glucose alone gave ahigher Prevalence of Diabetes than a pre-vious study that used the optimal estimates for type 1 diabe-tes for people 20 years of age for indi-vidual countries were estimated fromavailable incidence data using methodsdescribed in the International DiabetesFederation (IDF) Diabetes Atlas 2000 (6).Population-based data are not availablefor type 2 Diabetes in people 20 years ofage, and this group has been excludedfrom these and sex-specific estimates for di-abetes Prevalence were extrapolated toother countries using a combination ofcriteria including geographical proximity,ethnic, and socioeconomic similaritiesapplied by the authors with the adviceof the WHO regional officer and other From the1 Public Health Sciences, University of Edinburgh, Edinburgh, Scotland; the2 Department ofNon-Communicable Diseases, World Health Organization, Geneva, Switzerland.

6 The3 Department of Epi-demiology and Social Medicine, University of Aarhus, Aarhus, Denmark; and the4 International DiabetesInstitute, Caulfield, Victoria, correspondence and reprint requests to Dr. Sarah Wild, Public Health Sciences, University ofEdinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland. E-mail: for publication 18 October 2003 and accepted in revised form 26 January received honoraria for speaking engagements from Bayer Corporation. is a paid consultant ofNovo information for this article can be found in an online appendix at :IDF, International Diabetes Federation; WHO, World Health table elsewhere in this issue shows conventional and Syste` me International (SI) units and conversionfactors for many substances.

7 2004 by the American Diabetes Services/Psychosocial ResearchORIGINAL ARTICLEDIABETESCARE,VOLUME27,NUMBER5, MAY20041047 Table 1 List of Diabetes Prevalence studies by country of study giving sample size, age-group, and the countries to which the data wereextrapolatedCountry of study, year, andreference*Sample sizeAge-group(years)Additional countries that estimates were applied toAustralia, 2000 (21) 11,247 25 New ZealandBolivia, 1998 (22) 2,948 20 Ecuador, PeruBrazil, 1988/1989 (23) 2,05130 69 Argentina, Chile, Cuba, Mexico, Uruguay, VenezuelaCameroon, published 1997 (24) 1,76724 74 Angola, Central African Republic, Congo, Gabon, Guinea, SaoTome, and PrincipeChina, 1994 (4) 224,25125 64 North Korea/Democratic People s Republic of Korea Colombia, 1988/1989 (25)670 30 Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua,PanamaFiji, 1980 (26) 1,709 20 Kiribati , Marshall Islands , Micronesia (Federated States) ,Palau , Papua New Guinea , Solomon Islands , Vanuatu Ghana, 1998 (27) 4,733 25 Benin, Burkina Faso, Cape Verde, Chad, Cote d Ivoire,Equatorial Guinea, Guinea Bissau, Gambia, Liberia,Nigeria, Senegal, Sierra Leone, TogoIndia, 2000 (28) 11,216 20 Bangladesh, Bhutan, Sri Lanka, Maldives, NepalIran, 1999/2000 (29) 9,229 20 Azerbaijan, Iraq, YemenIsrael (30) 1,50225 64 Japan Funagata, 1990 1992 (31) 2,624 40 Jordan (32) 2,836 25 Syria, urban EgyptLebanon 2,518 30 Malta (33)

8 2,149 15 Mauritius (34) 4,92925 74 SeychellesMongolia (35) 2,449 35 Nauru (36) 1,546 20 Netherlands, 1989 1992 (37) 2,48450 74 Austria, Belgium, Denmark, Finland, France, Germany,Iceland, Ireland, Luxembourg, Norway, Sweden,Switzerland, , 1991 (38)2,963 20 QatarPakistan: rural Baluchistan (39) 570 25 AfghanistanPakistan: Sindh, 1994 (40)967 25 Paraguay, 1991/1992 (41) 1,606 urban white Hispanic20 74 SurinamePoland 2,52325 74 Bosnia, Croatia, Czech Republic, Estonia, Hungary, Latvia,Lithuania, Serbia, Slovakia, Slovenia, the Former YugoslavRepublic of Macedonia, UkraineRussia 1,60225 64 Samoa (42) 1,77225 74 Cook Islands , Niue , Tonga , Tuvalu Saudi Arabia (43) 25,3372 77 Bahrain , Kuwait Singapore (44) 3,56818 69 Brunei , Indonesia, Malaysia, Philippines, ThailandSouth Africa (45) 729 30 Botswana, Lesotho, Namibia, Swaziland, ZimbabweSouth Korea/Republic of Korea (46) 2,520 30 Spain (47) 2,21430 89 Andorra, Italy, Monaco, San Marino, PortugalSudan (48) 1,284 25 Eritrea, Ethiopia, Mali, Mauritania, NigerTanzania, 1996/1997 (5)

9 1,698 15 Burundi, Comoros, Democratic Republic of the Congo,Djibouti, Kenya, Madagascar, Malawi, Mozambique,Rwanda, Somalia, Uganda, ZambiaTrinidad, 1977 1981 (49)2,31535 69 Antigua and Barbuda , Bahamas , Barbados, Belize,Dominica, Dominican Republic, Grenada , Guyana, Haiti,Jamaica, St. Kitts and Nevis , St. Lucia , St. Vincent andthe Grenadines Tunisia, 1976/1977, 1980/1981 (50)3,826 urban 20 Algeria, Libya, Morocco1,787 ruralTurkey (51) 24,788 20 Albania, Belarus, Bulgaria, Cyprus, Greece, Moldova,RomaniaUnited Arab Emirates, 2000 #5,844 , 1988 1994 (52) 2,84440 74 CanadaUzbekistan, 1996 (53) 1,956 35 Armenia , Georgia , Kazakhstan , Kyrgyzstan , Tajikistan ,Turkmenistan Vietnam **1,121 25 Cambodia, Laos, Myanmar*Year indicates year of study, if given, or year of publication.

10 Indicates data that were not used in estimates for 1990. Indicates same Diabetes Prevalence data usedfor urban and rural populations. I. Salti, M. Khogali, S. Alam, N. Nassar, A. Masri, personal communication. E. Shubnikov, personal communication. Z. Szybinski,W. Zukowski, R. Rita, J. Sieradzki, I. Turska-Karbowska, M. Gizler, personal communication. #M. Malik, A. Bakir, B. Abi Saab, , , personal communication.**P. Khi, personal Prevalence of diabetes1048 DIABETESCARE,VOLUME27,NUMBER5, MAY2004experts. Table 1 shows the studies usedand the countries to which data were generally performed onmiddle-aged populations, and data aremore limited at younger and older on Diabetes Prevalence are usuallypresented in broad age bands, which sug-gest a biologically implausible step-likeincrease in Diabetes Prevalence with in-creasing age.