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Global estimates of the prevalence of diabetes for 2010 and 2030

Published:November 09, 2009DOI:https://doi.org/10.1016/j.diabres.2009.10.007

      Abstract

      Aim

      We estimated the number of people worldwide with diabetes for the years 2010 and 2030.

      Methods

      Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20–79 year range. Self-report or registry data were used if blood glucose assessment was not available.

      Results

      The world prevalence of diabetes among adults (aged 20–79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries.

      Conclusion

      These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries.

      Keywords

      1. Introduction

      Diabetes mellitus is one of the most common chronic diseases in nearly all countries, and continues to increase in numbers and significance, as changing lifestyles lead to reduced physical activity, and increased obesity. Estimates of the current and future burden of diabetes are important in order to allocate community and health resources, and to emphasise the role of lifestyle, and encourage measures to counteract trends for increasing prevalence.
      There have been several previous estimates of the number of persons with diabetes [
      • King H.
      • Rewers M.
      Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults.
      ,
      • King H.
      • Aubert R.
      • Herman W.
      Global burden of diabetes, 1995–2025: prevalence, numerical estimates and projections.
      ,
      • Amos A.
      • McCarty D.
      • Zimmet P.
      The rising global burden of diabetes and its complications: estimates and projections to the year 2010.
      ,
      • Wild S.
      • Roglic G.
      • Green A.
      • Sicree R.
      • King H.
      Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
      ]. The World Health Organization (WHO) published estimates for the years 2000 and 2030, using data from 40 countries but extrapolated to the 191 WHO member states [
      • Wild S.
      • Roglic G.
      • Green A.
      • Sicree R.
      • King H.
      Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
      ]. Other estimates have been produced by the International Diabetes Federation (IDF) [
      • International Diabetes Federation
      Diabetes Atlas.
      ,
      • International Diabetes Federation
      Diabetes Atlas.
      ]. The estimates produced here update the previous IDF estimates, and include all 216 countries of the United Nations.

      2. Materials and methods

      2.1 Study selection

      The Medline database was searched for publications between January 1989 and March 2009, using the following search term “Diabetes Mellitus/epidemiology” MeSH AND “Prevalence” MeSH. Studies were identified that reported on the prevalence of diabetes for at least three adult age-groups from a population-based sample. A number of other avenues were explored in the search for relevant data. Relevant citations from each article were obtained, and diabetes researchers in each major IDF geographical region, and IDF member associations in each member country were asked about relevant data. Studies were included if they assessed diabetes prevalence for a defined adult population-based sample, using WHO or American Diabetes Association (ADA) diagnostic criteria [

      World Health Organization, Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Department of Noncommunicable Disease Surveillance, Geneva, 1999. Report No.: WHO/NCD/NCS/99.2.

      ,

      World Health Organization, Diabetes mellitus: report of a WHO Study Group. Technical Report Series 727. WHO, Geneva, 1985.

      ,
      • American Diabetes Association
      Report of the Expert Committee on the diagnosis and classification of diabetes mellitus.
      ,

      World Health Organization, Expert Committee on diabetes mellitus, second report. Technical Report Series 646. WHO, Geneva, 1980.

      ,

      World Health Organization, Prevention of diabetes mellitus. Technical Report Series no. 844. World Health Organization, Geneva, 1994.

      ], with age-specific prevalences indicated for at least three distinct age-groups within the 20–79 year range. Self-report data, or registry data were used if blood glucose assessment was not available. The final selection of a study or studies for each country was determined by the study size, response rate, diagnostic criteria used (with preference for the oral glucose tolerance test) and by assessing the degree to which studies reflected the national population. The final selection included 133 studies from 91 countries. For those countries that did not have their own suitable study, a study (or studies) from another country were used, with selection of that study on the basis of the ethnic and socio-economic similarity of the population, as well as geographical proximity. National member associations of the IDF assisted with choice of which other country to use. Estimates were based on the total diabetes population, including those newly diagnosed on blood glucose testing by surveys, and those with type 1 diabetes.

      2.2 Statistical methods

      Prevalence estimates were derived for adults aged 20–79 years. Smoothed age-specific (5 year intervals) and sex-specific prevalence estimates were generated by applying logistic regression models using SPSS Version 15.0 (SPSS, Chicago, IL) to the available data, including a quadratic term to allow flattening for older ages. The age-specific data were centred on the mid-point of each age-group, and weighted by the number of cases with and without diabetes. Open-ended age-groups (such as 65+) were treated as if the open age-group were of the same size as the highest inclusive group (e.g. 55–64).
      The smoothed age- and sex-specific prevalences were then applied to each national population distribution for the years 2010 and 2030 (United Nations Population estimates [

      United Nations, Population Division, World Population Prospects: The 2006 Revision. United Nations (Ed.). Geneva, 2007.

      ]) to estimate national prevalence and numbers of adults with diabetes. The age-specific prevalences of each country were also applied to the world population distribution to determine age- and sex-adjusted prevalences for each country. For countries designated as developing, by the UN classification [

      United Nations, Population Division, World Population Prospects: The 2006 Revision. United Nations (Ed.). Geneva, 2007.

      ] (i.e. all countries outside Europe, except Australia, Canada, Japan, New Zealand, USA, Singapore, Hong Kong and Taiwan), for which separate urban and rural prevalences were available, these were applied to the urban and rural components of the national adult population. For cases in which only urban or only rural data were available, urban prevalences were assumed to be twice those of rural, in keeping with previous assessments [
      • King H.
      • Rewers M.
      Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults.
      ]. For the countries with multiple studies, data were combined. The same age- and sex-specific prevalence data were applied to 2010 and 2030, so that changes in national estimates were only affected by demographic (i.e. age, sex and urbanization) changes for each country.
      Countries were assigned to regions based on the IDF membership regions (Africa; Eastern Mediterranean and Middle-East (EMME); Europe; North America; South and Central America (SACA); South Asia; Western Pacific).
      For several of the studies (Canada, France, Italy, Netherlands, Norway, Slovenia, United Kingdom) data were only available on self-reported diabetes. To account for undiagnosed diabetes, the prevalences of diabetes for the United Kingdom and Canada were multiplied by a factor of 1.5, in accordance with local recommendation (UK) and data from the USA (Canada), and for the other countries doubled, based on data from a number of nearby countries.

      3. Results

      There were 133 studies identified from 91 countries. The data sources and the results for the 80 most populous countries (those with 2010 adult population of greater than 6.307 million, with a combined 2010 population of 95% of the world adult population) are shown in Table 1, Table 2. There were 47 of the 80 countries that had their own data (85 separate studies). Details of prevalence and case numbers for all 216 countries can be found in the online Appendix.
      Table 1Studies identified for the largest 80 countries.
      CountryData used (country, year of publication, reference)Screening methodDiagnostic criteriaSample sizeAge range
      Africa: Sub-Sahara
      AngolaTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      Burkina FasoCameroon (2006)
      J. Mbanya, personal communication (2006).
      and Ghana (2002)
      • Amoah A.G.
      • Owusu S.K.
      • Adjei S.
      Diabetes in Ghana: a community based prevalence study in Greater Accra.
      OGTTWHO-199914,11015+
      CameroonCameroon (2006)
      J. Mbanya, personal communication (2006).
      OGTTWHO-1999937715+
      Dem. Rep. of CongoTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      Cote d’IvoireCameroon (2006)
      J. Mbanya, personal communication (2006).
      and Ghana (2002)
      • Amoah A.G.
      • Owusu S.K.
      • Adjei S.
      Diabetes in Ghana: a community based prevalence study in Greater Accra.
      OGTTWHO-199914,11015+
      EthiopiaTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      GhanaGhana (2002)
      • Amoah A.G.
      • Owusu S.K.
      • Adjei S.
      Diabetes in Ghana: a community based prevalence study in Greater Accra.
      OGTTWHO-199914,11015+
      KenyaTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      MadagascarTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      MalawiTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      MozambiqueTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      NigerCameroon (2006)
      J. Mbanya, personal communication (2006).
      and Ghana (2002)
      • Amoah A.G.
      • Owusu S.K.
      • Adjei S.
      Diabetes in Ghana: a community based prevalence study in Greater Accra.
      OGTTWHO-199914,11015+
      NigeriaCameroon (2006)
      J. Mbanya, personal communication (2006).
      and Ghana (2002)
      • Amoah A.G.
      • Owusu S.K.
      • Adjei S.
      Diabetes in Ghana: a community based prevalence study in Greater Accra.
      OGTTWHO-199914,11015+
      SenegalCameroon (2006)
      J. Mbanya, personal communication (2006).
      and Ghana (2002)
      • Amoah A.G.
      • Owusu S.K.
      • Adjei S.
      Diabetes in Ghana: a community based prevalence study in Greater Accra.
      OGTTWHO-199914,11015+
      South AfricaSouth Africa (1993; 1993; 2001; 2008)
      • Omar M.
      • Seedat M.
      • Motala A.
      • Dyer R.
      • Becker P.
      The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks.
      ,
      • Levitt N.
      • Katzenellenbogen J.
      • Bradshaw D.
      • Hoffman M.
      • Bonnici F.
      The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa.
      ,
      • Erasmus R.T.
      • Blanco Blanco E.
      • Okesina A.B.
      • Matsha T.
      • Gqweta Z.
      • Mesa J.A.
      Prevalence of diabetes mellitus and impaired glucose tolerance in factory workers from Transkei, South Africa.
      ,
      • Motala A.A.
      • Esterhuizen T.
      • Gouws E.
      • Pirie F.J.
      • Omar M.A.
      Diabetes and other disorders of glycemia in a rural South African community: prevalence and associated risk factors.
      OGTTWHO-1985, 1999378015+
      UgandaTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      UR TanzaniaTanzania (1989 and 2000)
      • McLarty D.
      • Kitange H.
      • Mtinangi B.
      • Makene W.
      • Swai A.
      • Masuki G.
      • et al.
      Prevalence of diabetes and impaired glucose tolerance in rural Tanzania.
      ,
      • Aspray T.J.
      • Mugusi F.
      • Rashid S.
      • Whiting D.
      • Edwards R.
      • Alberti K.G.
      • et al.
      Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living.
      OGTT/FBGWHO-1985, 1999778115+
      ZimbabweSouth Africa (1993; 1993; 2001; 2008)
      • Omar M.
      • Seedat M.
      • Motala A.
      • Dyer R.
      • Becker P.
      The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks.
      ,
      • Levitt N.
      • Katzenellenbogen J.
      • Bradshaw D.
      • Hoffman M.
      • Bonnici F.
      The prevalence and identification of risk factors for NIDDM in urban Africans in Cape Town, South Africa.
      ,
      • Erasmus R.T.
      • Blanco Blanco E.
      • Okesina A.B.
      • Matsha T.
      • Gqweta Z.
      • Mesa J.A.
      Prevalence of diabetes mellitus and impaired glucose tolerance in factory workers from Transkei, South Africa.
      ,
      • Motala A.A.
      • Esterhuizen T.
      • Gouws E.
      • Pirie F.J.
      • Omar M.A.
      Diabetes and other disorders of glycemia in a rural South African community: prevalence and associated risk factors.
      OGTTWHO-1985, 1999378015+
      Asia
      BangladeshBangladesh (2005, 2003, 2007)
      • Hussain A.
      • Rahim M.A.
      • AzadKhan A.K.
      • Ali S.M.
      • Vaaler S.
      Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh.
      ,
      • Sayeed M.A.
      • Mahtab H.
      • AkterKhanam P.
      • AbdulLatif Z.
      • KeramatAli S.M.
      • Banu A.
      • et al.
      Diabetes and impaired fasting glycemia in a rural population of Bangladesh.
      ,
      • Rahim M.A.
      • Hussain A.
      • AzadKhan A.K.
      • Sayeed M.A.
      • KeramatAli S.M.
      • Vaaler S.
      Rising prevalence of type 2 diabetes in rural Bangladesh: a population based study.
      OGTT/FBGWHO-1999, ADA-199715,21620+
      CambodiaCambodia (2005)
      • King H.
      • Keuky L.
      • Seng S.
      • Khun T.
      • Roglic G.
      • Pinget M.
      Diabetes and associated disorders in Cambodia: two epidemiological surveys.
      OGTTWHO-1999224625+
      People's Republic of ChinaPeople's Republic of China (2003)
      • Gu D.
      • Reynolds K.
      • Duan X.
      • Xin X.
      • Chen J.
      • Wu X.
      • et al.
      Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA).
      FBGADA-199715,83835–74
      IndiaIndia (2001; 2004; 2008)
      • Sadikot S.M.
      • Nigam A.
      • Das S.
      • Bajaj S.
      • Zargar A.H.
      • Prasannakumar K.M.
      • et al.
      The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes in India study (PODIS).
      ,
      • Ramachandran A.
      • Snehalatha C.
      • Kapur A.
      • Vijay V.
      • Mohan V.
      • Das A.K.
      • et al.
      High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.
      ,
      • Mohan V.
      • Mathur P.
      • Deepa R.
      • Deepa M.
      • Shukla D.K.
      • Menon G.R.
      • et al.
      Urban rural differences in prevalence of self-reported diabetes in India—the WHO-ICMR Indian NCD risk factor surveillance.
      OGTT, SRWHO-199969,00815+
      IndonesiaIndonesia (2008)

      Ministry of Health, Republic of Indonesia, National Basic Health Research 2007, Official Report (translated from RISKESDAS 2007, Sidartawan Soegondo), Jakarta, 2008.

      OGTTWHO-199924,41715+
      JapanJapan (1993 and 2000)
      • Ohmura T.
      • Ueda K.
      • Kiyohara Y.
      • Kato H.
      • Nakayama K.
      • Nomiyama K.
      • et al.
      Prevalence of type 2 (non-insulin dependent) diabetes mellitus and impaired glucose tolerance in the Japanese general population: the Hisayama study.
      ,
      • Sekikawa A.
      • Eguchi H.
      • Tominaga M.
      • Igarashi K.
      • Abe T.
      • Manaka H.
      • et al.
      Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in a rural area of Japan. The Funagata diabetes study.
      OGTTWHO-1985521140+
      Dem. Rep. of KoreaRepublic of Korea (1995)
      • Park Y.
      • Lee H.
      • Koh C.
      • Min H.
      • Yoo K.
      • Kim Y.
      • et al.
      Prevalence of diabetes and IGT in Yonchon County, South Korea.
      OGTTWHO-1985252030+
      Republic of KoreaRepublic of Korea (2006)
      • Kim S.M.
      • Lee J.S.
      • Lee J.
      • Na J.K.
      • Han J.H.
      • Yoon D.K.
      • et al.
      Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001.
      FBGADA-1997584421+
      MalaysiaMalaysia (2006)

      Institute for Public Health, Ministry of Health Malaysia, Diabetes Mellitus, 2006.

      FBGADA-199734,53918+
      MyanmarVietnam (2006)

      Ministry of Health, Vietnam, Follow-up study on diabetic complications in patients since their first presentation at National Hospital of Endocrinology, TaVan Binh (Ed.), Ha Noi, 2006.

      FBGWHO-1999905730–64
      NepalNepal (2003; 2000; 2006)
      • Singh D.L.
      • Bhattarai M.D.
      High prevalence of diabetes and impaired fasting glycaemia in urban Nepal.
      ,
      • Karki P.
      • Baral N.
      • Lamsal M.
      • Rijal S.
      • Koner B.C.
      • Dhungel S.
      • et al.
      Prevalence of non-insulin dependent diabetes mellitus in urban areas of eastern Nepal: a hospital based study.
      ,
      • Shrestha U.K.
      • Singh D.L.
      • Bhattarai M.D.
      The prevalence of hypertension and diabetes defined by fasting and 2-h plasma glucose criteria in urban Nepal.
      OGTT, FBGWHO-1999, 1985469320+
      PhilippinesPhilippines (2004)
      • Baltazar J.C.
      • Ancheta C.A.
      • Aban I.B.
      • Fernando R.E.
      • Baquilod M.M.
      Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines.
      OGTTWHO-1999704420–65
      Sri LankaSri Lanka (2008)
      • Katulanda P.
      • Constantine G.R.
      • Mahesh J.G.
      • Sheriff R.
      • Seneviratne R.D.
      • Wijeratne S.
      • et al.
      Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka—Sri Lanka Diabetes, Cardiovascular Study (SLDCS).
      OGTTWHO-1999453218+
      TaiwanTaiwan (1992, 1994)
      • Chou P.
      • Chen H.
      • Hsiao K.
      Community-based epidemiological study on diabetes in Pu-Li, Taiwan.
      ,
      • Chou P.
      • Liao M.
      • Kuo H.
      • Hsiao K.
      • Tsai S.
      A population survey on the prevalence of diabetes in Kin-Hu, Kinmen.
      OGTTWHO-1985428730–79
      ThailandThailand (2003)
      • Aekplakorn W.
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      • Neal B.
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      • Cheepudomwit S.
      • et al.
      The prevalence and management of diabetes in Thai adults: the international collaborative study of cardiovascular disease in Asia.
      FBGADA-1997535035+
      Viet NamVietnam (2006)

      Ministry of Health, Vietnam, Follow-up study on diabetic complications in patients since their first presentation at National Hospital of Endocrinology, TaVan Binh (Ed.), Ha Noi, 2006.

      FBGWHO-1999905730–64
      Europe/North America/Oceania
      AustraliaAustralia (2002)
      • Dunstan D.W.
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      The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study.
      OGTTWHO-199911,24725+
      AustraliaAustralia (2009)

      National Diabetes Service Scheme, Diabetes Australia, 2009 [cited 2009, 14/1/2009]. Available from: http://www.ndss.com.au/Australian-Diabetes-Map/Map/.

      SRKnown diabetesNAAll ages
      BelarusPoland (2001)
      • Szurkowska M.
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      Prevalence of type II diabetes mellitus in population of Krakow.
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      • Matej A.
      • et al.
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      OGTTWHO-1985684235+
      BelgiumThe Netherlands (1995)
      • Ubink-Veltmaat L.J.
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      • Meyboom-deJong B.
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      OGTTWHO-1985254050–74
      CanadaCanada (2007; 2008)
      • Lipscombe L.L.
      • Hux J.E.
      Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study.
      ,

      Public Health Agency of Canada, Report from the National Diabetes Surveillance System: diabetes in Canada, 2008 [cited 2009, 1/2/2009].

      RegistryKnown diabetesNA20+
      Czech RepublicSlovakia
      • Mokan M.
      • Galajda P.
      • Pridavkova D.
      • Tomaskova V.
      • Sutarik L.
      • Krucinska L.
      • et al.
      Prevalence of diabetes mellitus and metabolic syndrome in Slovakia.
      OGTTWHO-1999151718+
      FranceFrance (2008)
      • Kusnik-Joinville O.
      • Weill A.
      • Salanave B.
      • Ricordeau P.
      • Allemand H.
      Prevalence and treatment of diabetes in France: trends between 2000 and 2005.
      Treated diabetesNAAll ages
      FranceFrance (2001)
      • Gourdy P.
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      • Ducimetiere P.
      • Amouyel P.
      • Arveiler D.
      • et al.
      Prevalence of type 2 diabetes and impaired fasting glucose in the middle-aged population of three French regions—the MONICA study 1995–97.
      SR and FBGKnown diabetes, ADA 1997350835–64
      GermanyGermany (2003)
      • Rathmann W.
      • Haastert B.
      • Icks A.
      • Lowel H.
      • Meisinger C.
      • Holle R.
      • et al.
      High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000.
      OGTTWHO-1999135355–74
      GermanyGermany (2007)
      • Hauner H.
      • Koster I.
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      Prevalence of diabetes mellitus and quality of care in Hesse, Germany, 1998–2004.
      SRKnown diabetes310,000All ages
      GermanyGermany (2008)
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      FBGWHO-199935,86918+
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      The epidemiology of type 2 diabetes mellitus in Greek adults: the ATTICA study.
      FBGADA-1997303220+
      HungarySlovakia
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      SRKnown diabetes432,74715+
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      Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1).
      SRKnown diabetes155,57420+
      PolandPoland (2001)
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      The prevalence of type II diabetes mellitus in rural urban population over 35 years of age in Lublin region (Eastern Poland).
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      L. Gardete-Correia, J. Boavida, J. Raposo, S. Massano-Cardoso, C. Mesquita, C. Fona, et al., Diabetes Prevalence Study in Portugal. National Diabetes Program (unpublished data, personal communication) (2009).
      OGTTWHO-1999514720–80
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      Prevalence of diabetes mellitus in Croatia.
      FBGWHO-1999165318–65
      RussiaPoland (2001)
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      Prevalence of type II diabetes mellitus in population of Krakow.
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      FBGWHO-1999165318–65
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      Incidence, prevalence and coronary heart disease risk level in known type 2 diabetes: a sentinel practice network study in the Basque Country, Spain.
      SRKnown diabetes65,65124+
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      No increase in the prevalence of known diabetes between 1986 and 1999 in subjects 25–64 years of age in northern Sweden.
      OGTTWHO-1999695225–74
      UkrainePoland (2001)
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      Prevalence of type II diabetes mellitus in population of Krakow.
      ,
      • Lopatynski J.
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      OGTTWHO-1985684235+
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      ,
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      OGTTWHO-1985252925–75
      United States of AmericaUSA (2009)
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      OGTTWHO-198525,37130–69
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      2hBGWHO-198567030–79
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      OGTTWHO-1980130325–74
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      • Barcelo A.
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      2hBGWHO-1985294825+
      GuatemalaNicaragua (2007)
      Organizacion Panamericana de Salud (E. Medina, personal communciation), Prevalence of diabetes in Nicaragua. Managua, 2007.
      N/AN/A199320+
      MexicoMexico (2003; 2005)
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      OGTT/FBGADA-199784,05420+
      PeruBolivia (2006)
      • Barcelo A.
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      Diabetes in Bolivia.
      2hBGWHO-1985294825+
      VenezuelaBrazil (1996; 1992; 2003)
      • Oliveira J.
      • Milech A.
      • Franco L.
      Prevalence TBCGotSoD
      The prevalence of diabetes in Rio de Janeiro, Brazil.
      ,
      • Malerbi D.
      • Franco L.
      Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69 yr.
      ,
      • Torquato M.T.
      • Montenegro Junior R.M.
      • Viana L.A.
      • de Souza R.A.
      • Lanna C.M.
      • Lucas J.C.
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      Prevalence of diabetes mellitus and impaired glucose tolerance in the urban population aged 30–69 years in Ribeirao Preto (Sao Paulo), Brazil.
      OGTTWHO-198525,37130–69
      Middle-East Crescent
      AfghanistanPakistan (1995, 1999, 1999, 2002)
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      Pakistan National Diabetes Survey prevalence of glucose intolerance and associated factors in North West Frontier Province (NWFP) of Pakistan.
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      Prevalence of diabetes, impaired fasting glucose and associated risk factors in a rural area of Baluchistan province according to new ADA criteria.
      OGTTWHO-1985644125+
      AlgeriaAlgeria (2001)
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      OGTTWHO-1985145730–64
      EgyptEgypt (1995 and 1997)
      • Herman W.
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      OGTT/post prandial GTWHO-1985525120+
      IranIran (2003)
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      Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study.
      OGTTWHO-199910,36820+
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      Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors.
      OGTTWHO-1985277625–79
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      2hBGWHO-1994, 1999286535+
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      Prevalence of the main cardiovascular risk factors in Morocco: results of a National Survey, 2000.
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      Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in Baluchistan province.
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      • Rafique G.
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      • Khan I.A.
      • King H.
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      Pakistan National Diabetes Survey prevalence of glucose intolerance and associated factors in North West Frontier Province (NWFP) of Pakistan.
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      • Ahmed K.
      • Hakeem R.
      Prevalence of diabetes, impaired fasting glucose and associated risk factors in a rural area of Baluchistan province according to new ADA criteria.
      OGTT, FBGWHO-1985, ADA-1997544125+
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      ,
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      A population-based study of the prevalence of diabetes and impaired glucose tolerance in adults in Northern Sudan.
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      Glucose intolerance and associated factors in the Fergana Valley, Uzbekistan.
      ,
      • King H.
      • Djumaeva S.
      • Abdullaev B.
      • Gacic Dobo M.
      Epidemiology of glucose intolerance and associated factors in Uzbekistan: a survey in Sirdaria province.
      2hBGWHO-1994, 1999286535+
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      Type II diabetes mellitus and impaired glucose tolerance in Yemen: prevalence, associated metabolic changes and risk factors.
      OGTTWHO-199949820–69
      OGTT, oral glucose tolerance test; FBG, fasting blood glucose; 2hBG, 2-h blood glucose; SR, self-report; NA, not available.
      a J. Mbanya, personal communication (2006).
      b L. Gardete-Correia, J. Boavida, J. Raposo, S. Massano-Cardoso, C. Mesquita, C. Fona, et al., Diabetes Prevalence Study in Portugal. National Diabetes Program (unpublished data, personal communication) (2009).
      c S. Wild, personal communication, on behalf of the Scottish Diabetes Research Network, Diabetes prevalence estimates for Scotland (2009).
      d Organizacion Panamericana de Salud (E. Medina, personal communciation), Prevalence of diabetes in Nicaragua. Managua, 2007.
      Table 2Prevalence of diabetes and estimated diabetes numbers among adults aged 20–79 years for the years 2010 and 2030: 80 most populous countries.
      CountryPrevalence (%) adjusted toNumbers of adults with diabetes (000s)Mean annual increment (000s)
      World populationNational population20102030
      2010203020102030
      Africa: Sub-Sahara
      Angola3.54.72.83.522450614
      Burkina Faso3.84.63.03.520947013
      Cameroon3.94.84.44.841574516
      Cote d’Ivoire4.75.54.04.439471316
      Dem. Rep. of Congo3.24.42.63.27431,76051
      Ethiopia2.53.52.02.88262,03160
      Ghana4.35.23.64.345889622
      Kenya3.54.72.83.75191,23136
      Madagascar3.24.42.73.527064018
      Malawi2.33.31.82.31152668
      Mozambique4.05.13.33.732958513
      Niger3.94.73.43.722449914
      Nigeria4.75.53.94.32,8195,316125
      Senegal4.75.64.04.525650312
      South Africa4.55.64.54.91,2831,64418
      Uganda2.23.11.72.222461720
      UR Tanzania3.24.32.63.35041,15533
      Zimbabwe4.15.33.44.02353898
      Asia
      Bangladesh6.67.96.17.45,68110,423237
      Cambodia5.26.54.35.635472419
      China4.25.04.55.843,15762,553970
      Dem. Rep. of Korea5.36.25.76.89431,25616
      India7.89.37.18.650,76887,0361813
      Indonesia4.85.94.66.06,96411,980251
      Japan5.05.97.38.07,0896,879−11
      Malaysia11.613.810.913.41,8463,24570
      Myanmar3.24.32.84.39221,75542
      Nepal3.95.23.34.25111,07028
      Philippines7.78.96.77.83,3986,164138
      Republic of Korea7.99.09.011.43,2924,32352
      Sri Lanka10.913.511.514.91,5292,15831
      Taiwan7.58.55.76.88161,23221
      Thailand7.18.47.79.83,5384,95671
      Viet Nam3.54.42.94.41,6473,41588
      Europe/North America/Oceania
      Australia5.76.87.28.41,0861,50321
      Belarus7.69.09.111.16617253
      Belgium5.36.78.09.66107507
      Canada9.210.911.613.92,8663,98156
      Czech Republic6.47.88.710.76777936
      France6.78.39.411.04,1645,20152
      Germany8.910.212.013.57,4948,01426
      Greece6.07.48.810.37548756
      Hungary6.47.88.810.36597273
      Italy5.97.28.810.43,9264,48328
      Netherlands5.36.77.79.59221,17813
      Poland7.69.09.311.62,6753,15324
      Portugal9.611.212.214.497811438
      Romania6.98.08.410.01,3511,4696
      Russian Federation7.69.09.010.99,62510,33035
      Serbia6.98.08.69.56136874
      Spain6.68.08.711.12,9393,86646
      Sweden5.26.27.38.04845564
      Ukraine7.69.09.611.33,3283,3491
      United Kingdom3.64.34.95.42,1402,54920
      USA10.312.012.314.026,81435,958457
      Latin America/Caribbean
      Argentina5.76.56.06.61,5582,15830
      Brazil6.47.76.07.87,63312,708254
      Chile5.76.56.17.26991,00615
      Colombia5.26.24.86.31,4272,50654
      Cuba9.510.911.013.59031,14312
      Ecuador5.97.15.56.844375315
      Guatemala8.610.66.98.046598326
      Mexico10.812.910.113.36,82711,910254
      Peru6.27.35.67.09621,66635
      Venezuela6.57.85.97.41,0341,84040
      Middle-East Crescent
      Afghanistan8.69.96.67.08561,72643
      Algeria8.59.47.49.31,6322,85061
      Egypt11.413.710.412.84,7878,615191
      Iran (Islamic Rep. of)8.09.86.19.32,8725,981155
      Iraq10.212.07.89.31,1762,60571
      Kazakhstan5.87.05.67.158484313
      Morocco8.39.87.69.71,5132,58954
      Pakistan9.110.57.69.37,14613,833334
      Saudi Arabia16.818.913.617.02,0654,183106
      Sudan4.25.23.34.06751,36735
      Syrian Arab Republic10.813.28.311.09742,09956
      Tunisia9.311.08.511.76021,05222
      Turkey8.09.47.49.63,6796,323132
      Uzbekistan5.26.64.05.86741,40737
      Yemen3.03.52.52.927062218
      The highest regional prevalence (Table 3) for 2010 (after age-standardization to the world population) was for North America, followed by the EMME and South Asia. The African region is expected to have the largest proportional increase in adult diabetes numbers by 2030, followed by the EMME, though North America will continue to have the world's highest prevalence. Every region will have an increase in numbers well in excess of adult population growth, and total numbers with diabetes are likely to increase by 50% over the 20 years.
      Table 3Prevalence
      Prevalences for each region are standardized to world age distribution of that year.
      of diabetes and estimated diabetes numbers by region among adults aged 20–79 years for the years 2010 and 2030.
      201020302010/2030
      Total adult population (000s)No. of adults with diabetes (000s)Diabetes prevalence (%)Total adult population (000s)No. of adults with diabetes (000s)Diabetes prevalence (%)Increase in the no. of adults with diabetes (%)
      Africa37912.13.865323.94.798.1
      EMME34426.69.353351.710.893.9
      Europe64655.46.965966.58.120.0
      N America32037.410.239053.212.142.4
      S & C America28718.06.638229.67.865.1
      S Asia83858.77.61200101.09.172.1
      W Pacific153176.74.71772112.85.747.0
      World4345284.86.45589438.77.754.1
      a Prevalences for each region are standardized to world age distribution of that year.
      Considering only the 91 countries in which prevalence studies have been undertaken, 5 of the 10 world's highest national prevalences occur in the Middle-East (Table 4), although only Saudi Arabia (18.7%) is among the 80 most populous. The Gulf States have prevalences similar to that of Saudi Arabia, and 20 of the EMME Region's 22 countries have prevalences above the world 2010 prevalence of 6.4%.
      Table 4Top 10 countries for diabetes prevalence in 2010 and 2030.
      20102030
      CountryPrevalence (%)CountryPrevalence (%)
      1Nauru30.9Nauru33.4
      2United Arab Emirates18.7United Arab Emirates21.4
      3Saudi Arabia16.8Mauritius19.8
      4Mauritius16.2Saudi Arabia18.9
      5Bahrain15.4Reunion18.1
      6Reunion15.3Bahrain17.3
      7Kuwait14.6Kuwait16.9
      8Oman13.4Tonga15.7
      9Tonga13.4Oman14.9
      10Malaysia11.6Malaysia13.8
      Only includes countries where surveys with blood glucose testing were undertaken for that country.
      Table 5 shows the 10 countries with the largest numbers of people with diabetes. As might be expected, the countries with the largest populations have the highest number of persons with diabetes. Only Bangladesh and Nigeria of the world's 10 most populous countries are not among the 10 countries with the highest diabetes numbers (replaced by Germany and Mexico) for 2010.
      Table 5Top 10 countries for numbers of people aged 20–79 years with diabetes in 2010 and 2030.
      20102030
      CountryNo. of adults with diabetes (millions)CountryNo. of adults with diabetes (millions)
      1India50.8India87.0
      2China43.2China62.6
      3USA26.8USA36.0
      4Russian Federation9.6Pakistan13.8
      5Brazil7.6Brazil12.7
      6Germany7.5Indonesia12.0
      7Pakistan7.1Mexico11.9
      8Japan7.1Bangladesh10.4
      9Indonesia7.0Russian Federation10.3
      10Mexico6.8Egypt8.6
      There are marked differences between developed and developing countries. Fig. 1 shows current estimated numbers of people with diabetes by age-group for 2010 and 2030. For developing countries, adult diabetes numbers are likely to increase by 69% from 2010 to 2030, compared to 20% for developed countries, whereas total adult populations are expected to increase by 36% and 2% respectively. For the developing countries, increases in diabetes numbers are expected for each age-group, with a doubling for the over 60-year age-group. For developed countries, an increase (38%) is only expected amongst the over 60s, with slight decreases predicted for the younger age-groups. Currently, the greatest number of people worldwide with diabetes is in the 40–59 year-old age-group, but by 2030, there will be slightly more people with diabetes in the 60–79 year-old age-group.
      Figure thumbnail gr1
      Fig. 1Numbers of adults with diabetes in developed and developing countries in 2010 and 2030, according to age-group.
      The overall total predicted increase in numbers with diabetes from 2010 to 2030 is 54%, at an annual growth of 2.2%, which is nearly twice the annual growth of the total world adult population. Thirty-six percent of the anticipated absolute global increase of 154 million people with diabetes is projected to occur in India and China alone.

      4. Discussion

      These estimates suggest that in 2010 there will be 285 million people worldwide with diabetes, with considerable disparity between populations and regions. The pattern of diabetes varies considerably according to countries’ economic status. For developed countries, the majority with diabetes are aged over 60 years, whereas for developing countries most people with diabetes are of working age, between 40 and 60 years. This difference is likely to still be present in 2030, although less marked, as the average age of developing countries’ populations will increase slightly more than in the developed countries. Population growth, ageing of populations, and urbanization with associated lifestyle change is likely to lead to a 54% increase in worldwide numbers with diabetes by 2030.
      These projections are somewhat higher than predictions made only a few years ago [
      • Wild S.
      • Roglic G.
      • Green A.
      • Sicree R.
      • King H.
      Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
      ], with a greater discrepancy from those made in 1998 [
      • King H.
      • Aubert R.
      • Herman W.
      Global burden of diabetes, 1995–2025: prevalence, numerical estimates and projections.
      ]. The current estimate for 2010 of 285 million adults with diabetes is 67% higher than the 2004 published estimate for the year 2000 [
      • Wild S.
      • Roglic G.
      • Green A.
      • Sicree R.
      • King H.
      Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
      ], and our 2030 estimate of 439 million is 20% higher than the same study's estimate for 2030 [
      • Wild S.
      • Roglic G.
      • Green A.
      • Sicree R.
      • King H.
      Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
      ]. Comparisons with other older estimates show even greater differences. In 1998, King et al. [
      • King H.
      • Aubert R.
      • Herman W.
      Global burden of diabetes, 1995–2025: prevalence, numerical estimates and projections.
      ] estimated 300 million adults with diabetes for 2025. We used a different statistical technique to that used in the most recent WHO estimates [
      • Wild S.
      • Roglic G.
      • Green A.
      • Sicree R.
      • King H.
      Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
      ], but doubt that this is the cause for the increase in prevalence, as prevalences tended to be similar for those countries based on the same original studies, but differed when based on different reports (which applied for the majority of cases). We believe that the increases reported in the current estimates are likely to relate to the use of more recent studies, most of which reported higher prevalences than earlier studies; this was the case for a number of the largest countries, with newer reports showing higher prevalences for India [

      B. Shah, K. Anand, P. Joshi, J. Mahanta, V. Mohan, K. Thankappan, et al. Report of the surveillance of risk factors of non-communicable diseases (STEPS 1 and 2) from five centres in India—WHO India-ICMR initiative. New Delhi: http://www.whoindia.org/LinkFiles/NCD_Surveillance_NCD_RF_surveillance_report.pdf2004.

      ,
      • Sadikot S.M.
      • Nigam A.
      • Das S.
      • Bajaj S.
      • Zargar A.H.
      • Prasannakumar K.M.
      • et al.
      The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes in India study (PODIS).
      ,
      • Ramachandran A.
      • Snehalatha C.
      • Kapur A.
      • Vijay V.
      • Mohan V.
      • Das A.K.
      • et al.
      High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.
      ], China [
      • Gu D.
      • Reynolds K.
      • Duan X.
      • Xin X.
      • Chen J.
      • Wu X.
      • et al.
      Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA).
      ], and USA [
      • Cowie C.C.
      • Rust K.F.
      • Ford E.S.
      • Eberhardt M.S.
      • Byrd-Holt D.D.
      • Li C.
      • et al.
      Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006.
      ] than those used previously [
      • Ramachandran A.
      • Snehalatha C.
      • Latha E.
      • Manoharan M.
      • Vijay V.
      Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population.
      ,
      • Pan X.-R.
      • Yang W.-Y.
      • Li G.-W.
      • Lui J.
      The National Diabetes Prevention and Control Cooperative Group
      Prevalence of diabetes and its risk factors in China.
      ,
      • Cowie C.C.
      • Rust K.F.
      • Byrd-Holt D.D.
      • Eberhardt M.S.
      • Flegal K.M.
      • Engelgau M.M.
      • et al.
      Prevalence of diabetes and impaired fasting glucose in adults in the U.S. population: National Health and Nutrition Examination Survey 1999–2002.
      ].
      Thus, the likeliest explanation for the differences is that prevalence is genuinely increasing, as a consequence of increasing incidence (due to demographic changes such as ageing, and as the undesirable result of risk factors such as obesity and sedentary life becoming more common), and also a result of better health care improving longevity of people with diabetes.
      We have not addressed the issues of changing incidence, nor whether medical care will increase lifespan with diabetes. We have based our projections for 2030 on predicted demographic changes: urbanization and ageing. Urbanization in developing countries is associated with a more sedentary lifestyle tending to increase diabetes prevalence [
      • Ramachandran A.
      • Snehalatha C.
      • Latha E.
      • Manoharan M.
      • Vijay V.
      Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population.
      ], so to some extent is a proxy for lifestyle changes. The challenge is to minimize the detriments of urbanization, as the process is unlikely to be reversed. Specific lifestyle intervention programs have been shown to be efficacious [
      • Pan X.
      • Li G.
      • Hu Y.
      • Wang J.
      • Yang W.
      • An Z.
      • et al.
      Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study.
      ,
      • Ramachandran A.
      • Snehalatha C.
      • Mary S.
      • Mukesh B.
      • Bhaskar A.D.
      • Vijay V.
      The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).
      ] in reducing diabetes incidence. Apart from the impact of urbanization, we have not attempted to account for the effects of changes in risk factors (e.g. obesity), as accurately assessing the relationship between risk factors and diabetes is difficult across the diverse global population. Thus, if the prevalence of obesity and other risk factors continue to rise, it is likely that the estimates presented here will be lower than the actual figures.
      The principal issue of course is the accuracy of our estimates. The major limitations are paucity of data, which applies varyingly throughout the world, and the representativeness of studies chosen. Thus, only 37 out of the 133 studies were national studies, with only two of these (Iceland, Turkey [
      • Vilbergsson S.
      • Sigurdsson G.
      • Sigvaldason H.
      • Hreidarsson A.
      • Sigfusson N.
      Prevalence and incidence of NIDDM in Iceland: evidence for stable incidence among males and females 1967–1991—the Reykjavik Study.
      ,
      • Satman I.
      • Yilmaz T.
      • Sengul A.
      • Salman S.
      • Salman F.
      • Uygur S.
      • et al.
      Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP).
      ]) in Europe. Studies were only available from 5 out of 50 sub-Saharan African countries, and data from Poland were used for 7 Eastern European countries. There is a clear need for more studies on the prevalence of diabetes. We can have most confidence in results from regions where repeated surveys have shown similar patterns. This particularly applies to the Middle-East, and small Pacific Island states, where a number of surveys has quantified the problem.
      The worldwide pattern is dominated by large countries, and these data highlight the extent to which demographic changes in India, China and Brazil are likely to affect the total numbers with diabetes. Each of these countries has had relatively recent national surveys, so that the likelihood of unrepresentative data is reduced.
      In summary, these results serve as another piece of evidence that diabetes is continuing to be an increasing international health burden. The estimates here are higher than those previously made [
      • Wild S.
      • Roglic G.
      • Green A.
      • Sicree R.
      • King H.
      Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
      ], which supports the concern that they were conservative, and that the prevalence of diabetes continues to rise. Ageing and urbanization are increasingly adding to the burden of diabetes in developing countries, where resources for dealing with the associated clinical problems are most scarce.

      Conflict of interest

      There are no conflicts of interest.

      Acknowledgements

      The authors would like to thank the members of the IDF Diabetes Atlas Committee (JC Mbanya, D Gan, B Allgot, K Bakker, J Brown, A Ramachandran, M Silink, L Siminerio, G Soltesz, R Williams) for their advice in compiling these estimates. Funding was provided by the IDF.

      Appendix A. Supplementary data

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