Mar 2, 2020 — Heather Ward, Sarah Wild, Xilin Yang, Lili Yuen, Ping Zhang Note: The American Diabetes Association (ADA)2 recommends diagnosing
176 pages
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Table of contents Acknowledgements 1Forewords 2Summary 4Introduction 6Chapter 1 What is diabetes? 10Type 1 diabetes 13Type 2 diabetes 14Impaired glucose tolerance and impaired fasting glucose 15Diagnostic criteria for diabetes 15Hyperglycaemia in pregnancy 15Other types of diabetes 17Chapter 2 Methods 22Gathering and selecting data sources 24Estimating diabetes prevalence and projections for the future 25Extrapolating data 26Estimating con˜dence intervals 26Age-adjusted comparative estimates 26Estimating undiagnosed diabetes 26Estimating the incidence and prevalence of type 1 diabetes in children and adolescents 27Estimating the prevalence of impaired glucose tolerance 28Estimating the prevalence of hyperglycaemia in pregnancy 29Estimating diabetes-related mortality 30Estimating the economic impact of diabetes 30Chapter 3 Global picture 32Diabetes prevalence in 2019 and projections to 2030 and 2045 (20Œ79 years) 36Diabetes prevalence in 2019 and projections to 2030 and 2045 (65Œ99 years) 40Undiagnosed diabetes 43Diabetes incidence 45Diabetes incidence and prevalence in children and adolescents 46Impaired glucose tolerance 50Hyperglycaemia in pregnancy 53Diabetes-related mortality 54Economic impact of diabetes 56
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Chapter 4 Diabetes by Region 62AFRICA 64EUROPE 66MIDDLE EAST AND NORTH AFRICA 68NORTH AMERICA AND CARIBBEAN 70SOUTH AND CENTRAL AMERICA 72SOUTH-EAST ASIA 74WESTERN PACIFIC 76Chapter 5 Diabetes complications and co-morbidities 78Acute complications 80Diabetes and cardiovascular diseases 82Diabetic eye disease 84Diabetic kidney disease 86Nerve and/or vascular damage and diabetic foot complications 88Diabetes-related complications of pregnancy 90Complications in children Œ type 1 and type 2 diabetes 92The economic impact of complications 93Co-morbidities 94Chapter 6 Action on diabetes 106Preventing diabetes: prospects for the prevention or delay of type 1 and type 2 diabetes 108Delivering diabetes care Œusing data to drive action 114Universal health coverage and diabetes: addressing the double challenge of increasing prevalence and economic impact 118Insulin: one hundred years of saving lives but, a century later, barriers to access remain 122Appendices 134Country summary table 136Abbreviations and acronyms 156Glossary 158Lists of ˜gures, maps and tables 164
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© International Diabetes Federation, 2019 No part of this publication may be reproduced, translated or transmitted in any form or by any means without the prior written permission of the International Diabetes Federation. The copyright permission form is available at: https://www.idf.org/e-library/welcome/copyright-permission.html Online version of IDF Diabetes Atlas: www.diabetesatlas.org ˝˘˝ ˆ˛ˇ˘˚ ˜ ˜€ ˜˝˛ƒ˝ ˜š Fifth edition ˜˚˛˝˜˚˛˝˙ˆ˙ˇ ˜˚˛˝ ˜˚˛˝˙ˆ˙ˇ ˝‹ Fifth edition 21991_diabAtlas_5thEd_cover.indd 1 21991_diabAtlas_5thEd_cover.indd 16/10/11 14:16 6/10/11 14:16˜˚˛˝ ˝˜˚˛˝˙ˆ˙ˇ˘ ˘˙ˆˇ˙˘ Seventh Edition 2015˜˚˛˝˜˚˛˝˙ˆ˙ˇ˘˛ ˜˚˛˝˙˝ˆˇ˘˚˙˚ ˝˙ˆˇ˘INTERNATIONAL DIABETES FEDERATION The mission of the International Diabetes Federation is to work with our member associations to enhance the livesof people with diabetes. Diabetes Atlas 2000DIABETES DIABETES ATLASATLAS ATLAS DIABETES ATLAS Unless indicated otherwise all photographs in this edition of the IDF Diabetes Atlas were taken by the following Panos Pictures photographers: Andrew Esiebo, Jordi Ruiz Cirera, Ore Huying, Atul Loke, Dieter Telemans, Mary Turner and Mansoor Shaikh. Other photo credits: amenic181/envatoelements ( page 81 ); Aurélia Rusek/UNDP ( page 90).Technical editing and design by Inís Communication: www.iniscommunication.com ISBN: 978-2-930229-87-4 The boundaries and names shown and the designations used in this report do not imply the expression of any opinion whatsoever on the part of the International Diabetes Federation concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. First edition, 2000 Second edition, 2003 Third edition, 2006 Fourth edition, 2009 Fifth edition, 2011 Sixth edition, 2013 Seventh edition, 2015 Eighth edition, 2017
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2Forewords The IDF Diabetes Atlas has been our flagship publication since it was first published almost 20 years ago. Over that time, it has become a trusted source of evidence on the impact of diabetes worldwide and the publication of each edition is eagerly anticipated. Since that first edition in 2000, the estimated prevalence of diabetes (type 1 and type 2 combined, both diagnosed and undiagnosed) in people aged 20Œ79 years has risen from 151 million (4.6% of the global population at the time) to 463 million (9.3%) today. Without su˜icient action to address the pandemic, we predict 578 million people (10.2% of the population) will have diabetes by 2030. That number will jump to a staggering 700 million (10.9%) by 2045. Diabetes is a serious threat to global health that respects neither socioeconomic status nor national boundaries. People living with diabetes are at risk of developing a number of serious and life-threatening complications, leading to an increased need for medical care, a reduced quality of life, and undue stress on families. Diabetes and its complications, if not well managed, can lead to frequent hospital admissions and premature death. Globally, diabetes is among the top 10 causes of death. Despite the stark truth the data represent, there is a positive message: with early diagnosis and access to appropriate care, diabetes can be managed and its complications prevented. Furthermore, type 2 diabetes can often be prevented and there is compelling evidence to suggest it can be reversed in some cases. In recent years, the World Health Organization (WHO) and the United Nations (UN) have set global targets to encourage action to improve care and strengthen healthcare systems. These actions include reducing premature death from non-communicable diseases (NCDs), including diabetes, by 30% by 2030, establishing national diabetes plans and achieving universal health coverage (UHC) by 2030. These are important steps towards guaranteeing access to a˜ordable high- quality care and alleviating financial catastrophe for the close to 580 million who will then be living with diabetes. However, many countries still lack a national diabetes plan, and at least half the world™s population does not have full coverage for essential health services. Most countries are also falling short of the WHO 2025 target of halting the rise of type 2 diabetes. Urgent national actions are required to improve type 2 diabetes prevention and the management of all types of diabetes. Governments will need to adopt a health-in-all-policies approach to secure the best possible care and quality of life for people living with diabetes. In this edition of the IDF Diabetes Atlas , diabetes estimates are based on information from 255 data sources from 138 countries. The data are robust and with each edition our estimates become more precise. However, there is still a significant number of countries for which high-quality data sources on diabetes prevalence are not available. Epidemiological studies and reports based on solid evidence are necessary to present the true impact of diabetes and to help establish targets for national and global health. We highly recommend, in addition to focussing on prevention and improving care, that advocacy strategies seek to mobilise resources for further epidemiological research. We sincerely hope this latest edition of the IDF Diabetes Atlas will support IDF Member Associations and other key diabetes stakeholders to advocate more action to identify undiagnosed diabetes, to take further steps to prevent diabetes in those at risk, and to improve care for people with diabetes. It is our desire that the data published herein will help stimulate governments and the private sector to take action. Professor Nam H. Cho President 2017Œ2019, International Diabetes Federation
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3Since its first edition, the IDF Diabetes Atlas has been among the most quoted sources of information on the impact of diabetes and related conditions. The use of the IDF Diabetes Atlas information can be gauged by, for example, the 102,000 downloads of the English version that were made between release of the 8 th edition in November 2017 and June 2019. The IDF Diabetes Atlas is, however, not the only source of estimates of prevalence and other vital statistics on the impact of diabetes. Others have used di˜erent sources and made di˜erent assumptions. Unsurprisingly, these sometimes di˜er in the detail of their conclusions. Nevertheless, the consistent overall picture is one of a globally significant intrusion into the health and wealth of individuals, families and nations Œ an intrusion that, with a few notable exceptions, is increasing. The challenges of estimating the global impact of diabetes are considerable and relate to two main issues: available data are not homogenous nor are they comprehensive. Data heterogeneity results from many factors. For example, various diagnostic tests are employed for the diagnosis of diabetes and the diagnostic criteria used may be based on those of WHO or of the American Diabetes Association (ADA). These are closely aligned but there are di˜erences. Other areas of potential heterogeneity are the sampling frames used, the responses achieved, the age groups invited, etc., the list goes on. The lack of comprehensive global data is epitomised by the fact that, in the 8 th edition of the IDF Diabetes Atlas , only 131 out of 221 countries (59%) had quality data derived from in-country studies. Estimates for the remaining 90 were extrapolated from countries deemed to be similar in key respects Œ an essential compromise for global coverage. The improved situation for the 9 th edition is that 138 out of 211 countries (65%) had quality data and the rest (73) were extrapolated. Making projections into the future is even more perilous than making estimates for the present. In making such predictions many factors can be taken into account: predicted trends in overweight and obesity, for example. In this IDF Diabetes Atlas edition, we have taken the view that the fewer uncertainties we factor into projections the more likely they are to be accurate. The parameters we have included in our predictions are the same as those used in the previous edition. Reassuringly, experience has shown that past attempts to project the future of diabetes have been conservative rather than excessive. That is the way it should be: we are being realistic and not scaremongering. An immense amount of thought and hard work has gone into this edition and I am grateful to my colleagues in the Editorial Team and members of the IDF Diabetes Atlas Committee for this. This IDF Diabetes Atlas is o˜ered for careful and considered use in the support of continued and enhanced action to improve the lives of people with diabetes and those at risk of developing the condition. Professor Rhys Williams Chair, IDF Diabetes Atlas Committee (9 th edition) Forewords
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Colour palette // Regions Colour palette // 6 colour way 3 colour way // Tables in Appendices Brand Colours 51% increaseWORLD2045700 million2030578 million2019463 millionNorth America & Caribbean63 million204556 million203048 million201933% increaseSouth & Central America 49 million40 million32 million20452030201955% increaseAfrica143% increase47 million29 million20452030201919 million4Summary Diabetes is a major health issue that has reached alarming levels: today, nearly half a billion people are living with diabetes worldwide. The IDF Diabetes Atlas is an authoritative source of evidence on the prevalence of diabetes, related mortality and diabetes-related health expenditure at global, regional and national levels. The IDF Diabetes Atlas also serves as a reminder to readers of the classification of diabetes and its diagnostic criteria. It presents the global picture of diabetes, including estimates for each of the seven IDF Regions, the impact of diabetes complications based on the current literature and, finally, provides information on specific actions that can be taken on diabetes such as prevention of type 2 diabetes and close management of all forms of diabetes to avoid subsequent complications. The credibility of diabetes estimates relies on the rigorous methods used for the selection and analysis of high-quality data sources. Every two years, the IDF Diabetes Atlas Committee Πcomposed of thematic experts from each of the seven IDF Regions Πreviews the methods underlying the IDF Diabetes Atlas estimates and projections, and available data sources. The methods have been explained in detail by Guariguata et al,1 and more recently, by Saeedi et al. 2 The majority of the data sources used are population-based studies that have been published in peer-reviewed periodicals. Furthermore, information from national health surveys, including some of the World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) are used where they meet inclusion criteria. Findings of the current 9 th edition confirm that diabetes is one of the fastest growing global health emergencies of the 21 st century ( see Map 1 ). In 2019, it is estimated that 463 million people have diabetes and this number is projected to reach 578 million by 2030, and 700 million by 2045. Two-thirds of people with diabetes live in urban areas and three
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Colour palette // Regions Colour palette // 6 colour way 3 colour way // Tables in Appendices Brand Colours Number of people with diabetes worldwide and per IDF Region in 2019, 2030 and 2045 (20Œ79 years)143% increaseMiddle East & North Africa 204520302019108 million76 million55 million96% increase212 million2045197 million2030163 million2019Western Paci˜c 31% increase153 million115 million88 million204520302019South-East Asia 74% increaseMap 1 Europe 68 million204566 million203059 million201915% increase5out of four are of working age. Over four million people aged 20Œ79 years are estimated to die from diabetes-related causes in 2019. The number of children and adolescents (i.e. up to 19 years old) living with diabetes increases annually. In 2019, over one million children and adolescents have type 1 diabetes. An estimated 136 million people over 65 years old have diabetes, and the prevalence of diabetes in this age group varies significantly between IDF Regions. This IDF Diabetes Atlas edition also shows that hyperglycaemia in pregnancy (HIP) affects approximately one in six pregnancies. Another cause for alarm is the consistently high percentage of people with undiagnosed diabetes (overwhelmingly type 2 diabetes), which is currently over 50%. This reveals the urgent need to diagnose the undiagnosed people with diabetes and provide appropriate and timely care for all people with diabetes as early as possible. The chapter on complications of diabetes is based on up-to-date literature and includes descriptions of diabetes-related complications and co-morbidities. This edition of the IDF Diabetes Atlas also emphasises actions that can be taken at various levels Œ such as ensuring evidence is used to enhance diabetes management, highlighting the important linkages between diabetes and universal health coverage (UHC), and improving access to insulin Œ with a view to strengthening the global fight to reduce the impact of diabetes for individuals, their families and society. References 1. Guariguata L, Whiting D, Weil C, Unwin N. The International Diabetes Federation Diabetes Atlas methodology for estimating global and national prevalence of diabetes in adults. Diabetes Res Clin Pract. 2011 Dec;94(3):322Œ32; DOI:10.1016/j.diabres.2011.10.040. 2. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract; DOI:10.1016/j. diabres.2019.107843. Summary
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