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Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants

Zhou, B and Lu, Y and Hajifathalian, K and Bentham, J and Di Cesare, M and Danaei, G and Bixby, H and Cowan, MJ and Ali, MK and Taddei, C and Lo, W-C and Reis-Santos, B and Stevens, GA and Riley, LM and Miranda, JJ and Bjerregaard, P and Rivera, JA and Fouad, HM and Ma, G and Mbanya, JCN and McGarvey, ST and Mohan, V and Onat, A and Pilav, A and Ramachandran, A and Ben Romdhane, H and Paciorek, CJ and Bennett, JE and Ezzati, M and Abdeen, ZA and Kadir, KA and Abu-Rmeileh, NM and Acosta-Cazares, B and Adams, R and Aekplakorn, W and Aguilar-Salinas, CA and Agyemang, C and Ahmadvand, A and Al-Othman, AR and Alkerwi, A and Amouyel, P and Amuzu, A and Bo Andersen, L and Anderssen, SA and Anjana, RM and Aounallah-Skhiri, H and Aris, T and Arlappa, N and Arveiler, D and Assah, FK and Avdicová, M and Azizi, F and Balakrishna, N and Bandosz, P and Barbagallo, CM and Barceló, A and Batieha, AM and Baur, LA and Benet, M and Bernabe-Ortiz, A and Bharadwaj, S and Bhargava, SK and Bi, Y and Bjertness, E and Bjertness, MB and Björkelund, C and Blokstra, A and Bo, S and Boehm, BO and Boissonnet, CP and Bovet, P and Brajkovich, I and Breckenkamp, J and Brenner, H and Brewster, LM and Brian, GR and Bruno, G and Bugge, A and De León, AC and Can, G and C ndido, APC and Capuano, V and Carlsson, AC and Carvalho, MJ and Casanueva, FF and Casas, J-P and Caserta, CA and Castetbon, K and Chamukuttan, S and Chaturvedi, N and Chen, C-J and Chen, F and Chen, S and Cheng, C-Y and Chetrit, A and Chiou, S-T and Cho, Y and Chudek, J and Cifkova, R and Claessens, F and Concin, H and Cooper, C and Cooper, R and Costanzo, S and Cottel, D and Cowell, C and Crujeiras, AB and D Arrigo, G and Dallongeville, J and Dankner, R and Dauchet, L and De Gaetano, G and De Henauw, S and Deepa, M and Dehghan, A and Deschamps, V and Dhana, K and Di Castelnuovo, AF and Djalalinia, S and Doua, K and Drygas, W and Du, Y and Dzerve, V and Egbagbe, EE and Eggertsen, R and El Ati, J and Elosua, R and Erasmus, RT and Erem, C and Ergor, G and Eriksen, L and Escobedo-De La Pe na, J and Fall, CH and Farzadfar, F and Felix-Redondo, FJ and Ferguson, TS and Fernández-Bergés, D and Ferrari, M and Ferreccio, C and Feskens, EJM and Finn, JD and Föger, B and Foo, LH and Forslund, A-S and Francis, DK and Do Carmo Franco, M and Franco, OH and Frontera, G and Furusawa, T and Gaciong, Z and Garnett, SP and Gaspoz, J-M and Gasull, M and Gates, L and Geleijnse, JM and Ghasemian, A and Ghimire, A and Giampaoli, S and Gianfagna, F and Giovannelli, J and Giwercman, A and Gross, MG and Rivas, JPG and Gorbea, MB and Gottrand, F and Grafnetter, D and Grodzicki, T and Grøntved, A and Gruden, G and Gu, D and Guan, OP and Guerrero, R and Guessous, I and Guimaraes, AL and Gutierrez, L and Hambleton, IR and Hardy, R and Kumar, RH and Hata, J and He, J and Heidemann, C and Herrala, S and Hihtaniemi, IT and Ho, SY and Ho, SC and Hofman, A and Hormiga, CM and Horta, BL and Houti, L and Howitt, C and Htay, TT and Htet, AS and Htike, MMT and Hu, Y and Hussieni, AS and Huybrechts, I and Hwalla, N and Iacoviello, L and Iannone, AG and Ibrahim, MM and Ikeda, N and Ikram, MA and Irazola, VE and Islam, M and Iwasaki, M and Jacobs, JM and Jafar, T and Jamil, KM and Jasienska, G and Jiang, CQ and Jonas, JB and Joshi, P and Kafatos, A and Kalter-Leibovici, O and Kasaeian, A and Katz, J and Kaur, P and Kavousi, M and Keinänen-Kiukaanniemi, S and Kelishadi, R and Kengne, AP and Kersting, M and Khader, YS and Khalili, D and Khang, Y-H and Kiechl, S and Kim, J and Kolsteren, P and Korrovits, P and Kratzer, W and Kromhout, D and Kujala, UM and Kula, K and Kyobutungi, C and Laatikainen, T and Lachat, C and Laid, Y and Lam, TH and Landrove, O and Lanska, V and Lappas, G and Laxmaiah, A and Leclercq, C and Lee, J and Lee, J and Lehtimäki, T and Lekhraj, R and León-Mu noz, LM and Li, Y and Lim, W-Y and Lima-Costa, MF and Lin, H-H and Lin, X and Lissner, L and Lorbeer, R and Lozano, JE and Luksiene, D and Lundqvist, A and Lytsy, P and Machado-Coelho, GLL and Machi, S and Maggi, S and Magliano, DJ and Makdisse, M and Rao, KM and Manios, Y and Manzato, E and Margozzini, P and Marques-Vidal, P and Martorell, R and Masoodi, SR and Mathiesen, EB and Matsha, TE and McFarlane, SR and McLachlan, S and McNulty, BA and Mediene-Benchekor, S and Meirhaeghe, A and Menezes, AMB and Merat, S and Meshram, II and Mi, J and Miquel, JF and Mohamed, MK and Mohammad, K and Mohammadifard, N and Mohd Yusoff, MF and M ller, NC and Molnár, D and Mondo, CK and Morejon, A and Moreno, LA and Morgan, K and Moschonis, G and Mossakowska, M and Mostafa, A and Mota, J and Motta, J and Mu, TT and Muiesan, ML and Müller-Nurasyid, M and Mursu, J and Nagel, G and Náme ná, J and Nang, EEK and Nangia, VB and Navarrete-Mu noz, EM and Ndiaye, NC and Nenko, I and Nervi, F and Nguyen, ND and Nguyen, QN and Nieto-Martínez, RE and Ning, G and Ninomiya, T and Noale, M and Noto, D and Al Nsour, M and Ochoa-Avilés, AM and Oh, K and Ordunez, P and Osmond, C and Otero, JA and Owusu-Dabo, E and Pahomova, E and Palmieri, L and Panda-Jonas, S and Panza, F and Parsaeian, M and Peixoto, SV and Peltonen, M and Peters, A and Peykari, N and Pham, ST and Pitakaka, F and Piwonska, A and Piwonski, J and Plans-Rubió, P and Porta, M and Portegies, MLP and Poustchi, H and Pradeepa, R and Price, JF and Punab, M and Qasrawi, RF and Qorbani, M and Radisauskas, R and Rahman, M and Raitakari, O and Rao, SR and Ramke, J and Ramos, R and Rampal, S and Rathmann, W and Redon, J and Reganit, PFM and Rigo, F and Robinson, SM and Robitaille, C and Rodríguez-Artalejo, F and Del CristoRodriguez-Perez, M and Rodríguez-Villamizar, LA and Rojas-Martinez, R and Ronkainen, K and Rosengren, A and Rubinstein, A and Rui, O and Ruiz-Betancourt, BS (2016) Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. The Lancet, 387 (10027). pp. 1513-1530. ISSN 0140-6736


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Background One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. Methods We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries.

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