[Epidemiology of type II diabetes, diagnosis, prevalence, risk factors, complications]

Abstract

The prevalence of type 2 diabetes varies from 1.1% in sub-Saharian Africa to 3.3% in developing countries and to 5.6% in the industrialised countries, which brings the number of diabetics in the world to 135 millions. The projections of the WHO suggest a 35% increase in the prevalence of diabetes. This increase is explained by a progressively more sedentary life style, the overabundant and attractive food sources, the increase in life expectancy leading to diabetogenic ageing and, more specifically for Europe, the baby-boom effect after the Second World War, and finally, the changes in diagnostic criteria (fasting glucose > or = 1.26 g/L (7 mM) on two occasions, serum glucose > or = 2 g/L 2 hours after a loading dose of 75 g of glucose, in terms of prevalence of diagnosis and the prediction of specific diabetic complications). Age, birth weight (over or underweight) and heredity are established non-modifiable risk factors, whereas it is possible to change high risk behaviour, overweight, the syndrome of insulin resistance and hyperglycaemia. The major role of hyperglycaemia in the specific microangiographic complications of diabetes which are aggravated by hypertension, has been established. Hyperglycaemia does not seem to be a major risk factor in macroangiographic complications, especially coronary artery disease, in contrast to smoking, hypertension and certain lipid or fibrinolytic abnormalities. Epidemiological analysis of diabetes shows its invalidating feature, especially in terms of fatal vascular risk, which may be attenuated by correction of all associated metabolic abnormalities. The progression of the incidence of diabetes should alert the physician to be more attentive in the diagnosis and management of diabetes, especially with regards to early dietary intervention.