Inadequate diabetic care: global figures cry for preventive measures and personalized treatment

Abstract

Diabetes mellitus (DM) is a lifelong progressive disease. Currently there are more than 285 million DM-affected people worldwide. Globally the prevalence of diabetes continues to rise and is more pronounced in countries with large populations such as China, India and USA. Driving forces behind the epidemic are obesity, aging of the population and longer life expency. Prospective, the majority of diabetic population will be in their six to eight decades of life with the implication of more females than males. Severe micro- and macrovascular complications associated with diabetes lead to a highly increased morbidity and mortality. Therefore, DM is projected to be one of the leading health problems of 21st centuary. Urgent measures are required to reduce the diabetic burden. Thus advanced predictive diagnostic tools and personalized treatment strategies in (pre)diabetic care are critical and should exert beneficial impact on public health.

Fig. 1

Global prevalence of diabetes mellitus (DM) for the years 1995–2030. Total DM-affected population is projected to rise from 285 million in 2010 to 439 million in 2030. Worldwide, a strong increase in diabetic burden is predicted, particularly starting from the year 2020 [, , –12]

Fig. 2

Top six countries with highest DM-affected population between 20–79 years of age in 2010 and 2030 [2]. India has the largest DM prevalence, with the growth rate percentage of 71.3%, followed by China (44.9%), USA (34.3%) and Russia (7.3%). For Germany and Japan the prevalence data for the year 2030 are currently not available

Fig. 3

Global DM prevalence in different age groups for the years 2010 and 2030 [2]. Current DM prevalence is likely to be largest among the age group of 40–59 years with 132 million people, followed by the age group of 60–79 years with 108 million. In 2030, an increase is expected in all age groups, with greatest number of people in the 60–79 years of life. Estimates indicate an increase of 88 million and 56 million for the age groups of 60–79 years and 40–59 years, respectively

Fig. 4

Global prevalence of diabetes in men and women aged between 20–79 years, estimated for the years 2003–2030 [2, 23, 24]. Currently, there are 6.6% people with diabetes mellitus worldwide; 143 million of them are women and 142 million are men. Prospectively, the prevalence of DM will continue to increase. For 2030, it is expected that there will be about 6 million more women than men with diabetes (222 million women versus 216 million men)

Fig. 5

a. Prevalence of type 2 DM micro- and macrovascular complications, in percentage, for Indian population during the year 2000. Among microvascular complications, nephropathy (32.5%) is the most frequent followed by neuropathy and retinopathy with 30.1% and 28.9%, respectively. Among macrovascular complications, cardiovascular complications are more common and hypertension is significantly associated with all complications [25]. b. Prevalence of type 2 DM complications, in percentage, for USA, from NHANES (National Health and Nutrition Examination Survey) for the years 1999–2004 [26]. Nephropathy is one of the major microvascular complications, with the prevalence of 25% followed by foot problems and eye damage. Heart disease are prevalent common among macrovascular complications

Fig. 6

Worldwide documented DM-associated mortality for the population aged between 20–79 years in contest of regional differences as updated for 2010 [23]. Diabetes accounted for over 1 in 20 deaths. Total percentage of diabetic mortality is very high particularly in North America (15.7%) and South-East Asia (14.3%), both regions with large populations

Fig. 7

Number of deaths (in thousands) attributable to diabetes by age groups and gender. Global mortality was lowest in the Eastern Mediteran and Africa regions, while the highest numbers were documented in South-East Asia and America. DM-associated deaths are particularly increased for the age group of 35–64 years, in regions where the prevalence of diabetes is very high in younger ages (South East Asia, America and Africa). In Europe, DM mortality tends to be more frequent in men than in women. On the other hand, for all other regions, the prevalence of DM mortality is higher in female population, mainly in the age group older than 64 years. Among the younger age group of 0–34 years, the numbers of deaths were high in South-East Asia (29.1 thousand men and 33.1 thousand women) and Africa (20 thousand men and 32.2 thousand women) [33]