The Dynamics of Diabetes Prevalence, Morbidity, and Mortality

Diabetes mellitus has caught the attention of the world as a major public health problem due to the explosive increases in prevalence that have occurred, affecting virtually all regions of the world, and within regions, affecting all age and demographic subgroups and across the full range of socioeconomic status [1–3]. The global prevalence is now estimated at around 420 million, affecting 9% of men and 8% of women, with lowest regional prevalence in Northeastern Europe (6%) and highest prevalence in Polynesia and Macronesia (25%) [1]. This growth has included both type 1 and type 2 diabetes, although between 90 and 95 percent of the cases and the predominant increase in prevalence has been driven by type 2 cases [4]. Dozens of individual-level genetic and environmental have been prospectively associated with type 2 diabetes, but the increases in prevalence in most societies have likely been driven by a smaller set of trends, including increasing prevalence of overweight and obesity, declining levels of physical activity, poor-quality carbohydrate in our diets, sugary drinks, increased fast food and portion sizes, aging and longer lifespan, and increasingly diverse socioeconomics [5, 6]. There is also increasing recognition of heterogeneity in diabetes types, even within the classic categories of type 2 and type 1 diabetes, that likely have different patterns of risk factors that may further vary by region and context [7].