DIABETES ATLAS SecondSecond edition The mission of the International Diabetes Federation is to work with our member associations to enhance the lives of people with diabetes. Diabetes Atlas committee Bjørnar Allgot (co-chair) Delice Gan (co-chair) Hilary King Pierre Lefèbvre Jean-Claude Mbanya Martin Silink Linda Siminerio Rhys Williams Paul Zimmet Editor and project manager: Delice Gan Project coordinator: Catherine Regniers Diabetes Atlas, second edition, and other IDF publications are available from: International Diabetes Federation Executive Office 19 Avenue Emile de Mot B-1000 Brussels Belgium Tel +32-2-5385511 Fax +32-2-5385114 [email protected] www.idf.org Electronic version of Diabetes Atlas: www.idf.org/e-atlas © International Diabetes Federation, 2003 No part of this publication may be reproduced or transmitted in any form or by any means without the prior written permission of the International Diabetes Federation. First published, 2000 Second edition, 2003 Permission has been obtained to use material from the following organizations: (1) United Nations (2) World Bank (3) World Health Organization Copyright permission has been obtained from Martin Dunitz to adapt ‘The St Vincent Declaration: experience gained for better outcome of cardiovascular, eye and kidney complications in the future’ in Chapter 8. ISBN 2-930229-27-6 Design and layout: perplex | Aalst, Belgium Cover: De Blauwe Peer, Gent, Belgium Printer: Imprimerie L Vanmelle SA, Gent/Mariakerke, Belgium Diabetes Atlas Second Edition Diabetes Atlas Second Edition Acknowledgements The International Diabetes Federation (IDF) Chapter 1 would like to express its thanks to the World 1.1 R Sicree, J Shaw, P Zimmet Diabetes Foundation for its generous support 1.2 R Tapp, J Shaw, P Zimmet in making the Diabetes Atlas, second edition, Chapter 2 possible. 2.1 G Soltèsz, C Patterson, G Dahlquist 2.2 R Singh, J Shaw, P Zimmet IDF would also like to thank Novo Nordisk A/S for its generous support. Chapter 3 Introduction P Zimmet IDF would like to thank Novartis Pharma AG 3.1 N Rigby, RJ Leach, WPT James for its generous support in making possible 3.2 CS Cockram, K Hynes the report on impaired glucose tolerance in Chapter 4 Chapter 1. R Williams IDF would also like to thank Johnson and Chapter 5 Johnson for its generous support in making J-C Mbanya, L Fezeu possible the report on type 2 diabetes in the Chapter 6 young in Chapter 2. 6.1 J Piette 6.2 L Siminerio A publication such as this would not have 6.3 T Songer been possible without the commitment and contribution of many people around the Chapter 7 world. IDF would like to thank and gratefully 7.1 K Ramaiya, R Sicree, C Patterson acknowledges the contributions of the 7.2 M Arab, AS Shera, R Sicree, C Patterson following authors: 7.3 M Massi-Benedetti, L Etu-Seppälä, R Sicree, C Patterson 7.4 Y Vovides, B Wentzell, R Sicree, C Patterson 7.5 A Pérez-Comas, R Sicree, C Patterson 7.6 H Mahtab, MA Sayeed, R Sicree, C Patterson 7.7 G Bunyan, R Sicree, C Patterson Chapter 8 8.1 M Massi-Benedetti, J Akwe Akwi, P Ferolla, MO Federici 8.2 Y Vovides, B Wentzell 8.3 CS Cockram Chapter 9 C Regniers, D Gan, B Allgot Chapter 10 P Lefèbvre Profiles J Colquhoun, D Lukoseviciene, N Ojha, G Rafique, M Silink Appendix 2 A Hornsby Special thanks to S Murray for coordinating the work at the International Diabetes Institute. Diabetes Atlas Second Edition Diabetes Atlas Second Edition IDF also gratefully acknowledges the help of the following people in making this publication possible: N Abdella, K Ajlouni, C Alexander, AS Alkuwari, MC Almaraz, A Al-Nuaim, FI Al-Zurba, T Aspray, V Augustiniene, B Balkau, TK Banerjee, A Barceló, T Beljic, P Bennett, O Bernard, C Berne, PR Betts, G Booth, E Briganti, C Castell, A Chan, S-Y Chen, B Choi, P Chou, LM Chuang, SS Chung, R Colagiuri, S Colagiuri, M Comaschi, D Dabelea, M Dagmar, R Dankner, H Dean, D De Bacquer, B Detournay, CL de Visser, M Dragan, R Duarte, T Dwyer, R Dyck, M Elbagir, M Eliasson, M Engelau, J Eriksson, E Eskelinen, J Feinglass, E Ford, MC Foss, M M-T Fuh, MM Garcia de Belaunde, C Giorda, RT Go, A Goday, R Gupta, CH Han, N Hancu, M Harris, J Harvey, L de Hassine, GE Holder-Nelson, G Hu, C Invitti, ED Janus, J Jervell, F Johansen, AJ Karter, S Kiauka, T Kitagawa, D Koev, M Korecova, CF Kwok, L Lavery, A Lerario, N Levitt, S Likitmaskul, B McBride, M McGill, SM Makled, K Midthjell, J Mohith, Z Naeemullah, P Nilsson, W Nitiyanant, F Nobels, H-H Parving, J Perusicova, G Piatt, E Placzkiewicz, D Ragoobirsingh, A Ramachandran, U Ramdanee, H Rashidi, W Rathmann, I Raz, G Rennert, G Roglic, A Rotchford, E Rudinskiene, M Sadikot, I Satman, MA Sayeed, A Schranz, D Simon, A Sinha, J Skrha, E Spichler, E Stern, S Tandhanand, W Thefeld, R Toomath, J Tuomilehto, G Uwaifo, K Van Acker, D Webb, S Wild, P Wilson, JP Yeo IDF gratefully acknowledges the support and help given by its member associations, task forces and consultative sections. Special thanks to L Al Obaidi, S Ash, V Campanella de Lemes, L Cann, E Ng, N Ohja, P Onraed, L Rabemananjara and Y Vovides for their invaluable contribution in the regions. Diabetes Atlas Second Edition Contents Contents Foreword 7 Introduction 9 Executive Summary 11 1. The Global Burden of Diabetes 15 1.1 Diabetes and Impaired Glucose Tolerance: Prevalence and Projections 17 1.2 Complications of Diabetes 72 2. Diabetes in the Young: a Global Perspective 113 2.1 Global Trends in Childhood Type 1 Diabetes 114 2.2 Type 2 Diabetes in the Young 135 3. The Widening Circle 157 3.1 Obesity 159 3.2 Cardiovascular Disease and Diabetes: Double Jeopardy 167 4. The Economic Impact of Diabetes 175 5. Access to Insulin and Diabetes Supplies 193 6. Diabetes Education 207 6.1 Effectiveness of Self-management Education 208 6.2 Educational Practices: a Global View 216 6.3 Cost-Effectiveness of Diabetes Education 221 7. Meeting the Challenges 225 7.1 Africa 226 7.2 Eastern Mediterranean and Middle East 231 7.3 Europe 237 7.4 North America 244 7.5 South and Central America 250 7.6 South-East Asia 255 7.7 Western Pacific 260 8. Reducing the Burden 267 8.1 The St Vincent Declaration 268 8.2 Declaration of the Americas on Diabetes 276 8.3 Western Pacific Declaration on Diabetes 278 8.4 Declaration of the Eastern Mediterranean and Middle East Region 280 5 Diabetes Atlas Second Edition Contents 9. Diabetes Associations: from Patients to Partners 283 10. Prevention and Strategic Action 301 Appendices Appendix 1 Methodology 305 Appendix 2 Socio-economic Indicators 316 Appendix 3 IDF Member Associations Address List 329 Glossary 345 Acronyms 349 World Diabetes Foundation 352 Index 354 Index of Countries 357 6 Diabetes Atlas Second Edition Foreword Foreword everal years ago it was proposed by my predecessors that it would be helpful to bring together relevant data about diabetes and diabetes associations around Sthe world. This culminated in the publication of the first edition of the Diabetes Atlas at the 17th IDF Congress in Mexico. It was beautifully produced and instantly popular. It went to Ministers of Health in IDF member countries, WHO offices, diabetes associations and many others. The Diabetes Atlas has proved to be an invaluable resource. It was decided that it should go on the IDF website to be updated regularly – but should reappear in hard copy for the 18th IDF Congress in Paris. Many new sections have been included since the first edition. The epidemiology section has been updated, stressing again the rapid rise in prevalence, as has that on economics. A new section on impaired glucose tolerance (IGT) is included, giving an indication of the further rise in diabetes that is to come. This is the first time worldwide data on IGT have been collected together. The prevalence of complications is now included – important for planners, health professionals and people with diabetes alike. It is also the first time that such information has been compiled in one publication. It is useful in showing not only the prevalence data but also the gaps in our knowledge in this area. Another new chapter discusses the relationship between obesity and diabetes as well as the effect of diabetes on cardiovascular disease. The vital topic of access to insulin is also covered – an area of critical importance in many IDF member countries. Diabetes education has an expanded section, emphasizing its role in the successful management of the disease. There are then very useful chapters on IDF regional activities and diabetes associations. Primary prevention and socio-economic indicators complete the text. The evidence that we have shows beyond doubt that diabetes is on an epidemic increase and that the toll from this disease will be huge in economic, social and individual terms if action is not taken now. There is also evidence that prevention of type 2 diabetes is possible. What remains now is for all of us – governments, health organizations, diabetes associations – to take the next step to use the knowledge that we have to curb the rise of diabetes and its complications. 7 Diabetes Atlas Second Edition Foreword I personally feel that the second edition is a major step forward and will prove invaluable to governments and diabetes associations as well as individuals. Production of the Diabetes Atlas is a costly undertaking. We should acknowledge the time given by many colleagues in IDF and also our various sponsors, particularly the new charity the World Diabetes Foundation, without whom the second edition of the Diabetes Atlas would not have been possible.