Diabetes Guide:: Epidemiology of Type 2 Diabetes

Trinidad and Tobago Specific Information

Trinidad and Tobago Information Author: Brader Brathwaite, BSc, MSc, DipEd, MEd, EdD

Of 1.3 million people, estimated 143,000 persons (11%) have diabetes in T&T.
1,000 new cases diagnosed in people aged 20 years or older in 2007.
Over 450 children in T&T have type 1 diabetes.
T&T has the most persons with diabetes per capita in the Western Hemisphere.
T&T is 5th in the world in diabetes per capita.
1 in 4 hospital admissions attributed to diabetes.
Diabetes was the second most common cause of death listed in T&T (2007). Diabetes is likely to be underreported as a cause of death.
Overweight/obesity: 1 in 8 people in T&T is overweight. 80% of persons with type 2 diabetes are overweight.
Heart Disease and Stroke:Adults with diabetes have heart diseaseand stroke rates about 2 to 4 times higher than adults without diabetes.
Blindness:Diabetes is the leading cause of blindness in T&T.
Kidney Disease:There are presently 365 persons receiving dialysis in T&T as an alternative for kidney transplant.
Nervous System Disease: About 60% to 70% of people with diabetes have mild to severe forms of neuropathy, usually impairing sensation or pain in the feet and hands, slow digestion of food in the stomach, carpal tunnel syndrome, and other neuropathies. Severe forms of diabetic neuropathy contribute to lower-extremity amputations.
Amputations: More than 450 non-traumatic lower-limb amputations occured in people with diabetes last year. 50% of persons who have lower limb amputations go into depression and 20% die within two years.
Erectile Dysfunction: 74% of men who are affected with diabetes for over 15 years have erectile dysfunction.
Dental Disease: Among young adults, those with diabetes have about twice the risk of periodontal disease. Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 mm or more.

Prevalence of type 2 diabetes in the U.S.

In 2005-2006, crude prevalence of diabetes in adults >20 years was 12.9% of which 40% was undiagnosed (fasting plasma glucose >7 mmol/l and/or 2-hour glucose >11.1 mmol/l).

In adults > 20 years, crude prevalence of impaired fasting glucose was 25.7% and impaired glucose tolerance 13.8%; 30% had either.

One-third of elderly had diabetes; three-quarters had diabetes or pre-diabetes.

Compared with non-Hispanic whites, age- and sex-standardized prevalence of diagnosed diabetes was twice as high as in non-Hispanic blacks and Mexican Americans.

Crude prevalence of diagnosed diabetes in adults > 20 years rose from 5.1% (1988-1994) to 7.7% (2005-2006).

Using A1c criteria alone, prevalence of undiagnosed diabetes (A1c > 6.5%) and high risk of diabetes (A1c 6 - 6.5%) were one-third and one-tenth of that, respectively, using glucose criteria.

Cowie (information above)

Economic burden of diabetes in the U.S.

New research suggests total cost of diabetes in 2007 was $218 billion, including $153 billion in excess medical expenditures and $65 billion in reduced national productivity.

Medical costs attributed to diabetes include: $27 billion for care to directly treat diabetes, $58 billion to treat diabetes-related chronic complications, $31 billion in general medical costs.

Largest components of medical expenditures attributable to diabetes: hospital inpatient care (50% of total cost); diabetes medication and supplies (12%); retail prescriptions to treat complications (11%); physician office visits (9%).

Average cost per case: $2,864 for undiagnosed diabetes, $9,975 for diagnosed diabetes ($9,677 for type 2 and $14,856 for type 1), and $443 for pre-diabetes (medical costs only).

For each American, regardless of diabetes status, this burden represents a cost of approximately $700 annually.

People with diagnosed diabetes incur average medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

In U.S., approximately $1 in $5 health care dollars spent caring for someone with diagnosed diabetes, while $1 in $10 health care dollars attributed to diabetes.

Indirect costs include absenteeism from work, reduced work productivity, unemployment from disease-related comorbidity, lost productive capacity due to early mortality.

For the Medicare-eligible population, the diabetes population will rise from 8.2 million in 2009 to 14.6 million in 2034; associated spending is estimated to rise from $45 billion to $171 billion.

American Diabetes Association; Dall; Huang (information above)

Global prevalence of type 2 diabetes

World prevalence of diabetes among adults (20-79 years) was 6.4% or 285 million adults in 2010.

By 2030, prevalence of diabetes will increase to 7.7% or 439 million adults.

Anticipated 69% increase in diabetes in developing countries and 20% increase in developed countries between 2010 and 2030.

Top 10 countries for diabetes prevalence in 2010: Nauru (31%), United Arab Emirates (19%), Saudi Arabia (17%), Mauritius (16%), Bahrain (15%), Reunion (15%), Kuwait (15%), Oman (13%), Tonga (13%), Malaysia (12%).

Top 10 countries for number of people aged 20-79 years with diabetes in 2010 (millions): India (50.8), China (43.2), United States (26.8), Russian Federation (9.6), Brazil (7.6), Germany (7.5), Pakistan (7.1), Japan (7.1), Indonesia (7.0), Mexico (6.8).

In 2030, projected that top countries for numbers of people with diabetes will remain India (87 million), China (62.6 million) and United States (36 million).

Shaw (information above)

Global economic burden of diabetes

Global health care expenditure on diabetes expected to total $376 billion USD in 2010, and $490 billion USD in 2030.

12% of global health care expenditures ($1330 USD/person) anticipated to be spent on diabetes in 2010.

Top 10 countries with highest national total health care expenditures (USD) estimated for 2010: United States ($197 billion), Germany ($28 billion), Japan ($22 billion), France ($17 billion), Canada ($11 billion), Italy ($11 billion), United Kingdom ($8 billion), Spain ($7 billion), China ($5 billion), Mexico ($5 billion).

Top 10 countries with highest national health care expenditures (USD) per person with diabetes for 2010: United States ($7383), Luxembourg ($7268), Iceland ($7001), Norway ($6933), Switzerland ($5995), Monaco ($5866), Ireland ($5035), Austria ($4007), Canada ($3914), Slovenia ($1626).

Top 10 countries with highest percentage of national health expenditure on diabetes: Nauru (41%), Saudi Arabia (21%), Mauritius (20%), Tuvalu (19%), Bahrain (19%), Tonga (18%), Oman (18%), Qatar (18%), Seychelles (18%), Malaysia (16%).

In 2030, projected that United States will continue to spend the most on diabetes, with $264 billion USD or 54% of world total.

Zhang (information above)

Global morbidity and mortality attributable to diabetes

Top 10 leading causes of burden of disease (by disability-adjusted life years) for high-income countries for 2001: 1) ischemic heart disease, 2) cerbrovascular disease, 3) unipolar depressive disorders, 4) dementia, 5) lung cancer, 6) hearing loss, 7) COPD, 8) diabetes, 9) alcohol use, 10) osteoarthritis.

In low- and middle-income countries, communicable diseases (i.e. HIV/AIDS, respiratory infections, diarrheal diseases, malaria, tuberculosis) and perinatal conditions associated with relatively greater burden of disease in 2001.

Total number of excess deaths attributable to diabetes worldwide was 3.96 million in age group 20-79 years (6.8% of global all ages mortality) for year 2010, calculated using computerized WHO disease model.

Diabetes accounted for the following % of deaths in adults: Africa (6%), North America (15.7%).

Beyond age 49 years, diabetes constituted a higher proportion of deaths in females than males in all regions, reaching 25% in some regions and age groups.

As diabetes prevalence increases, overall morbidity and mortality from diabetes will likely also increase especially in low- and middle-income countries.

Lopez; Roglic (information above)