WHO’s beating the trend?
WHO’s predicted 39% rise in the global rate of diabetes from 2000 to 2030 might be an underestimate write Canadian researchers in The Lancet (March 3). When Drs Lorraine Lipscombe and Janet Hux tracked the trends over 10 years in Ontario, Canada, they found that between 1995 and 2005 the prevalence of diabetes rose to nearly 9 per cent, already surpassing the global rate of 6.4% predicted by the World Health Organization (WHO) to occur by 2030. ‘We found that the rising number of new cases of diabetes, coupled with declining mortality rates due to people living longer with the disease, have led to steady increases in the overall prevalence of diabetes in Ontario,’ said Dr. Lorraine Lipscombe, ICES Research Fellow and lead author of the study.
Yearly diabetes prevalence in Ontario
In their study, they tracked all Ontario adults aged 20 years and older to examine trends in diabetes prevalence (the number of both new and existing cases) and mortality between 1995 and 2005, and trends in incidence (the number of new cases only) from 1997 to 2003. The results showed that:
‘Given this linear growth in the prevalence of diabetes, more than 10 per cent of the adult population of Ontario will be diagnosed with diabetes before 2010,’ said Dr Lipscombe. ‘If similar trends are occurring throughout the developed world, then the magnitude of the emerging diabetes epidemic is far greater than we anticipated," said Lipscombe.
- Diabetes prevalence has increased 69%, from 5.2% in 1995 to 8.8% in 2005.
- Although prevalence rates have remained higher among persons aged 50 years and older compared to persons aged 20 to 49 years, rates increased to a greater extent in the younger population (94% for those 20 to 49 years vs 63% for those aged 50 and older).
- There was a 31% increase in annual incidence, from 6.6 per 1,000 persons in 1997 to 8.2 per 1,000 persons in 2003.
- The mortality rate among persons with diabetes declined by 25% between 1995 and 2005.
Ethnicity may matter too. Where Ontario may differ slightly from other regions may be in the ethnic makeup of its immigrant population. ‘Although we did not look at the impact of ethnicity in the paper, we do know that Ontario has seen a large increase in immigration of at-risk populations such as people of South Asian origin,’ comments Lipscombe. ‘So it’s possible that that has also contributed to the increased rate, in that our mix has changed over the past 10 years and we’re seeing more susceptible populations within our province.’
In their discussion of the findings, the authors say: ‘We showed that most cases of diabetes were in older individuals. However, rates of diabetes grew most rapidly in the population under 50 years and in particular, in young women. This pattern might be due to a greater rise in obesity in younger than in older adults. The greatest effect of diabetes in developed countries might thus be emerging in young individuals. Although the yearly cost of caring for elderly people with diabetes might be higher than caring for younger people with diabetes, the lifetime health burden and cost will be greater still for young people because they have longer to live with the disease.’
– The Lancet, 3 March 2007; Media release ICES (Media Contact: Julie Dowdie, Media Relations Officer, ICES (416) 480-4780 or cell (416) 432-8143.
Job burn-out may increase diabetes risk
People who suffer from job burn-out may be prone to developing type 2 diabetes, research suggests. An Israeli study of 677 mostly male, middle-aged workers found people who experienced job burn-out were nearly twice more likely than others to develop type 2 diabetes, even when factors like age, sex and obesity were taken into account. When the possible effect of blood pressure levels was eliminated, the risk was more than four-fold higher. The study, in Psychosomatic Medicine, suggests stress can be added to other factors known to increase risk of diabetes. The research doesn't definitively confirm a link between workplace stress and diabetes. But it does suggest that burnout could boost the risk of illness by a ‘magnitude similar to other risk factors, such as high body mass index, smoking and lack of physical exercise,’ said study lead author Samuel Melamed, an associate professor at Tel Aviv University in Israel.
– Psychosomatic Medicine, November/December 2006
Protecting women with PCOS
PCOS is a hormone disorder that affects up to 10% of women. Symptoms include irregular or absent periods, infertility or reduced fertility, facial hair, acne, obesity and difficulty losing weight. As Kate Marsh wrote in October 2006 GI News, ‘We don’t know why PCOS develops, but we do know that there are a number of different causes and for many women, it’s high levels of insulin in the blood resulting from insulin resistance’. In March Diabetes Care, Medical researchers from the Jean Hailes Foundation for Women’s Health and Monash University report that metformin, used for more than 60 years to treat diabetes, has a greater role in the treatment of PCOS than previously thought. The findings revealed that for women with symptoms of PCOS, low-dose and high-dose contraceptives and metformin were all effective at treating symptoms. However, the high-dose Pill increased insulin levels, increasing future diabetes risk. The low-dose Pill had no effect on insulin and metformin considerably reduced insulin levels.
Ovaries produce excess androgens
Lead writer Prof Helena Teede says: ‘Significantly, these results suggest that long-term use of the high-dose Pill for PCOS sufferers is not ideal as it increases insulin resistance, increasing diabetes risk. It’s extremely important for women with PCOS to change their lifestyles by incorporating regular physical activity into their daily routine and eating a well-balanced, low-fat diet with plenty of fresh vegetables and fruit. Lifestyle changes, as well as medication, are vital for a reduction in symptoms and insulin resistance. This is an important study which will help the medical profession and women choose the best clinical treatment for this common hormone disorder.’ For more information call Aleeza Zohar on 613 9562 6771.
Diabetes Care 2007 30: 471-478; Jean Hailes Foundation Press Release
GI Group: Dietitian Kate Marsh shows you how to take charge and manage your symptoms in The Low GI Guide to Managing PCOS.