Measuring the global, regional, and national burden of type 2 diabetes and the attributable risk factors in all 194 countries

BACKGROUND

No detailed quantitative global, regional, or national estimates of the disability-adjusted life years (DALYs) of type 2 diabetes mellitus (T2DM) are available.

METHODS

We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to estimate the global, regional, and national incidence rates and DALYs of T2DM, as well as the associated risk factors, in all 194 countries and territories by age, sex, and sociodemographic status during the period from 2007 to 2017.

RESULTS

Globally, the age-standardized incidence and DALY rates increased by 3.23% and 5.07% during 2007 to 2017, respectively. The age-standardized incidence and DALY rates in 2017 and the corresponding percentage changes during 2007 to 2017 were highest in the low-middle sociodemographic index (SDI) quintile. Regionally, the highest 2017 age-standardized incidence and DALY rates were observed in Oceania, whereas the largest percentage increases in both rates during 2007 to 2017 were observed in Southeast Asia. Nationally, Iran, the United Kingdom, and Indonesia reported the largest percentage increases in the age-standardized incidence rates, whereas Georgia, Czech Republic, and Iran showed the largest percentage increases in the age-standardized DALY rates. Globally, the largest percentage increases in risk-attributable DALYs were associated with a high body mass index, low physical activity level, high fasting plasma glucose level, and high sugar-sweetened beverage and red meat consumption.

CONCLUSIONS

The global T2DM age-standardized incidence and DALY rates increased globally between 2007 and 2017, especially in the low-middle SDI quintile, Southeast Asia.

Gonadal hormonal factors before menopause and incident type 2 diabetes in women: A 22-year follow-up of 83 799 women from the E3N cohort study

BACKGROUND

In many populations the incidence of type 2 diabetes is higher in men than in women. This may be explained by exposure to female gonadal hormones, but so far, there is no consensus on their role over the life course in type 2 diabetes etiology.

METHODS

Data are from 83 799 French women from the E3N (Etude Épidémiologique de Femmes de la Mutuelle Générale de l'Education Nationale) cohort study, followed for 22 years. Multivariable Cox models including classical risk factors were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) between gonadal hormonal factors and incident type 2 diabetes.

RESULTS

Older age at menarche, more menstrual cycles, older age at menopause, longer duration of exposure to gonadal hormones and breastfeeding were inversely associated with incident type 2 diabetes cases (n = 4806). While a longer duration of menstrual cycles (HR = 1.23 [95% CI: 1.07-1.41] comparing ≥32 vs ≤24 days) and use of contraceptive pills (HR = 1.33 [1.25-1.42]) were associated with a greater risk of type 2 diabetes.

CONCLUSIONS

In women, a longer exposure to endogenous gonadal hormones with a later menopause as well as breastfeeding were associated with a lower risk of developing type 2 diabetes, independently of classical diabetes risk factors. In contrast, the use of contraceptive agents was associated with incident diabetes, but the influence of each type of contraception and of exposure duration remain to be investigated.

Synergistic effects of depression and obesity on type 2 diabetes incidence in Chinese adults

BACKGROUND

Cross-sectional studies have supported the association among depression, obesity, and type 2 diabetes, but the causality remains controversial in Chinese adults. In this longitudinal study, we evaluated the synergistic effect of depression and obesity on the risk of type 2 diabetes.

METHODS

This study included 2809 participants randomly selected from the Qingdao Diabetes Prevention Program, and their type 2 diabetes incidence was determined over a follow-up period of 3 years. The WHO 2006 criteria and the Zung Self-Rating Depression Scale score were employed to identify type 2 diabetes and depression at baseline, respectively. Multivariable-adjusted logistic regression was used to evaluate the synergistic effects of depression and obesity indicators on type 2 diabetes, with adjustment for age, sex, family history of diabetes, and other potential risk factors.

RESULTS

During 3-year follow-up, 316 new incident cases were identified. The relative risk and 95% confidence interval of depression for diabetes incidence was 1.52 (1.05-2.21), after controlling for potential confounders. Sensitivity analysis showed that depression was significantly associated with diabetes incidence in women, younger people, and obese people (1.82 [1.14-2.92], 1.94 [1.25-3.02], and 4.29 [1.44-12.78], respectively]. The synergistic effects of positive depression and body mass index ≥30 kg/m² on type 2 diabetes incidence were observed, with a synergy index of 5.49 (1.75-17.19).

CONCLUSIONS

Depression was associated with a 52% increased risk of type 2 diabetes incidence and exerts synergistic effects with obesity on diabetes incidence in Chinese adults. Early identification and intervention for depression and obesity can reduce the risk of diabetes.

Incidence of type 2 diabetes and number of events attributable to abdominal obesity in China: A cohort study

BACKGROUND

The aim of the present study was to estimate the incidence of type 2 diabetes (T2D) and the number of diabetes events attributable to abdominal obesity in China.

METHODS

A cohort study was conducted in a sample of 24,996 Chinese adults aged 35-74 years, with 19.9% of subjects lost to follow-up. Waist circumference (WC) was measured at baseline in 1998 and 2000-01, and abdominal obesity was defined as WC ≥ 90 cm in men and ≥80 cm in women. Information on incident diabetes was collected during follow-up in 2007-08. We estimated the number of T2D events attributed to abdominal obesity using confounder-adjusted population-attributable risk, incidence of diabetes, and the population size of China in 2010.

RESULTS

After a mean follow-up of 8.0 years, the age-standardized incidence of T2D was 9.6 and 9.2 per 1000 person-years in men and women, respectively. Abdominal obesity accounted for 28.1% (95% confidence interval [CI] 14.8%, 40.5%) of incident diabetes among men and 41.2% (95% CI 28.3%, 52.6%) among women using the diagnostic criteria of abdominal obesity recommended by the International Diabetes Federation. We estimated that, in 2010, 2.4 (95% CI 1.5, 3.2) million diabetes events were attributable to abdominal obesity: 1.0 (95% CI 0.5, 1.4) million in men and 1.4 (95% CI 1.0, 1.8) million in women.

CONCLUSIONS

Abdominal obesity is a major risk factor for T2D. Strengthening programs and initiatives for preventing and controlling obesity focusing on lifestyle changes should be a priority in the national strategy to reduce diabetes burden in China.

Clinical Collaborative Group of Fujian Medical Association Hematological Branch. [Incidence of newly diagnosed adult acute leukemia in Fujian province from 2011 to 2012]

OBJECTIVE

To investigate the incidence of adult (≥14-year-old) acute leukemia (AL) in Fujian Province from 2011 to 2012, based on the survey in 2010.

METHODS

All newly diagnosed adult AL cases were collected during 2011 and 2012 retrospectively, which were registered identically by the clinical collaborative group of Fujian Medical Association Hematological Branch. The group included all the hospitals that could diagnose leukemia.

RESULTS

①We registered 1 551 new adult AL cases totally during 2011 and 2012. The average annual incidence was 2.479/10⁵. 777 new adult AL cases were diagnosed among the whole adult population in Fujian Province in 2011.The crude incidence rate (CIR) was 2.498/105, and age- standardized incidence rate (ASR) was 2.504/10⁵. 774 new adult AL cases were diagnosed in 2012 with 2.460/10⁵ of CIR and 2.455/10⁵ of ASR. No significant changes of the adult AL incidence were found over time during 2011 and 2012. ② During 2011 and 2012, 938 cases of acute myeloid leukemia (AML, non-M) were diagnosed,with 1.499/10⁵ of CIR. 393 cases of acute myeloid leukemia (ALL) with 0.628/10⁵ of CIR, 199 cases of acute promyelocytic leukemia (APL) with 0.318/10⁵ of CIR, 21 cases of the special type with 0.034/10⁵ of CIR. The incidence of AML (non-M) was highest (accounting for 60.48%）, followed by ALL (25.34%）, APL (12.83%）. The special type (1.35%) was the lowest. ③ The survey revealed differences in gender, age, region and season of incidence in Fujian province. The male gender bias of AML and ALL were also observed. The incidence of adult AL increased with age, and reached to the peak in group aged 75-79 (7.081/10⁵）.

CONCLUSION

The incidence of adult AL in Fujian province is in average level in China from 2011 to 2012, according to the leukemia incidence data of International Agency for Research on Cancer (IARC). Compared with the previous national leukemia incidence during 1986 and 1988, the incidence in Fujian is slightly higher. We find no significant changes of the incidence from 2011 to 2012. The constituent ratios of various types of adult AL in Fujian are similar to the previous studies of national incidence rate during 1986-1988.

[Two-year longitudinal investigation of 733 twelve-year-old children's caries status in Sichuan province]

OBJECTIVE

This study aims to investigate the dental caries status of 12-year-old children (born in 1998) in Sichuan province in 2010 and 2011, monitor the tendency of dental caries, and update available information and scientific basis for oral health care program.

METHODS

The oral health of 733 twelve-year-old children was surveyed for two consecutive years according to the methods proposed by the World Health Organization. The children were selected using multi-stage, stratified, randomized sampling. The collected data were analyzed using SPSS 17.0 software.

RESULTS

Caries prevalence, DMFT, and DMFS in 12-year-old children were 34.8%, 0.93, and 1.09, respectively, and increased to 44.3%, 1.08, and 1.40 in the following year. The eruption of permanent teeth among females was higher than that of males (P < 0.05). The significant caries index was 2.54 in 2010 and 2.90 in 2011. F/D+F were 4.2% and 6.5% separately. Annual incidence of dental caries was 9.6%.

CONCLUSION

Caries prevalence in the permanent teeth of 12-year-olds is high and worsens as the children age. Despite the high incidence of dental caries, the filling rate is low, hence the need for immediate preventive measures.

[Estimation and projection of lung cancer incidence and mortality in China]

BACKGROUND AND OBJECTIVE

The aim of this study is to analyze lung cancer epidemiological trend and estimate lung cancer burden in China.

METHODS

Lung cancer age specific mortality and incidence rate ratios in different areas and sexes were obtained from national cancer registration database in 2004 and 2005. Cancer crude mortalities were retrieved from the database of the third national death survey, 2004-2005. Age specific incidence rates of lung cancer were calculated using mortality and M/I ratios. Annual percent change (APC) was estimated by log regression model using Joint Point software by analyzing pooled lung cancer incidence data from 10 cancer registries from 1988 to 2005.

RESULTS

The total estimated new cases and deaths of lung cancer in 2005 were 536 407 and 475 768 which were higher in male than in female. There was 1.63% increase of lung cancer incidence per year from 1988 to 2005, however, the trend showed a slowdown by 0.55% annually after adjusted by age.

CONCLUSION

Lung cancer is one of major health issues in China and the burden is getting serious. Ageing population is main cause for increasing incidence and mortality of lung cancer. Effective cancer prevention and control is imperative. Especially, tobacco control should be carried out in statewide.