Been meaning to do this for a while but had 0 time to do it, so here goes: Follow here for a tweetorial on diabetes epidemiology!
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Whilst that's going, I should add an important note: this is NOT true of gestational diabetes, for which the threshold is lower
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The reason I put that poll out is because of an important fact: diabetes recommendations change! They've changed a LOT over the last two decades Currently, the recommendation is HbA1c>6.5% with a fasting blood glucose corroborating this if necessarypic.twitter.com/WoDquBnX5F
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So bearing that in mind, what do you think the diabetes prevalence was in the 90s? (FYI, a lot of figures are going to be based on Australia because that's where I am, but they are fairly similar to most OECD countries especially UK/US)
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And given those diabetes rates, what do you think the rates of DIAGNOSED diabetes are today?
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It's important to remember that we are mostly talking about DIAGNOSED diabetes here. People are often undiagnosed with type 2 diabetes for years, or even decades!
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So a few votes rolling in (remember to vote it's fun). For the figures above, what's the ratio of type 1 diabetes to type 2?
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Going back to the 90s, most people are pretty close. The answer is about 1.5% prevalence of diabeteshttps://twitter.com/GidMK/status/986746545889423360 …
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Now, the big reveal. How much have diabetes rates increased in the last 20 years?https://twitter.com/GidMK/status/986746821857886208 …
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Not quite as much as everyone thinks, but enough It's about 6% now So a fourfold increase in diabetes rates since the late 90s
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BUT remember what I said above about changed diagnostic criteria? Yes, diabetes rates have shot up, but a part of that increase is to do with what we call 'diabetes'
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And this increase is largely being driven by one thing: type 2 diabetes! The answer here is ~roughly~ 10:90, with type 1 making up 1 in 10 patients with diabeteshttps://twitter.com/GidMK/status/986750411221577729 …
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So, diabetes rates have gone from 1.5% to 6% in only two decades This is bad
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But wait! Remember, these figures are only for DIAGNOSED patients What percentage of people with diabetes are currently living undiagnosed?
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And the answer is... Trick question! What you see above is a list of estimates, but the answer is we don't really know
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The WHO says it's probably around 20%. Work done by my team found it to be more like 33% in a high acuity patient population. More recent work done by me is looking to be 12-15% in the general population http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=CB03C43BE57BBF27E96366E2E2E9E9C8?sequence=1 …
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But the basic answer is: a lot. Even if the number is only 15%, you're still pushing that 6% estimate up to 8 or even 9%
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Diabetes is going up. This is VERY BAD. What is the main driver behind this increase?
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Identifying the main driver behind increased diabetes rates is ~very important~, because they are predicted to go up. And up. And up.pic.twitter.com/tKeQAIJrXQ
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In Australia, we're looking at a potential 30% (!) prevalence of diabetes by the year 2050 That is truly unsupportable
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When diabetes rates go up, so too do the rates of diabetes complications. Macrovascular (heart) disease, retinopathy/blindness, and amputations skyrocket
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Now, something raised by
@timsenior already - socio-economic drivers of diabetes To put it briefly: disadvantage and diabetes go hand-in-handShow this thread -
Work from my team has shown this time and again. This map in particular paints a sad picture. Red=diabetes, blue=less diabetes. The wealthy areas are near the sea, the poorer areas further awaypic.twitter.com/2m3csvlaaW
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And we have new data (upcoming study plug!) that shows this even more starkly. The poorer your neighborhood, the more likely you are to have diabetes
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Unsurprisingly, this links very well with other socially-determined disease like cardiovascular problems and eventually death Social disadvantage killspic.twitter.com/s3YzyvP5UR
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And we see these issues in every data source. Here's the graph of a wealthy are (left) compared to a rural/disadvantaged area (right) for diabetes ratespic.twitter.com/XuGZFxi29A
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I've talked a lot about wealth here. What is another major social determinant of diabetes?
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Probably worth coming back to this, because the answers are somewhat linked. As you've correctly identified, the answer is all of the abovehttps://twitter.com/GidMK/status/986758774873468928 …
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The thing is, the main driver of diabetes increases - increases in average population weight - is closely linked to social disadvantagepic.twitter.com/WSstr6vBsw
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Less wealth = more obesity = higher rates of type 2 diabetes
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