Epidemiology

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Diabetes Mellitus Type 2Published by: Domus Medica | SSMGLast published: 2017Diabète sucré de type 2Published by: SSMG | Domus MedicaLast published: 2017

Type 2 diabetes prevalence is increasing worldwide, driven by increasing prevalence of obesity and overweight and ​compounded by population growth and aging.[4][5]​​ Between 2000 and 2021, global age-standardized prevalence increased from 4.6% to 10.5%.[6] However, while the overall burden of type 2 diabetes is increasing, trends in the incidence rate plateaued from the mid-2000s and now appear to be decreasing.[7] Data from the US National Health Interview Survey documented that the incidence of age-adjusted, diagnosed diabetes decreased from 2007 to 2017, from 7.8 to 6.0 per 1000 adults.[8] This may be in part due to increased awareness, education, and risk factor modification.[7]​ Lifetime risk of diabetes is now 40% for both men and women in the overall US population, and is 50% in the US African-American population.[9]​ Evidence also shows an increased prevalence of type 2 diabetes in the Asian-American population (when compared with non-Hispanic white adults), and based on limited data available, this appears to be true to varying degrees across all Asian-American subgroups.[10]

Type 2 diabetes accounts for approximately 90% of all diabetes cases and has a prevalence of 8.5% in the US.[11] Clinical onset is usually preceded by many years of insulin resistance and hyperinsulinemia before elevated glucose levels are detectable.[1] Reflecting the insidious onset of the condition, high rates of undiagnosed type 2 diabetes have been reported. In the US, 29.4 million adults were living with diabetes in 2021; of those, 8.7 million (28%) were undiagnosed, corresponding to 3.4% of all adults.[12]​ By the time of clinical onset of diabetes, there has already been significant loss of beta cell mass and function.[13]

Patients with type 2 diabetes have a very high risk of concurrent hypertension (80% to 90%), lipid disorders (70% to 80%), and overweight or obesity (60% to 70%).[14] According to one systematic review, approximately 32% of patients with type 2 diabetes globally are affected by cardiovascular disease.[15]​ On average, adults with type 2 diabetes are up to twice as likely to die of stroke or myocardial infarction compared with those without diabetes.​[16][17][18]​​​​​​ While evidence suggests a link between suboptimal glycemic control and increased risk of cardiovascular (CV) events, the results from randomized controlled trials investigating the impact of optimizing glycemic management on CV risk in patients with type 2 diabetes have produced varied and sometimes seemingly contradictory findings.[19][20][21][22][23]​​​ However, data indicate that a multifactorial risk factor intervention involving optimal management of glucose, blood pressure, lipids, smoking, and weight is associated with a risk of major CV events comparable to that of age- and sex-matched individuals without diabetes.[24][25][26][27]

The epidemiology of complications of type 2 diabetes is changing.[28] The emergence of newer glucose-lowering agents such as sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists has contributed to this, as these agents have demonstrated significant CV benefits, frequently independent of intensive glucose lowering.[29][30][31]​ Rates of macrovascular complications (e.g., myocardial infarction, lower extremity amputation) and hyperglycemic death have declined in high-income countries due to improvements in multiple-risk factor management and diabetes care.[28]​[32]​​[33]​​ Data on rates of microvascular complications (e.g., diabetic kidney disease, diabetic retinopathy, neuropathy) are scarce and trends are less conclusive.[28]

When diabetes is diagnosed at age 40 years, men lose an average of 5.8 years of life, and women lose an average of 6.8 years of life, highlighting the importance of primary prevention of the disease.[34] Young-onset (<40 years) type 2 diabetes is associated with worse metabolic control and an increased risk of chronic complications and all-cause mortality.[32] However, onset of diabetes at older ages has much less effect on life expectancy if acceptable glucose, blood pressure, and lipid management can be achieved and maintained.

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