Genetic test aims to improve diabetes diagnosis

REUTERS

PublishedMar 25, 2016, 9:07 pm IST

UpdatedMar 25, 2016, 9:05 pm IST

Type 1 diabetes occurs when the body's immune system destroys the cells that release insulin.

Radiographer Paul Martin was wrongly diagnosed with type 2 diabetes in April 2013. After months of taking two medications that failed to improve his condition, Martin visited a consultant who subsequently diagnosed him correctly with type 1.

"They put me on tablets - metformin and glycoside - and then I was able to just continue taking those for months until I saw a consultant who then said that my diabetes had got worse. So I was actually diagnosed as type 1 then and introduced to insulin," he explained.

Martin is one of a number of patients diagnosed with the wrong type of diabetes, which differ markedly in causation and treatment. Type 1 diabetes, which accounts for less than ten percent of patients, occurs when the body's immune system destroys the cells that release insulin. Without insulin, patients' bodies cannot absorb sugar. Most type 1 diabetics are diagnosed young.

Type 2 diabetes is often linked with obesity and can be developed at any age. In those cases patients' bodies are unable to use insulin correctly and can suffer damage to their pancreas, although the condition can sometimes be managed through improved diet and weight loss.

Correctly diagnosing which type a patient has is crucial, and in a small minority of cases the wrong diagnosis can be fatal. But in an age of growing obesity in the western world, diagnosis is becoming increasingly difficult for doctors.

According to diabetes expert Dr Richard Oram, from the University of Exeter Medical School, clinical diagnosis is currently based almost entirely on age at diagnosis and whether a patient is obese.

So Oram has come up with a new, relatively inexpensive, genetic test for the disease, which he thinks will help doctors.

"This is a genetic test which essentially means that it measures genetic risk factors for type 1 diabetes and it measures very simply and cheaply in a way that's easy to do, and it means that when a patient presents with diabetes we could measure that genetic risk and if the genetic risk is higher for type 1 diabetes it means they're very likely to have autoimmune type-1 diabetes, and if the genetic risk is low for type 1 diabetes then they're much more likely to have type 2 diabetes, the kind of diabetes associated with obesity," he told Reuters.

Oram's team devised a test which measures 30 genetic variants in DNA and combines all the risks associated with them in a single score, acting as a summary of genetic risk for type 1 diabetes. If a person's score is high they are likely to have type 1 diabetes. If the score is low they may have type 2. A further commonly used test which measures anti-bodies would then be undertaken to complete individual diagnosis.

Oram says early diagnosis is crucial. "If you get this wrong, if you label someone who actually has type 2 diabetes as type 1 they'll be left on insulin for the rest of their life when they don't need it. Even worse, if someone with type 1 diabetes is mislabelled as having type 2 diabetes then they may not be treated with the insulin they need and they may suffer life threatening complications," he said.

A National Institute for Health Research Clinical Lecturer and specialist in Diabetes and Nephrology, Oram says his test will also benefit patients' understanding and attitude towards their condition.

In the short term the University of Exeter Medical School, a leading centre in genome-wide association studies, could test genetic samples sent by patients from hospitals across the UK. Oram's team is also working to develop a bench-side test that any clinical laboratory could run cheaply and quickly.

"If someone could have a blood sample taken it would be sent to our lab here and have the genetic risk score tested," Oram said. "What we think is better for people with diabetes both in the UK and around the rest of the world is if their local hospital could do this test on a bench-side machine."

The research was supported by the UK's National Institute for Health Research (NIHR) and the Wellcome Trust, an independent, global charitable foundation dedicated to improving health. It's also been backed by research charity Diabetes UK.

The latter's regional manager Claire Gordon called the research "excellent." She added: "They're looking at making it a very cheap process, so people can literally have a phone app that will help them determine whether it's type 1 or type 2, and it will be cheap enough that you can do it universally, so one of the problems with lots of research is that things cost a lot of money. This is really great because it identifies what the risk of type 1 and type 2 are and means you're much more likely to get the right diagnosis quickly."

Paul Martin agrees, and says his health has improved markedly since his correct diagnosis two years ago. "Basically my blood sugars have come right down. I don't seem to be as tired as I used to be," he said.

Oram's team published its research in peer-reviewed journal Diabetes Care last November.

1 person dies of diabetes every seven seconds

DC CORRESPONDENT

PublishedApr 19, 2015, 11:22 am IST

UpdatedJan 10, 2016, 8:38 am IST

In India, one in every 10 is diagnosed with diabetes

Chennai: We usually see the doctors saying diabetes is not a disease and the person with diabetes can lead a more healthy life than a normal person, if sugar levels are kept in control. Yes, it is true that diabetes is not a disease and just a metabolic syndrome. But, the latest diabetes numbers released by International Diabetes Federation in the year 2014 observe that a patient is dying every 7 seconds due to diabetes complication.

Delivering a lecture on “Health and Environment” at State-level conference held at Madras Medical Mission (MMM) college of Health Sciences on Saturday, Dr. Nagaraj Manickam, scientist at Madras Diabetes Research Foundation (MDRF), said, quoting sixth edition IDF world diabetes atlas, that the burden of diabetes is increasing globally at an alarming pace. By 2035, there will be around 592 million people with diabetes from current 387 million, which is a steep increase of 53 percent. 

In India, one in every 10 is diagnosed with diabetes and half of people with diabetes in South-East Asia are undiagnosed.What will happen if a person is having diabetes? The scientist said its impact on economy is enormous. Diabetes caused at least $612 billion dollars in health expenditure in 2014 – 11% of total spending on adults.  

Due to last of awareness, more than 79,000 children developed type 1 diabetes in 2013. 

More than 21 million live births were affected by diabetes during pregnancy in 2013 and 77 percent of people with diabetes live in low-and-middle income countries. Diabetes caused 4.9 million deaths in 2014. Dr. Manickam said inadequate knowledge on food content, high calorie intake, sedentary lifestyle have increased the risk of Type 2 

diabetes. 

“It is everyone’s responsibility to have good healthy foods to reduce the burden of diabetes and diabetic related complications”.On the research front, the scientist said recently, novel polymorphisms or genetic variants at six different loci associated with Type 2 diabetes were identified in South Asian people.  These discoveries will give additional insight into the mechanism of the disease.  However, it is really a big task to control Type 2 diabetes by gene  therapy. 

Diabetes may shorten healthy years of life

REUTERS

PublishedApr 20, 2016, 8:50 am IST

UpdatedApr 20, 2016, 8:50 am IST

Managing blood sugar, blood pressure and lipids should be reasonable steps to maximize healthy years of life, experts advise.

 Diabetes shortens life expectancy through the development of diabetes complications such as retinopathy, kidney disease, and cardiovascular disease. (Photo: Pixabay)

Men and women with diabetes generally have shorter life expectancy and fewer years without disability than people without diabetes, according to a new study from Australia.

“Most individuals with diabetes are familiar with the classical complications affecting eyes, kidneys, feet and cardiovascular system, but this study highlights another impact, especially about the number of disability free years which were lost,” said senior author Dianna J. Magliano of Baker IDI Heart and Diabetes Institute and Monash University in Melbourne.

Based on Australian diabetes studies, disability surveys and the national death index, the researchers estimated that 50-year old men and women with diabetes had a life expectancy of 30 years and almost 34 years, respectively – or about three years less than for men and women without diabetes.

“Disability” meant having at least one of 17 limitations or impairments, for at least six months, that restricts everyday activities like bathing or getting into or out of bed. Fifty-year-olds with diabetes could expect an average of about 13 years of disability-free life, eight or nine years less than men and women without diabetes, as reported in Diabetologia.

Women age 50 with diabetes would spend more of their remaining years living with disability than men with diabetes, the researchers estimated. “The differential impact of diabetes by sex on life expectancy difference can be explained largely by the fact that women with diabetes had longer life expectancy and significantly higher prevalence of disability, which is consistent with previously reported data for women in general,” Magliano said.

Although people with diabetes are living longer now than in the past, diabetes still carries a large risk of other health problems, said Dr. Ed Gregg of the Division of Diabetes Translation at the Centers for Disease Control and Prevention, who was not part of the new study.

But, he said, there are wide variations among individuals. “Many people develop diabetes and manage it really successfully, have a life expectancy as long as anyone, based on how well they are able to manage it and work with their health system,” Gregg told Reuters Health by phone.

“Diabetes shortens life expectancy through the development of diabetes complications such as retinopathy, kidney disease, and cardiovascular disease,” Magliano told Reuters Health by email. “We believe the development of these complications may also influence the development of disability, although the mechanisms are not so clear yet.”

Managing blood sugar, blood pressure and lipids should be reasonable steps to maximize healthy years of life, she said. “Another important intervention is physical activity, which is of proven value in slowing the decline of physical function, and should be strongly recommended in older people with diabetes, even if obesity and poor glycemic control are not a problem,” Magliano said.

Helping individuals with diabetes meet recommended preventive care guidelines and maintain an active lifestyle should reduce years lived with disability, Gregg said. “The other thing that we can do in clinical settings is try to identify people at high risk for diabetes and help them make lifestyle changes,” since type 2 diabetes is largely preventable in the first place, he said.

Tendon pain linked to type 2 diabetes

REUTERS

PublishedJan 30, 2016, 10:52 am IST

UpdatedJan 30, 2016, 10:53 am IST

Having injured tendons may make it difficult to stick with exercise programs, which are essential for management of diabetes.

 Tendinopathy refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements.

Exercise is important to managing type 2 diabetes, but the condition may also make a person prone to tendon pain, which can interfere with exercise, researchers say.

Based on an analysis of past studies, researchers found that people with type 2 diabetes are more than three times as likely as those without the disease to have tendon pain, known as tendinopathy. And people with diagnosed tendinopathy have 30 percent higher odds of having diabetes.

The findings may indicate a problem healthcare providers need to be aware of, the study’s senior author said. “People with diabetes are more likely to develop tendinopathy, but the opposite is also true - people with tendinopathy are more likely to have undiagnozed diabetes,” Jamie Gaida told Reuters Health in an email.

“Tendinopathy is a problem for two key reasons,” he said. “First, feeling pain during movements that load the tendon is unpleasant, and second, having a painful tendon stops you being physically active.”

People with diabetes “should absolutely be physically active, as it is one of the most effective treatments for diabetes,” said Gaida, an assistant professor and physiotherapist at the University of Canberra in Australia.

Tendinopathy refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements. Having injured tendons may make it difficult to stick with exercise programs, which are essential for management of diabetes.

One past research review has also linked diabetes and increased risk of tendinopathies, the authors of the new study note in the British Journal of Sports Medicine.

To examine the relationship further, Gaida and colleagues reviewed 31 previous studies. Twenty-six of them focused on people with type 2 diabetes while five focused on people with diagnosed tendinopathy.

When they combined and reanalyzed the data in all the studies, Gaita’s team found that people with type 2 diabetes were 3.67 times more likely to develop tendinopathy compared to control participants without diabetes. People with tendinopathy were 1.3 times more likely than controls to have diabetes.

The study team also found that people with diabetes were more likely to have thickened tendons, which is often seen in tendinopathy. And people with both tendinopathy and diabetes typically had been diagnosed diabetic for longer than those with diabetes but no tendon problems.

“The risk of tendinopathy increases with the number of years that you’ve had diabetes,” Gaida said.

Physical activity is one of the most effective treatments for diabetes and tendinopathy can be one of the worst things for diabetes management as it stops physical activity, he said, adding that people who develop tendon pain should seek medical advice early for the speediest recovery.

“Physiotherapists/Physical Therapists are uniquely skilled to help you recover from tendinopathy and return to your chosen activity,” Gaida said.

People with diabetes shouldn’t see this study as a reason to stop exercising, stressed Dr. I. Martin Levy, director of the orthopedic surgery residency program at Montefiore Medical Center in New York.

Levy said that people with diabetes should take a measured approach to any type of exercise or activity. “I think whatever exercise program that you are going to take, use common sense, and start off slowly.”

People sometimes “launch themselves too aggressively into exercise programs and hurt themselves,” he said. “Any exercise that you take on, you should do it in a progressive manner. Start off gently and then increase in a rational way, and constantly observing results of your exercise to determine if in fact you are having any problems from the exercise program that you are on.”

Gaida said the risk of tendinopathy for anyone can be minimized by gradually increasing activity levels and the rate of progression should be slower for someone with diabetes.

Gaida also noted that good control of blood sugar levels can minimize the increased risk of tendinopathy in people with type 2 diabetes.

Youth diabetes is on the rise, study suggests

REUTERS

PublishedMay 6, 2014, 2:38 pm IST

UpdatedJan 10, 2016, 8:38 am IST

Researchers can’t say why exactly rates continue to go up, but it is important to monitor them

 New York: Both type 1 and type 2 diabetes became increasingly common among kids and teens in the U.S. between 2001 and 2009, according to a new study.

Though researchers can’t say why exactly these rates continue to go up, it is important to monitor them, Dr. Dana Dabelea told Reuters Health.

Dabelea worked on the study at the Colorado School of Public Health in Aurora.

“This should draw attention to the seriousness of pediatric diabetes especially for the clinical and public health community,” she said. “At the individual level, every new case of diabetes at a young age means a lifelong burden of difficult, expensive treatment and a high risk of complications.”

Dabelea and her team analyzed data from health plans in California, Colorado, Ohio, South Carolina and Washington state, as well as from American Indian reservations in the Southwest, including more than 3 million patients under age 19.

In 2001, about 14.8 kids in every 10,000 were diagnosed with type 1 diabetes, formerly known as 'juvenile diabetes,' in which the body’s own immune system destroys insulin-producing cells in the pancreas. Insulin is needed to remove sugar from the bloodstream so it can be used for energy.

By 2009, that rate had risen to 19.3 kids in every 10,000, a 21 percent increase, the authors found. Type 1 diabetes was most common among white children.

In type 2 diabetes, which is much more common but not usually diagnosed until adulthood, the body still makes insulin but can’t use it effectively. For the current study, the authors looked at type 2 diabetes among kids ages 10 and up.

Among that group in 2001, 3.4 kids in every 10,000 were diagnosed with type 2 diabetes, which increased to 4.6 per 10,000 in 2009, a 31 percent increase. This type of diabetes was most common among American Indian and black youth.

The results were published online Saturday in the Journal of the American Medical Association, to coincide with a presentation at the annual meeting of the Academic Pediatric Societies, held this year in Vancouver, Canada.

Though the study covered a large number of kids, it only included data from two years. So it’s hard to say there was a steady increase in diabetes among kids throughout the country over the same time period, the authors say.

Still, the increase they saw was larger than expected, according to Dabelea, especially given that other recent studies have found obesity rates in the U.S. have finally started to plateau.

Obesity, along with diet and lifestyle, is closely linked with type 2 diabetes.

“The obesity rates in the U.S. have been relatively stable since 2003-04 with a decline in rates recently, mainly in younger children rather than in older children, so I am not too surprised in the continued rise in type 2 (diabetes) in youth from 2001 to 2009, but I am hopeful that the rate of type 2 in youth will level off over the next five years,” Dr. Georgeanna J. Klingensmith told Reuters Health in an email.

Klingensmith, from the Barbara Davis Center for Childhood Diabetes at the University of Colorado School of Medicine in Aurora, was not part of the new study.

“I do think that we are better at diagnosing type 2 diabetes in youth today than we were 10-15 years ago, so part of the increase in type 2 diabetes may be related to improved detection of diabetes due to screening children at high risk,” she said.

The increase in type 2 diabetes seemed mostly to be driven by increases among minority populations, Dabelea said.

“Since minorities typically have less optimal (blood sugar) control, less access to care and more obesity, these are strong risk factors for type 2 diabetes,” she said.

Type 1 diabetes is not caused by obesity, so it could become more common regardless of U.S. obesity rates, Klingensmith said.

It’s still unclear what exactly causes type 1 diabetes, but it has been steadily increasing in European countries as well, Dabelea said.

“For type 1 we can’t really advise families to do anything differently,” she said.

“For type 2 diabetes on the other hand, since that’s so closely related to obesity it’s likely that implementing programs for kids and families being careful of certain things from very early in life is going to be important.”

To protect against type 2 diabetes, parents should help their children avoid excessive weight gain, eat less fried food and more fresh vegetables and get 30 to 60 minutes of exercise per day, Klingensmith said.

The lazy killer

PublishedApr 7, 2016, 2:16 am IST

UpdatedApr 7, 2016, 2:16 am IST

Diabetes kills more people around the world every year than terrorism.

 Diabetes is a silent killer, while terrorism is a loud one. (Representational image)

Do you have diabetes? You better find out. You live in the world’s diabetes hotspot. And if you live in a city, have a sedentary lifestyle and an unhealthy diet — especially lots of fried food and sugary drinks — you really better find out, fast. Not only should you find out for your own sake and act now, even the Prime Minister wants you to defeat diabetes. During his Mann ki Baat radio session last month, Narendra Modi spoke about diabetes. He said working to prevent, detect and treat diabetes is critical to the country’s development and asked fellow Indians to adopt a healthy lifestyle to beat the disease: “Please defeat diabetes this time. India was home to around 6.5 crore diabetics in 2014. The disease brings many other problems with it and it was responsible for more than three per cent deaths in our country.”

It was a timely reference. Beating diabetes is the theme of this year’s World Health Day, April 7. But let us be honest. Healthy lifestyle sounds like a great idea, everyone nods wisely, but far too many of us do not follow it. Many do not even quite understand what it means. Not everyone has the same ideas of how one goes about adopting a healthy lifestyle. If his radio address is any indicator, Mr Modi’s idea of a healthy lifestyle to beat diabetes is lots of yoga and exercise. That takes care of part of the problem. But why leave out unhealthy diet? Aren’t fizzy drinks, fast food, sugary snacks and so on equally responsible for diabetes and a host of other lifestyle related ailments?

Given the alarming rise in the prevalence of diabetes and other lifestyle diseases in this country, why doesn’t the political class talk more about Indians’ eating habits. Perspective. Diabetes kills more people around the world every year than terrorism. Diabetes and related symptoms kill more than three million people each year. According to the Economist, terrorist attacks claimed 32,700 lives last year. So why is this not big news? The only explanation — diabetes is a silent killer while terrorism is a loud one.

Terrorism leaves behind powerful images. It is hard to forget the terrifying pictures of the 2008 terror attacks in Mumbai — the billowing plumes of smoke from the top of the landmark Taj Hotel, the injured security men at Chhatrapati Shivaji Terminal railway station. And there have been so many more, before and after. Most Americans don’t just remember where they were on September 11, 2001, they remember the feel of being frightened. The anger, the memories linger. But diabetes? There are masses of statistics. Everyone knows someone who suffers from complications arising from diabetes. But chances are that it still comes across as a distant threat, not a killer.

To change your mind, consider these:

India has some 6.5 crore diabetics, as Mr Modi pointed out. This is second only to China. Most diabetes cases in our country are of Type 2. According to the World Health Organisation, in India 75,900 men and 51,700 women between 30 and 69 years died of diabetes last year. This may not seem to be a massive number in a country of 131 crore, but the real worry, as health professionals point out, is that a very large number of those with diabetes don’t even know that they have it. Even when they know it, far too often they do not take it seriously. Diabetes can lead to lots of complications, before death. It may cause blindness, kidney failure, loss of limbs...

Diabetes also digs a massive hole in one’s pocket due to the huge cost of treatment as well as reduced ability to work once the disease has advanced. Projections suggest that over 10 crore Indians between 20 and 79 years will be living with diabetes by 2030. The economic impact of this will be devastating, especially in a country where most people have to pay for their own medical treatment. According to the health ministry, out-of-pocket health expenses due to just lifestyle diseases, including diabetes, by individual households shot up from 31.6 per cent in 1995-96 to 47.3 per cent in 2004. Over half of what people spend out of their pockets goes on diagnostic tests, medicines and buying medical appliances. This can fell families.

Can we do something about this?

The good news is that we can. We know why there are more cases of diabetes and other lifestyle diseases than before — rapid urbanisation, sedentary lifestyle, unhealthy diet, and last but not the least, the very fact that we are living longer than before. Sedentary lifestyle and unhealthy diet are preventable at the individual level. Such prevention will also keep heart diseases — the other big killer — in check. At the policy level, urban planners have to take such lifestyle diseases into account and provide facilities for exercise.

Regular and adequate physical exercise is critical to arresting the spread of diabetes and other lifestyle diseases. Equally important is tackling unhealthy diet. But behaviour does not change easily. It changes only after sustained public awareness campaigns and a supportive policy environment. What we are seeing is the opposite. Since 1998, the consumption of sugary beverages has been increasing by 13 per cent every year. There is an urgent need to do something about this. A January 2014 study said that given the current sales of sugar-sweetened drinks in India, a 20 per cent increase in taxes will reduce diabetes by 1.6 per cent (4 lakh) between 2014 and 2023.

Why do we not seriously consider introducing additional taxes on sugar-laden drinks, alongside encouraging more physical activity? Without public awareness, a sin tax will not change things dramatically, but it will help. Diabetes can derail India’s emerging economy. It is not someone else’s problem; it is ours. We have to check its spread among the young generation. Health ministry officials are happy to share their laundry list of things that need to be done to beat diabetes and other lifestyle diseases. These include subsidy for healthy foods, steep prices of unhealthy food, control of salt and sugar content in processed foods, with labels indicating contents, replacement of trans-fats and saturated fats with polyunsaturated fats, provision of facilities and promotion of physical activity especially for the young, a firm policy for tobacco and alcohol, controlling air pollution and public awareness about healthy lifestyle.

It is a do-able list. But will it be done? What is the cost of ignoring the threat of diabetes and other lifestyle diseases? Quoting a 2013 Harvard study, the health ministry puts the cumulative economic cost associated with heart diseases, diabetes, chronic respiratory diseases and mental health between 2012 and 2030 at a mind-boggling Rs 38,302,200 crore at the 2010 value of the rupee. If that’s not a killer, what is?

The writer focuses on development issues in India and emerging economies. She can be reached at patralekha.chatterjee@gmail.com

 India sees alarming rise in diabetic population

DECCAN CHRONICLE. | TEENA THACKER

PublishedApr 7, 2016, 9:05 am IST

UpdatedApr 7, 2016, 2:28 pm IST

Moreover, the prevalence of diabetes has more than doubled for men in India and China.

 Keeping in view the dramatic rise in the number of diabetic cases, experts say that the probability of meeting the UN global target of 2025 is “virtually non-existent”. (Photo: AFP)

China, India and USA are among the top three countries with a high diabetic population. According to the recent Lancet study, the numbers climbed from 20.4 million in China in 1980 to 102.9 million in 2014 and in India from 11.9 million in 1980 to 64.5 million.

Ironically, the prevalence of diabetes has more than doubled for men in India and China (3.7 per cent to 9.1 per cent in India and 3.5 per cent to 9.9 per cent in China). It has also increased by 50 per cent among women in China (5.0 per cent to 7.6 per cent) and 80 per cent among women in India (4.6 per cent to 8.3 per cent). Worryingly, no other country saw a significant decrease in diabetes prevalence, claims the Lancet.

Ahead of World Health Day (April 7), the Lancet study disclosed that there has been a fourfold rise in the number of diabetics – from 108 million in 1980 to 422 million in 2014 with half of them living in India, China, USA, Brazil and Indonesia. The fastest increase has been seen in low and middle income countries. The prevalence of overweight people too jumped in China to 35.4 per cent and 21.4 in India. As per the data 7.3 per cent people in China are obese and 4.7 in India.

Keeping in view the dramatic rise in the number of cases, experts say that the probability of meeting the UN global target of 2025 is “virtually non-existent”. “Rates of diabetes are rising quickly in China, India, and many other low and middle income countries, and if current trends continue, the probability of meeting the 2025 UN global target is virtually non-existent,” said Professor Majid Ezzati, senior author from Imperial College London, London, UK.

The study includes data from 751 studies totalling 4.4 million adults in different world regions. According to the study, between 1980 and 2014, diabetes has become more common among men than women. In fact, the global age-adjusted prevalence of diabetes doubled among men (4.3% to 9.0%) and increased by two-thirds among women (5.0% to 7.9%).

Although there was an increase in overall rates (crude prevalence) of diabetes in many countries in Western Europe, age-adjusted rates were relatively stable suggesting that most of the rise in diabetes in Western Europe between 1980 and 2014 was due to the ageing population. In contrast, rates of diabetes increased significantly in many low and middle income countries – including China, India, Indonesia, Pakistan, Egypt and Mexico.

The study did not differentiate between type 1 and type 2 diabetes, but most (85-95%) of cases of adult diabetes are type 2 so the observed rise is likely to be due to increases in type 2 diabetes.

Major takeaways from the Lancet study:

*Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia. In the US, age-adjusted prevalence of diabetes in women increased by 50% (4.3% to 6.4%), and 80% in men (4.7% to 8.2%).

*In the UK, 4.9% of women had diabetes in 2014 (compared to 4.0% in 1980). Prevalence has increased more among men, from 4.8% in 1980 to 6.6% in 2014.

*Northwestern Europe has the lowest rates of diabetes among women and men, with age-adjusted prevalence lower than 4% among women and at 5-6% among men in Switzerland, Austria, Denmark, Belgium and the Netherlands.  Prevalence of diabetes was highest in Polynesia and Micronesia (age-adjusted prevalence is over 20% in men and women). In American Samoa, nearly one third of the adult population have diabetes.

*The greatest increases in diabetes prevalence were in Pacific island nations, followed by the Middle East and North Africa, in countries like Egypt, Jordan and Saudi Arabia.

*Pakistan, Mexico, Egypt and Indonesia are all now in the top 10 countries with the largest number of adults with diabetes. Age-adjusted prevalence of diabetes doubled in Pakistan (4.9 to 12.6% for men and 5.9 to 12.1% for women), Mexico (6.5 to 10.9% for men and 6.5 to11.5% for women), and Indonesia (3.2 to 7.4% for men and 4.1 to 8.0% for women) and nearly tripled in Egypt (6.5 to 16.0% for men and 8.0% to 19.8% for women).