国际糖尿病联合会2021年糖尿病图册 IDF Diabetes Atlas

537million

peopleworldwide

havediabetes

IDED!gpG=GeV=Jge了o了T

10thedition

IDFDiabetesAtlas

10thedition

Tableofcontents

1

Acknowledgements

2

Forewords

4

Summary

6

Introduction

10Chapter1Whatisdiabetes?

12Type1diabetes

14

Type2diabetes

15

Impairedglucosetoleranceandimpairedfastingglucose

15

Diagnosticcriteriafordiabetes

15

Hyperglycaemiainpregnancy

17

Othertypesofdiabetes

18

References

20Chapter2Methods

22

Interpretationofestimates

22

Gatheringandselectingdatasources

23

Estimatingdiabetesprevalenceandprojectionsforthefuture

24

Extrapolatingdata

24

Estimatingconfidenceintervals

24

Standardisationofestimates

24

Estimatingundiagnoseddiabetesprevalence

25Estimatingtheincidenceandprevalenceoftype1diabetesinchildrenandadolescents

26Estimatingtheincidenceandprevalenceofyouth-onsettype2diabetes

27Estimatingtheprevalenceofimpairedglucosetoleranceandimpairedfastingglucose

27

Estimatingtheprevalenceofhyperglycaemiainpregnancy

28

Estimatingdiabetes-relatedmortality

28

Estimatingtheeconomicimpactofdiabetes

29

References

30Chapter3Theglobalpicture

34

Diabetesprevalence

38

Undiagnoseddiabetes

41

Diabetesincidence

43Diabetesincidenceandprevalenceinchildrenand

adolescents

46

Incidenceandprevalenceofyouth-onsettype2diabetes

48

Adult-onsettype1diabetes

50

Impairedglucosetoleranceandimpairedfastingglucose

54

Hyperglycaemiainpregnancy

55

Diabetes-relatedmortality

57

Economicimpactofdiabetes

62

References

vi|IDFDiabetesAtlas2021–10thedition

|

64Chapter4COVID-19anddiabetes

66

Regionaldistribution

68

DiabetesasariskfactorforCOVID-19-relatedhospitalisation

68

DiabetesandCOVID-19-relatedmortality

68RiskfactorsforsevereCOVID-19-relatedoutcomesinthe

diabetespopulation

69

Limitationsofconductedresearch

69

Summary

70

References

72Chapter5Diabetesbyregion

74

Africa

78

Europe

82

MiddleEastandNorthAfrica

86

NorthAmericaandtheCaribbean

90

SouthandCentralAmerica

94

South-EastAsia

98

WesternPacific

102Appendices

104

Countrysummarytables

128

Abbreviationsandacronyms

129

Glossary

133

Listoffigures,mapsandtables

IDFDiabetesAtlas2021–10thedition|

|

vii

Nopartofthispublicationmaybereproduced,

translatedortransmittedinanyformorbyanymeans

withoutthepriorwrittenpermissionoftheInternational

DiabetesFederation.Thecopyrightpermissionformis

availableat:/e-library/welcome/

copyright-permission.html

Firstedition,2000

Secondedition,2003

Thirdedition,2006

Fourthedition,2009

Fifthedition,2011

Sixthedition,2013

Seventhedition,2015

Eighthedition,2017

Ninthedition,2019

OnlineversionofIDFDiabetesAtlas:

ISBN:978-2-930229-98-0

Unlessindicatedotherwiseallphotographsinthis

editionoftheIDFDiabetesAtlasweretakenbythe

followingPanosPicturesphotographers:Australiastills

andvideo–AlanaHolmberg,Bangladeshstillsand

video–GMBAkash,Brazilstillsandvideo–Lalode

Almeida,Lebanonstillsandvideo–AndrewMcConnell,

SouthAfricastillsandvideo–TommyTrenchard,UK

stills–MaryTuner,UKvideo–GregFunnell,USAstills

andvideo–IanWillms

TechnicaleditinganddesignbyBerkeleyCommunications:

Theboundariesandnamesshown,andthedesignations

usedinthisreportdonotimplytheexpressionofany

opinionwhatsoeveronthepartoftheInternational

DiabetesFederationconcerningthelegalstatusofany

country,territory,cityorareaorofitsauthorities,or

concerningthedelimitationofitsfrontiersorboundaries

viii|IDFDiabetesAtlas2021–10thedition

|

Acknowledgements

IDFDiabetesAtlas,10thEditionCommittee

DiannaJMagliano(Co-chair),EdwardJBoyko(Co-chair),Beverley

Balkau,NoelBarengo,ElizabethBarr,AbdulBasit,DominikaBhata,ChristianBommer,GillianBooth,BertrandCariou,JulianaChan,HongzhiChen,LeiChen,TawandaChivese,DanaDabalea,HemaDivakar,DaisyDuan,BruceBDuncan,MichaelFang,GhazalFazli,CourtneyFischer,KathrynFoti,LaercioFranco,EdwardGregg,LeonorGuariguata,AkhilGupta,AnthonyHanley,JessicaLHarding,WilliamHHerman,CheriHotu,CeciliaHøgfeldt,ElbertHuang,AdamHulman,StevenJames,AliciaJJenkins,SeungJinHan,CalvinKe,EmmaLKlatman,ShihchenKuo,JeanLawrence,DinkyLevitt,XiaLi,LorraineLipscombe,PazLopez-DorigaRuez,AndreaLuk,RonaldCMa,JayanthiManiam,LouiseMaple-Brown,Jean-ClaudeMbanya,NatalieMcGlynn,FernandoMijaresDiaz,HiliaryMonteith,AyeshaMotala,EstelleNobecourt,GrahamDOgle,KatherineOgurstova,RichardOram,BigeOzkan,EmilyPapadimos,ChrisPatterson,MedaPavkov,CatePihoker,JustinPorter,CamillePowe,AmbadyRamachandran,GojkaRoglic,MaryRooney,JulianSacre,ElizabethSelvin,BaijuShah,JonathanEShaw,DavidSimmons,CarolineStein,JannetSvensson,OliveTang,JustinEchouffoTcheugui,JincyVarghese,AmeliaWallace,PandoraLWander,DonaldWarne,MahmoudWerfalli,SarahWild,JenciaWong,YutingXie,XilinYang,LiliYuen,PhilipZeitler,PingZhang,SuiZhang,XingeZhang,ZhiguangZhou

Editorialteam

EdwardJBoyko,DiannaJMagliano

SuviKaruranga,LorenzoPiemonte,PhilRiley

PouyaSaeedi,HongSun

Contributors

MikkelPapeDysted,BalázsEsztergályos,SanjuGautam,BrunoHelman,MoritzPinkepank,AdilsonRandi,AgusSalim,KatherineWallis,BeatrizYáñezJiménez,MargauxYsebaert

GLOBODIABResearchConsortium

Data

ThelistofstudiesonwhichestimatesintheIDFDiabetesAtlasarebased,andthoseconsideredbutnotused,canbefoundat:

Corporatesponsors

TheIDFDiabetesAtlas10theditionhasbeenproducedthankstoeducationalgrantsfromNovoNordisk,Pfizer-MSDAlliance,andSanofi.

IDFDiabetesAtlas2021–10thedition

||

1

1

Foreword

TheInternationalDiabetesFederation(IDF)isproudtolaunchthe10theditionoftheIDFDiabetesAtlas.Wehavebeenpublishingglobalestimatesoftheprevalenceofdiabetesforjustover20years.Duringthistime,thepublicationhasestablisheditselfasthemostcitedandtrustedsourceontheglobalimpactofdiabetesandanindispensabletoolfordiabetesadvocacy.Witheachnewedition,thepopularityofthepublicationgrows.Eacheditionisfreelyavailableonlineanddownloadedmorethan250,000times.ThepublicationoftheIDFDiabetesAtlas10theditionistimely,anditsevidenceandmessagesaremorerelevantthanever.

IwishIcouldreportthatthepasttwodecadeshavewitnesseddecisiveactiontotacklediabetesandthattherisingtideofdiabeteshasfinallyturned.IwishIcouldsharenewsthatuniversalhealthcoveragehasgivenmorethanhalfabillionpeoplelivingwithdiabetesworldwideaccesstothecaretheyneedandcanafford.IwishIcoulddeclarethat,100yearsafteritsdiscovery,therapeuticinsulinisnowwithinreachofallthosewhoneedittosurvive.Alas,Icannot.Rather,Imustrepeatthemessagethatdiabetesisapandemicofunprecedentedmagnitudespirallingoutofcontrol.

Globally,morethanonein10adultsarenowlivingwithdiabetes.Moreover,thereisagrowinglistofcountrieswhereone-in-fiveorevenmoreoftheadultpopulationhasdiabetes.Sincethefirsteditionin2000,theestimatedprevalenceofdiabetesinadultsaged20–79yearshasmorethantripled,fromanestimated151million(4.6%oftheglobalpopulationatthetime)to537million(10.5%)today.Withoutsufficientactiontoaddressthesituation,wepredict643millionpeoplewillhavediabetesby2030(11.3%ofthepopulation).Iftrendscontinue,thenumberwilljumptoastaggering783million(12.2%)by2045.

Therisingnumberofpersonswithdiabetesisdrivenbymultiplefactors–peoplearelivinglongerandwehavehigherqualitydata.However,muchofthediabetesburdenremainshidden.Almosteverytimewefindnewandmoreaccuratedata,ourestimateshavetoberevisedupwards.

TheevidencepresentedinthiseditionwillnotcovertheimpactofCOVID-19onpeoplelivingwithdiabetes.Thisimpactwillbecomeclearerinsubsequenteditions.Wedoknowthatthevirushasplacedanadditionalburdenonmanywithdiabetes.Wehaveseenthatpeoplelivingwithdiabetescanbemoresusceptibletotheworstcomplications.Thereisconcernthatthecurrentsituationmaycauseariseintheprevalenceofdiabetesanditscomplicationsoverthecomingyears.Wehaveyettoseetheimpactoflockdowns,shieldingandthepotentialriskofCOVID-induceddiabetesonpopulationhealth.

Diabetesmustbetakenseriouslynotonlybyindividualslivingwith,orathighriskof,theconditionbutalsobyhealthcareprofessionalsanddecision-makers.Diabetesremainsaseriousandgrowingchallengetopublichealthandplacesahugeburdenonindividualsaffectedandtheirfamilies.Peoplelivingwithdiabetesareatriskofdevelopingseveraldebilitatingandlife-threateningcomplications,leadingtoanincreasedneedformedicalcare,reducedqualityoflifeandprematuredeath.Globally,diabetesranksamongthetop10causesofmortality.Whyisnotenoughbeingdonetopreventdiabetesanditscomplicationsandprovidethebestavailablecaretopeoplewiththecondition?

Ibelievetherearesomeraysofhope.Thecentenaryofthediscoveryofinsulinhasattractedgreaterattentiontothediabetescause.InApril2021,theWorldHealthOrganizationlauncheditsGlobalDiabetesCompact,markinganincreasedfocusondiabetes.WepledgedoursupporttothedevelopmentandimplementationoftheCompactthroughouradvocacyandawarenessactivities.Soonafter,alandmarkResolutionhighlightingtheimportanceofprevention,diagnosisandcontrolofdiabeteswasagreedbytheWorldHealthAssembly.Theseareimportantstepstowardsaddressingthecontinuedandrapidriseofdiabetesprevalence,particularlyincountriesthatdonothaveanationaldiabetesplanorcoverageforessentialhealthservices.

Thereremainmanycountriesforwhichwedonothavedataordataofsufficientqualitytocompletetheglobalpicture.TheIDFDiabetesAtlaswillcontinuetoencouragethedevelopmentofhigh-qualitydiabetesdatainallcountriestofillthegaps.Moreresearchisrequiredtogeneratesolidevidencetoimproveunderstandingoftheimpactofdiabetesandinformnationalandglobalhealthtargets.IDFiscommittedtofosteringfurtherepidemiologicalresearchindiabetesincollaborationwithalignedorganisationsandpartners.

Oursincerehopeisthatthis10theditionoftheIDFDiabetesAtlaswillhelpIDFmembersandthewiderdiabetescommunityadvocateformoreactiontoidentifyundiagnoseddiabetes,preventtype2diabetesinpeopleatrisk,andimprovecareforallpeoplewithdiabetes.United,theglobaldiabetescommunityhasthenumbers,theinfluenceandthedeterminationtobringaboutmeaningfulchange.

ProfessorAndrewBoulton

President2020–2022InternationalDiabetesFederation

2|IDFDiabetesAtlas2021–10thedition

|

1

Forovertwodecades,theIDFDiabetesAtlashasbeenaleadingsourceofinformationontheglobalimpactofdiabetes.Itswidespreadpopularityandreachistestamenttoitsvalueforpeoplewithapersonalorprofessionalinterestindiabetes.

The10theditionoftheIDFDiabetesAtlasreportsacontinuedglobalincreaseindiabetesprevalence,confirmingdiabetesasasignificantglobalchallengetothehealthandwellbeingofindividuals,familiesandcountries.Itisofferedforcarefulandconsidereduseinthesupportofcontinuedandenhancedactiontoimprovethelivesofpeoplewithdiabetesandthoseatriskofdevelopingthecondition.

Estimatingtheglobalimpactofdiabetesischallengingasrawdataarisesfromcountry-specificstudiesconductedusingdifferentmethodologies.WhilesomeefforthasbeenmadetostandardisetheapproachtomeasuringdiabetesprevalencebytheintroductionoftheWorldHealthOrganisation(WHO)STEPwiseapproach,notallcountrieshaveadopteditandthediabetesdataavailableremainnotalwaysofhighqualityandcanbeheterogeneous,evenwithinthesamecountry.Thisisfurthercomplicatedbythevariousdiagnostictestsemployedforthediagnosisofdiabetes,theuseofdifferingdiagnosticcriteria(WHOvsAmericanDiabetesAssociation)andarangeofdiagnosticmethodologies(plasmaorcapillaryglucose,hemoglobinA1c(HbA1c),self-report).Otherareasofpotentialdivergencearethesamplingframesused,responseratesachieved,age-groupsreportedandgeographicalscopeofeachstudy.ItshouldalsobenotedthatthediagnosticcriteriafordiabetesusedforestimationsintheIDFDiabetesAtlasisepidemiological,whichdiffersfromthecriteriausedforaclinicaldiagnosisofdiabetesthatrequirestwoabnormaltestsintheabsenceofsignsandsymptoms.

Ourinabilitytoprovidecomprehensivecoverageofglobaldiabetesprevalenceisalsoduetothesheerlackofdatainsomepartsoftheworld.Inthe9theditionoftheIDFDiabetesAtlas,only144outof215countries(67%)hadqualitydataderivedfromin-countrystudies.Estimatesfortheremaining71countriesweremodelledfromothercountrieswithsimilarcharacteristics,anecessarycompromisethatallowstheIDFDiabetesAtlastopresentacompletepictureofprevalenceforeachcountryandterritory.Forthe10thedition,wehaveintroducedmorechangestoimprovethequalityandrelevanceofourestimates.Wehaveremovedthemajorityofstudiespublishedbefore2005.Thismeanswenowhavefewerdatasources,butthoseincludedaremorerepresentativeofthecurrentprevalenceofdiabetes.Thislossofdatasourcesisoffsetsomewhatbytheinclusionofnewdata

fromnationalpopulation-baseddiabetesregistries.

Withtherecentemergenceofbigdatagenerallyand

specificallyintheareaofdiabetes,itwasimportantfor

theIDFDiabetesAtlastostayabreastofthegeneration

of‘realworld,realtime’diabetesdataandmodifyour

methodologytoincludeit.

PreviouseditionsoftheIDFDiabetesAtlashave

useddifferentsourcesofrawdata,madedifferent

assumptions,andfocusedondifferentmetricsofburden.

Therefore,ourestimatesmayvaryacrosseditionsdueto

improvementsinmethodologyanddatasources.Thismay

leadtounexpectedchangesinestimatesforacountryor

regionthatdonotreflectarealchange.Thisshouldbe

takenintoaccountwhencomparingestimatesfromthe

10theditionwithpreviouseditions.

Forecastingfuturediabetesprevalencecanbechallenging

andtheprojectionsareonlyasgoodasthedatainputs

whichinformthem.TheIDFDiabetesAtlastakesthe

viewthatsimplepredictionsthatonlyconsiderchanging

distributionsofage,sexandurban/ruralresidenceare

likelytobethemostrobust.Itisacknowledgedthatother

factorssuchastrendsinobesityandoverweightare

importantwhenpredictingdiabetesprevalence.Wehave

planstoincludetheseinthenextedition.

TheCOVID-19pandemichasdominatedourlivesoverthe

last18months,soitwouldhavebeenremissoftheIDF

DiabetesAtlasnottoaddresstherelationshipbetween

COVID-19anddiabetes.Wehaveincludedachapterthat

summarisesthedatacurrentlyavailablegloballyandwill

looktoupdateitinfutureeditions.

The10theditionoftheIDFDiabetesAtlaswasproduced

underuniquecircumstances.Thepandemicdelayedits

start,prohibitedface-to-facecontactwithmembersofthe

IDFExecutiveOfficeandimposeddifferentandnovelways

ofworking.Itwouldnothavebeenpossiblewithoutthe

tirelesscommitmentandeffortsofthetheEditorialTeam

andmembersoftheIDFDiabetesAtlasCommittee,to

whomweareextremelygrateful.

ProfessorDiannaMagliano

Chair

IDFDiabetesAtlasCommittee

(10thEdition)

ProfessorEdwardBoyko

Chair

IDFDiabetesAtlasCommittee

(10thEdition)

IDFDiabetesAtlas2021–10thedition

||

3

Summary

Map1Numq?Jo}d?odl?wi斗Vpieq?斗?swoJlpwip?enpd?Jla」\?8ionincocC-co臼S)co-L6(?eJs(

World

NorthAmerica&Caribbean(NAC)

Europe(EUR)

WesternPacific(WP)

2045

2030

2021

783

643

537

million

million

million

46%

increase

2045

2030

2021

63million

57million

51million

24%

increase

2045

2030

2021

69million

67million

61million

13%

increase

2045

2030

2021

260

238

206

million

million

million

27%increase

South&CentralAmerica(SACA)

Africa(AFR)

MiddleEast&NorthAfrica(MENA)

South-EastAsia(SEA)

2045

2030

2021

49million

40million

32million

50%

increase

2045

2030

55

33

million

million

134%

2045

2030

136million

95million

87%

2045

2030

152million

113million

68%

2021

24

million

increase

2021

73million

increase

2021

90million

increase

4|IDFDiabetesAtlas2021–10thedition|

The10theditionconfirmsthatdiabetesisoneofthefastestgrowingglobalhealthemergenciesofthe21stcentury

Diabetesisamajorhealthissuethathasreachedalarminglevels.Today,morethanhalfabillionpeoplearelivingwithdiabetesworldwide.

TheIDFDiabetesAtlasisanauthoritativesourceofevidenceontheprevalenceofdiabetes,relatedmorbidityandmortality,aswellasdiabetes-relatedhealthexpendituresatglobal,regionalandnationallevels.TheIDFDiabetesAtlasalsointroducesreaderstothepathophysiologyofdiabetes,itsclassificationanditsdiagnosticcriteria.Itpresentstheglobalpictureofdiabetesfordifferenttypesofdiabetesandpopulationsandprovidesinformationonspecificactionsthatcanbetaken,suchasprovenmeasurestopreventtype2diabetesandbestmanagementofallformsofdiabetestoavoidsubsequentcomplications.

Thecredibilityofdiabetesestimatesreliesontherigorousmethodsusedfortheselectionandanalysisofhigh-qualitydatasources.Foreveryedition,theIDFDiabetesAtlasCommittee–composedofthematicexpertsfromeachofthesevenIDFRegions–reviewsthemethodsunderlyingtheIDFDiabetesAtlasestimatesandprojectionsandavailabledatasources.ThemethodshavebeenexplainedindetailbyGuariguataetal,¹andmorerecently,bySunetal.²Themajorityofthedatasourcesusedarepopulation-basedstudiesthathavebeenpublishedinpeer-reviewedjournals.Inthisedition,wehavealsoincludeddatafromnationaldiabetesregistries.Withtheestablishmentofelectronicrecordsandnationalregistriesbecomingmorecommon,weanticipatemoredatalikethesewillbefeaturedinthefuture.Furthermore,informationfromnationalhealthsurveys,includingsomeoftheWorldHealthOrganization(WHO)STEPwiseapproachtoSurveillance(STEPS),areusedwheretheymeetinclusioncriteria.

Findingsofthecurrent10theditionconfirmthatdiabetes

isoneofthefastestgrowingglobalhealthemergencies

ofthe21stcentury(seeMap1).In2021,itisestimated

that537millionpeoplehavediabetes,andthisnumber

isprojectedtoreach643millionby2030,and783

millionby2045.Inaddition,541millionpeopleare

estimatedtohaveimpairedglucosetolerancein2021.

Itisalsoestimatedthatover6.7millionpeopleaged

20–79willdiefromdiabetes-relatedcausesin2021.

Thenumberofchildrenandadolescents(i.e.upto19

yearsold)livingwithdiabetesincreasesannually.In

2021,over1.2millionchildrenandadolescentshave

type1diabetes.Directhealthexpendituresdueto

diabetesarealreadyclosetoonetrillionUSDandwill

exceedthisfigureby2030.

ThisIDFDiabetesAtlas10theditionalsoshows

thathyperglycaemiainpregnancy(HIP)affects

approximatelyoneinsixpregnancies.Another

causeforalarmistheconsistentlyhighpercentage

(45%)ofpeoplewithundiagnoseddiabetes,which

isoverwhelminglytype2.Thishighlightstheurgent

needtoimprovetheabilitytodiagnosepeoplewith

diabetes,manyofwhomareunawaretheyhave

diabetes,andprovideappropriateandtimelycarefor

allpeoplewithdiabetesasearlyaspossible.

References

1GuariguataL,WhitingD,WeilC,UnwinN.TheInternationalDiabetesFederationdiabetesatlasmethodologyforestimatingglobalandnationalprevalenceofdiabetesinadults.DiabetesResClinPract.2011Dec;94(3):322–32.

2SunH,SaeediP,KarurangaS,PinkepankM,OgurtsovaK,DuncanBB,etal.IDFDiabetesAtlas:Global,regionalandcountry-leveldiabetesprevalenceestimatesfor2021andprojectionsfor2045.DiabResClinPract.2021(inpress).

IDFDiabetesAtlas2021–10thedition||5

Introduction

Keymessages

■TheIDFDiabetesAtlashasprovidedessentialinformationontheestimatedandprojectedglobalprevalenceofdiabetesformorethantwodecades

■Itdrawsattentiontotheimportanceandgrowingimpactofdiabetesinallcountriesandregions

Aproudhistoryofinformation

disseminationandadvocacy

Sinceitsfirstedition,publishedin2000,the

IDFDiabetesAtlashasprovidedrobustestimatesoftheprevalenceofdiabetesbycountry,IDFRegionandglobally.Sinceitssecondedition,publishedin2003,ithasalsoprojectedtheseestimatesintothefuture.Indoingso,ithasservedasanadvocacytool,notonlyforthequantificationoftheimpactof