Is there really an epidemic of diabetes?

Excerpt

Diabetologia has staged a debate as to whether there really is an epidemic of diabetes. As is often the case, the difference between the apparently opposing sides is less than it seems. For example, if ‘epidemic’ were considered in the commonly understood sense of an increase in total or crude prevalence, neither side would seriously argue that such an epidemic does not exist. Epidemiologists often consider disease prevalence after taking account of age by standardisation or stratification. However, total prevalence is relevant from a health service perspective, since the total number of cases drives demand and fills clinics. The marked increase in the total number of cases of diabetes predicted by the various widely quoted estimates is based on projections from age-and sex-specific prevalence in different countries multiplied by the forecasts of the population age/sex structure. Thus, an ageing population becomes the most important determinant of the predicted increase. Dramatic as these are, such estimates of the future total burden of diabetes may prove conservative if incidence rises in parallel with obesity, or mortality falls with improved health care. …