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Trends in Diabetes Prevalence, Incidence, and Mortality in Ontario, Canada 1995-2005: A Population-based Study

... a study review by Robert J. Goldberg, PhD, contributing editor of PROCOR

Authors: LL Lipscombe, JE Hux
Reference: Lancet 2007; 369: 750-56, www.thelancet.com

The study below examines the increase in prevalence and incidence rates of diabetes among residents of Ontario, Canada, during a recent 10-year period. The findings suggest that much work remains to be done with regards to the prevention of this highly prevalent condition.

Problem addressed: Changing trends in the magnitude and mortality associated with diabetes, from a broad population-based perspective.

The purpose of study was to examine recent decade long trends in the magnitude and death rates associated with diabetes among residents of Ontario, Canada. The location of study was Toronto, Ontario, Canada. The study design: Cross-sectional and longitudinal.

Results: Data for this study were derived from the Ontario diabetes database. This is a large regional disease registry, which collects information from hospital and physician's claims records for adult Ontario residents (population ~12 million) who had a diagnosis of diabetes over the 10-year period between 1995 and 2005. Any person who had at least one hospital admission, or two physician claims with a diagnosis of diabetes within two years, were included in this large observational database. Individuals eligible for coverage under the government funded Ontario health plan are included in this administrative health care database, which essentially includes all Ontario residents.

Over the period under study, there was a marked increase in the prevalence of diabetes in residents of Ontario (4.9% in 1995; 8.9% in 2005); in terms of absolute numbers, more than 388,000 Ontario residents carried a diagnosis of diabetes in 1995 whereas approximately 827,000 individuals were diagnosed with diabetes in 2005. Increases in the prevalence rates of diabetes were observed in men and in women and in younger as well as older adults. The incidence rates of diabetes also increased between 1997 (6.6/1,000 population) and 2003 (8.2/1,000 population) when the incidence rates of diabetes were able to be calculated in this study population based on predefined case criteria. These increases were observed in men and in women in the different age strata examined. On the other hand, the crude as well as age and sex adjusted all cause mortality rates in patients with diabetes declined by approximately one quarter between 1995 and 2005 with these encouraging declines observed in men and in women.

Conclusions: Despite often stated references to the emerging "epidemic" of diabetes in developed as well as in developing countries, there are relatively little published data that describe changing trends in the magnitude and mortality associated with diabetes, particularly from a more generalizable population-based perspective. Inasmuch, the present study provides important and contemporary data into this much-needed area. Consistent with published data from other population settings, as well as the latest report from the WHO which presents data showing that the number of people worldwide with diabetes increased from 30 million in 1985 to 171 million in 2000 [1], the prevalence and incidence rates of diabetes increased among residents of this large Canadian province during a recent 10-year period, with these increases observed in all demographic groups examined. The annual prevalence rates of diabetes increased by approximately 6% while slightly lesser increases were noted in new onset diabetes over the period under study. Of particular concern, if the present rates continue, the investigators estimate that approximately one in every 10 Ontario adults will be diagnosed with diabetes before the year 2010.

The findings from this large population-based disease registry suggest that much work remains to be done with regards to the prevention of this highly prevalent condition. This includes directed measures toward the principal risk factors associated with diabetes, most notably obesity, and use of broad population-based and individual strategies designed to enhance lifestyle and nutritional practices that are associated with the development of this chronic condition.

Additional reference: 1. World Health Organization. Global Strategy on diet, physical activity and health: diabetes. 1 Jan 2006. full article

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