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Canadian Journal of Cardiology

Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review

  • Alanna Weisman
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Ghazal S. Fazli
    Affiliations
    The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
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  • Ashley Johns
    Affiliations
    Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
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  • Gillian L. Booth
    Correspondence
    Corresponding author: Dr Gillian L. Booth, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada. Tel.: +1-416-864-6060 ×77448.
    Affiliations
    Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
    Search for articles by this author
Published:March 12, 2018DOI:https://doi.org/10.1016/j.cjca.2018.03.002

      Abstract

      Currently, the global prevalence of diabetes is 8.8%. This figure is expected to increase worldwide, with the largest changes projected to occur in low- and middle-income countries. The aging of the world’s population and substantial increases in obesity have contributed to the rise in diabetes. Global shifts in lifestyles have led to the adoption of unhealthy behaviours such as physical inactivity and poorer-quality diets. Correspondingly, diabetes is a rapidly-increasing problem in higher- as well as lower-income countries. In Canada, the prevalence of diabetes increased approximately 70% in the past decade. Although diabetes-related mortality rates have decreased in Canada, the number of people affected by diabetes has continued to grow because of a surge in the number of new diabetes cases. Non-European ethnic groups and individuals of lower socioeconomic status have been disproportionately affected by diabetes and its risk factors. Clinical trials have proven efficacy in reducing the onset of diabetes in high-risk populations through diet and physical activity interventions. However, these findings have not been broadly implemented into the Canadian health care context. In this article we review the evolving epidemiology of type 2 diabetes, with regard to trends in occurrence rates and prevalence; the role of risk factors including those related to ethnicity, obesity, diet, physical activity, socioeconomic status, prediabetes, and pregnancy; and the identification of critical windows for lifestyle intervention. Identifying high-risk populations and addressing the upstream determinants and risk factors of diabetes might prove to be effective diabetes prevention strategies to curb the current diabetes epidemic.

      Résumé

      La prévalence mondiale du diabète est actuellement de 8,8 %. Ce nombre est censé augmenter à l’échelle mondiale, et les variations les plus importantes devraient se produire dans les pays à revenu faible et moyen. Le vieillissement de la population mondiale et les augmentations considérables du taux d’obésité ont contribué à la hausse de la prévalence du diabète. Les modifications au mode de vie à l’échelle mondiale ont favorisé l’adoption de comportements malsains tels que la sédentarité et de piètres régimes alimentaires. Par conséquent, le diabète est un problème en croissance rapide dans les pays à revenu plus élevé, mais aussi dans ceux à revenu plus faible. Au Canada, la prévalence du diabète a augmenté d’environ 70 % au cours des dix dernières années. Bien que les taux de mortalité liée au diabète aient diminué au Canada, le nombre de personnes atteintes de diabète a continué d’augmenter à cause de la hausse du nombre de nouveaux cas de diabète. Les groupes d’origine ethnique non européenne et les personnes ayant un faible statut socioéconomique ont été touchés de manière disproportionnée par le diabète et ses facteurs de risque. Des essais cliniques ont montré que des interventions ciblant l’alimentation et l’activité physique pouvaient réduire efficacement l’apparition du diabète chez les populations à risque élevé. Cependant, ces résultats n’ont pas été totalement appliqués dans le contexte des soins de santé canadiens. Dans cet article, nous passons en revue trois volets: l’épidémiologie en évolution du diabète de type 2 en ce qui a trait aux tendances des fréquences et de la prévalence; le rôle des facteurs de risque, y compris ceux liés à l’origine ethnique, à l’obésité, à l’alimentation, à l’activité physique, au statut socioéconomique, au prédiabète et à la grossesse; et l’établissement de fenêtres critiques pour les interventions liées au mode de vie. La reconnaissance des populations à risque élevé et la prise en charge des déterminants en aval et des facteurs de risque de diabète pourraient s’avérer des stratégies efficaces de prévention du diabète pour enrayer l’épidémie actuelle de la maladie.
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