Three Patterns of Rising type 2 Diabetes Prevalence in the World: Need to Widen the Concept of Prevention in Individuals into Control in the Community

Abstract

This paper analyses the patterns of rising type 2 diabetes prevalence in the world with their plausible 
reasons focusing on control measures. It shows existence of combinations of three patterns of rises, viz. 
gradual, rapid and accelerated, leading to prevalence of 4–9% now in Europids, 14–20% in migrant or 
urbanized Asian Indians, Arabs, Chinese, Africans, and Hispanics and above 30–50% in indigenous 
peoples of Canada, USA, Australia and Pacifi c regions. It demonstrates that though ageing, sedentary 
life and obesity of people explain gradual rise in Europids, effects of rapid transition in nutritional 
status of population and of maternal hyperglycaemia on the risk of offspring developing glucose 
intolerance further add to rapid and accelerated rises respectively. It recommends that current 
approach of primary prevention of diabetes in people, particularly with impaired glucose tolerance, 
advocating modest loss of excess weight and moderate-intensity exercise, be widen into concept of 
control in community covering rapid and accelerated rises. The control programmes essentially are 
vigorous educational campaign and planning to improve nutritional status of women of childbearing 
age in rural and poorer sectors of society and to keep weight of adults within recommended 
body mass index (BMI) range, like 18.5–22.9 kg/m
2
for Asian and other similar populations. The 
population-based approaches with examples, considering developing countries, are outlined. The 
paper emphasizes the importance of keeping prepregnancy weight optimum, preferably below 
the middle of recommended BMI range, to avoid even sub-clinical maternal hyperglycemia, for 
prevention and control of accelerated rise in any population. 
Key Words: diabetes, diabetes control, diabetes epidemiology, diabetes prevention, prepregnancy weight