The incidence rate dropped by 10%!

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Guide: Diabetes prevention ushered in an important turning point? A recent study published in the journal Lancet Diabetes Endocrinol shows that since 2010, the incidence of type 2 diabetes has shown a significant decline in more than a dozen middle- and high-income countries/regions (a decrease of 1.
1% to 10.
8%).

However, some controversies have also arisen-is the incidence rate decline, is "the initial success of diabetes prevention" or is there another reason? The prevalence and incidence of diabetes mellitus The prevalence refers to the sum of new and old cases over a period of time; the incidence represents the sum of new cases over a period of time.

 In the past few decades, the prevalence of diabetes has risen sharply worldwide, and the assessment of the total burden of diabetes often focuses on the description of the prevalence of diabetes.

However, the prevalence rate is affected by both the morbidity rate and the survival rate of patients.
The statistics are often rough and may mislead the understanding of the true disease control status.

 In contrast, the incidence rate helps to better understand the changing trends of diabetes risk in recent years.

 An inflection point is emerging? The incidence of diabetes is declining in most middle- and high-income countries/regions! Recently, the journal Lancet Diabetes Endocrinol published a related study that included 24 items from 21 countries/regions (3 in the United States, 2 in Israel, and 1 in each of the remaining countries/regions, involving data for at least one year after 2009.
A total of 23 items) related to summary data of general diabetes and type 2 diabetes (T2DM) diagnosis information.

A total of 22 million cases of diabetes diagnosis and up to 5 billion person-years of follow-up data are included.

Two of the countries/regions are middle-income, and the rest are high-income.

 1.
The incidence rate is flat or decreasing-19 out of 23 reports.
Since 2010, 19 of the 23 reports have shown a trend of decreasing or flat incidence of diabetes (Figure 1): including the United States (Medicare data), Taiwan, China, Italy, the United States (NHIS data), Canada, Israel (CHS), South Korea, Israel (MHS), Hong Kong, the Netherlands, France, Scotland, Norway, Hungary, Denmark, Spain, Australia, Latvia, United Kingdom, Russia, onset in T2DM The rate of decrease is from -1.
1% to -10.
8%.

 2.
Incidence rate rises-only 4 out of 23.
At the same time, there are data showing that the incidence rate is on the rise: in the United States (KPNW data), Singapore, Lithuania and Ukraine, the annual incidence rate of T2DM has increased by 0.
9% to 5.
6%.

Figure 1 The incidence of T2DM in most countries/regions is stable or decreasing (age-standardized, gender-standardized, per 1,000 person-years).
Hong Kong and Taiwan, my country, the incidence of T2DM has shown a significant downward trend.
For Asian populations, this study included a total of Data from 4 countries/regions (including Hong Kong, Singapore, South Korea, and Taiwan), among which Hong Kong, Taiwan and South Korea have shown a significant decline in the incidence of T2DM after 2010, but Singapore, which belongs to Asia, has shown Obvious upward trend.

 There is controversy: Is the declining incidence rate "the initial success of diabetes prevention" or is there another reason? Researchers believe that there are several reasons that can partly explain the observed reduction or decline in the incidence of diabetes, but it has not been possible to conclude that it must be the improvement brought about by "diabetes prevention work.
"
 Diabetes prevention work may have a positive impact: Researchers pointed out that multi-level T2DM prevention activities carried out around the world may have a positive impact, including suggesting changes to the lifestyle of people at high risk of T2DM, raising people’s health awareness, and increasing exercise , Improving the living environment and imposing taxes on certain food and beverages.

A study in the United States reported that taxation has reduced the intake of sugary beverages and fats, reduced the purchase of unhealthy foods, and the overall energy intake of the population has also declined slightly.

 The prevalence of obesity has declined in some countries, such as Scotland, where the incidence of diabetes has stabilized, and the incidence of obesity has also stabilized.

In contrast, in the United States, although early research suggests that the rate of increase in obesity may slow down, recent data show a small increase.

 Controversy 1: The declining incidence is related to "incorporating HbA1c into the diagnostic criteria"? From 2009 to 2010, the WHO introduced HbA1c as an alternative method for diagnosing diabetes.

There has been evidence that compared with OGTT, HbA1c screening has higher specificity, but lower sensitivity, which can lead to a larger proportion of missed diagnoses and a relatively small amount of misdiagnosis.

In short, there are fewer diabetic patients identified by HbA1c than OGTT.
In this regard, some scholars have suggested that it may be the main reason for the decline in the incidence of diabetes.

 However, the author of this study pointed out that OGTT is not particularly commonly used in clinical applications, and as the most commonly used indicator for diagnosing diabetes, fasting blood glucose, its detection ability is equivalent to HbA1c.

In addition, unlike fasting blood glucose or OGTT, HbA1c can be performed in a non-fasting state, which will increase the number of people participating in diagnostic tests, but may increase the number of confirmed cases.

 Data from Israel shows that within a period of time after the introduction of HbA1c, the overall blood glucose test rate has not decreased (except for a small decrease in people aged 60 or older), and the number of people screened for diabetes has generally increased.

Although the blood glucose and HbA1c tests of the population covered by the relevant health care service data sources have increased, the incidence of diabetes is still on a downward trend for most of the time.

 Controversy 2: Is the incidence rate falling because the "diagnostic threshold" has changed? In 1997, the diagnostic threshold of fasting blood glucose for diabetes was adjusted from 7.
8mmol/L to 7.
0mmol/L.
In view of the fact that a large number of people reached the diagnostic threshold instantly, the incidence rate will rise significantly, and then there will be a period of decline.
This investigation Does the result happen to be in the "declining" phase? The authors of this study believe that the decline in the diagnostic threshold may indeed lead to a period of decline in the incidence rate after the "exploding", but the change in the diagnostic threshold in 1997 is unlikely to explain the continuous and gradual decline in the incidence of diabetes after 15 years.
.

 Summary of this article In summary, this study shows that in most of the countries/regions included in the data (mainly high-income countries/regions), the incidence of diabetes has been stable or declining in recent years.

Although HbA1c screening may have an impact, this change is unlikely to be the only reason for the decline in the incidence of diabetes.

Prevention strategies, the implementation of public health education, and other factors may have a positive impact.

However, this study did not include most low- and middle-income countries, and further exploration is needed in the future.

 Yimaitong compiled and compiled from: [1] Dianna J Magliano, Lei Chen, Rakibul M Islam, Bendix Carstensen, et al.
Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings[J].
Lancet Diabetes Endocrinol.
2021;9:203–11.
[2]HbA1c Misclassifies Patients in US Diabetes Screening Program.
Elsevier Global Medical News.
2011.
7.
22.
Contribution email: tougao@medlive.
cn