Before asking any questions, two of the sources consulted to write this report traced the same reflection on the other side of the phone with near perfect accuracy: “It’s a great study because it’s the first one around the world.” reflects what we see every day at a micro level in our consultations”. The study to which both experts refer was recently published in british medical journal and analyzes the evolution of the incidence of type 2 diabetes in adolescent and youth populations (15–39 years) in 204 countries of the world during the past three decades (1990–2019), which should be the lowest probability by age. Chronic pathology of the development of this type of diabetes. The results are worrying to say the least. In just 30 years, the prevalence of type 2 diabetes in these population groups has increased by 56.4%, from an incidence of 117 cases per 100,000 inhabitants in 1990 to one in 183 in 2019.
“As our findings suggest, early-onset type 2 diabetes is a growing public health problem,” said Fan Wang, a professor in the Department of Epidemiology at the Faculty of Public Health at Harbin Medical University. and one of the lead authors of the research, which highlights that this trend, while common around the world, is particularly visible in developing countries of middle or medium-low socioeconomic levels. Wang points out that some of this can be explained by the rapid social and economic changes taking place in these countries and how unhealthy lifestyle habits have been introduced and normalized in them: “For example, sugary drinks among Mexican teenagers. consumption more than doubled among 12- to 18-year-olds between 1999 and 2006. In our study we found a similar pattern of change in several countries and an increase in the proportion of comorbidities due to a diet rich in soft drinks, processed meat and red meat. Saw it.
As the researchers argue, what is worrying about these data on early-onset type 2 diabetes, in addition to the current scenario, lies in the future burden of the disease for health systems as the population ages. “Earlier onset of type 2 diabetes is associated with longer duration of hyperglycemia and more rapid progression of the disease process (including severe insulin resistance and impaired pancreatic beta cell function), leading to poorer glycemic control and an increased risk of complications.”
disability and death
Some of the complications that have already been observed in studies increase disability and mortality associated with the onset of type 2 diabetes, mainly in developing countries and especially in women under 30 years of age. According to Fan Wang, the rapid economic growth experienced in these decades by these countries with medium and medium-low socioeconomic status has brought with it a change in the spectrum of diseases, with disease burden increasingly shifting from showing disease prevalence to It is done. Increase in communicable, maternal, neonatal and nutritional diseases, non-communicable diseases and injuries. “In these countries, the level of universal health coverage for non-communicable diseases was much lower than for communicable or neonatal diseases, meaning that changes in health systems were slower than epidemiological changes,” the expert explains.
Ana Cebrian, spokeswoman for the diabetes working group of the Spanish Society of Family and Community Medicine (CemFYC), found the gender perspective proposed by the study “particularly important” because it shows that internationally women under 30 are worse off. poor quality of life related to diabetes, and higher rates of disability and mortality.
“The Journal of the American Society of Cardiology published a study a few years ago on the significant increase in chronic pathology in women and the gender disparity in access to diagnosis and treatment. The situation is even worse. We have a gender disparity in cardiovascular pathology in general and in diabetes in particular, and this study sheds a lot of light on the matter”, explains Cebrian.
Her opinion is supported by Wang: “We suspect that pregnancy in women and polycystic ovary syndrome, which are associated with insulin resistance, may contribute to the differences between the sexes. But we also found that women with type 2 diabetes have a higher risk of disease.” The highest burden of diabetes was in countries with low socioeconomic index, which may indicate that girls and women in less developed countries have less access to care services, medical conditions and poor glycemic control.
Obesity as the main reason
The main risk factors leading to an increase in the incidence of early-onset type 2 diabetes, regardless of country’s socioeconomic level, are overweight and obesity, the study authors point out. Although the study found a small proportional contribution of some risk factors to the development of type 2 diabetes, which differed by region, such as air pollution from environmental particles and smoking in countries with a high socio-demographic index and Diets low in fruit and air pollution from solid fuels in households in countries with a low sociodemographic index.
“Humanity is thousands and thousands of years old, but in the last 30 years we have experienced a brutal change in lifestyle, reflected in a sedentary lifestyle, poor diet and stress,” says Cristóbal Morales, endocrinologist at the University Hospital. ” Virgen Macarena of Seville and a member of the Spanish Diabetes Society (SED), who points out that obesity rates skyrocketed with this new lifestyle and with them, the incidence of type 2 diabetes skyrocketed. social. We live in an obese world which is a breeding ground for the development of this type of pathology”, he affirms.
The figures prove it. According to the latest WHO data, as of 2016, worldwide obesity rates have nearly tripled since 1975. In that year there were more than 340 million children and adolescents who were overweight or obese, and in the case of adults (13% of the world population), the figure reached almost 650 million.
It is a social disease. We live in an obese world which is a breeding ground for the development of this type of pathology”
Cristóbal Morales, Virgen Macarena University Hospital of Seville
With regard to Spain, data from the Global Obesity Observatory shows that 16% of the population over the age of 15 suffers from obesity. According to the latest 2019 update of the Agency for Food Safety and Nutrition’s (AESAN) Food, Physical Activity, Child Development and Obesity (ALLADINO) study, 23.3% of children under the age of 16 are overweight and 17.3% are obese.
To prevent what has been dubbed a global epidemic of diabetes (a term coined by Dr. Paul Zimet in 2001 to visualize the close relationship between type 2 diabetes and obesity), Cebrian stressed the importance of developing prevention policies. Highlighted: “We cannot change the socioeconomic reality of each country, not even of each neighborhood, but we can raise awareness among the population with accessible information adapted to each reality. Implement preventive policy from schools, families, etc. This is necessary, as it has been shown that poor nutrition in childhood has a great impact on the incidence of obesity and diabetes.
Morales, for his part, agrees on the importance of using resources in prevention: “Every euro invested means many euros saved for the health system.” Furthermore, he points to the need to develop a national obesity plan in Spain that covers from childhood to old age: “We need a political consensus with a long-term view to reverse this trend in the future.” In this national plan, the endocrinologist also highlights the importance of investing in early diagnosis, treatment, and patient training. “These patients who have type 2 diabetes from an early age are at a very high risk. You have to educate them medically from the first minute, because they have to be aware of the importance of changing their lifestyle, especially to lose weight”, emphasizes Morales.
Professor Fan Wang, from a more global perspective, points to the importance of developing countries implementing some public health interventions in their own regions that have already been implemented in countries with higher socioeconomic levels and that have proven to be effective , such as taxing cigarettes and regulating air quality. “Countries in a phase of rapid socioeconomic change can learn from these successful initiatives. For less socioeconomically developed countries, measures to improve household conditions and the availability, access and affordability of healthy foods are recommended .
Finally, the authors of the study state the need to consider the gender differences shown by the study in the formulation of public policies. “Our study suggests that effective prevention and control of type 2 diabetes in women under 30 should be further strengthened, especially in less developed regions,” they concluded.
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