The growth of the disease is especially visible in developing countries of medium or medium-low socioeconomic level and among women.
Before even being able to ask any question, two of the sources consulted to write this report clutch to the other side of the phone, with millimeter accuracy, the same reflection: “It is a very good study because it reflects worldwide what we see every day tomicro level in our consultations ”.
The study that both experts refer to was recently published in The British Medical Journal and analyzes the evolution during the last three decades (1990-2019) in 204 countries of the world of the incidence of type 2 diabetes in the adolescent and young population (15-39 years), the one that less likely should have to develop this chronic pathology.
The results are the least worrying.In just 30 years, the prevalence of type 2 diabetes in these population groups has increased by 56.4%, going from an incidence of 117 cases per 100,000 inhabitants in 1990, one of 183 in 2019.
"As our findings point out, early starting diabetes is an increasing public health problem," explains Fan Wang, professor of the Department of Epidemiology at the Faculty of Public Health of the Harbin Medical University (China) and one of the main authors of the investigation, which emphasizes that this trend, general worldwide, is especially visible in developing countries of medium or medium-low socioeconomic level.
Something that could be explained by the rapid social and economic changes that have occurred in these countries and that have introduced and generalized in them unhealthy life habits, Wang explains: “For example, the consumption of sugary drinks duplicated by far between theMexican adolescents from 12 to 18 years between 1999 and 2006. In our study we find similar patterns of change in many countries and an increase in the proportion of comorbidities attributable to diets rich in soft drinks, processed meat and red meat ”.
As the researcher argues, the worrying of these early starting data of type 2 diabetes, in addition to the present scenario, lies in the future load of the disease for health systems as the population ages.“An earlier start of type 2 diabetes is associated with a longer duration of hyperglycemia and faster progress in the pathological process (including severe resistance to insulin and worsening of the function of the beta cells of the pancreas), whatthat leads to worse glycemic control and a greater risk of complications. ”
disability and deaths
Complications that are already observed in the study in disability rates and deaths associated with early start diabetes, mainly in developing countries and especially among women under 30 years.According to Fan Wang, the rapid economic growth experienced in these decades by these nations of medium and medium-low socioeconomic level has brought with it a change in the spectrum of diseases, so that the morbidity load has quickly gone from showing a predominance of diseasesTransmissible, maternal, neonatal and nutritional, to an increase in noncommunicable diseases and injuries."In these countries, universal health coverage levels for noncommunicable diseases were much lower than those of communicable or neonatal diseases, which means that changes in health systems were slower than epidemiological changes," reflects the expert.
Ana Cebrián, spokesman for the Diabetes Working Group of the Spanish Society of Family and Community Medicine (SEMFYC), seems"Especially significant" the gender perspective offered by the study, since it shows that at the international level women under 30 years have a worse quality of life related to diabetes, and higher disability and mortality rates.
“The Journal of the American Society of Cardiology has already published a study on the significant increase in chronic pathology in women and on gender inequality in access to diagnosis and treatment.This study shows us that in many countries the situation of women with diabetes is even worse.We have a gender inequality in cardiovascular pathology in general and in in particular diabetes and this study offers a lot of light in this regard, ”says Cebrián.
His opinion is rewarded Wang: “We suspect that pregnancy and polycystic ovary syndrome in women, which are associated with insulin resistance, could contribute in part to the differences between sexes.But we also found that the greatest charge of disease in women with type 2 diabetes was shown in countries with a low socioeconomic index, which could indicate that in less developed countries girls and women have less access to care servicesMedical and worse glycemia control. ”
obesity as the main cause
The main risk factor attributable to the increase in the incidence of early onset diabetes is overweight and obesity, regardless of the country's socioeconomic level, as noted by the authors of the investigation.Although in the study they found a lower proportional contribution of some risk factors for the development of type 2 diabetes that varied according to the regions, such as air pollution by environmental particles and smoking in countries with a high sociodemographic index and poor diets in fruit and fruitAir pollution due to solid fuels in homes in countries with a low sociodemographic index.
"Humanity has thousands and thousands of years, but in the last 30 we have experienced a brutal change in lifestyles, reflected above all in sedentary lifestyle, in poor diet and stress," adds Cristóbal Morales, endocrinologist of the University HospitalVirgen Macarena of Seville and member of the Spanish Diabetes Society (SED), which points out that obesity rates are fired with this new lifestyle and, with them, the incidence of type 2 diabetes is also triggered. “It is a diseasesocial.We live in an obesogenic world that is a cultivation broth for the development of this type of pathologies, ”he says.
The figures show it.According to the latest WHO data, corresponding to 2016, since 1975 obesity rates have almost tripled throughout the world.In that year there were more than 340 million children and adolescents overweight or obesity and the figure shot up to almost 650 million in the case of adults (13% of the world's population).
It is a social disease.We live in an obesogenic world that is a cultivation broth for the development of this type of pathologies ”
With regard to Spain, the data of the Obesity Global Observatory report that 16% of the population over 15 years of age suffers obesity.23.3% of those under 16 are overweight and 17.3% have obesity, according to the latest 2019 update of the Food Study, Physical Activity, Child Development and Obesity (Aladdin) of the Food and Nutrition Security Agency(Aesan).
To stop what has already been baptized as a global diabhesity epidemic (term coined by Dr. Paul Zimmet in 2001 to visualize the intimate relationship between type 2 diabetes and obesity), Cebrián highlights the importance of developing prevention policies: “We cannot changerealitySocioeconomic of each country, not even that of each neighborhood, but we can raise awareness among the population with accessible information and adapted to each reality.Preventive politics must be done from schools, from families, etc., because it is shown that poor food in children's stages has a lot of impact on the incidence of obesity and diabetes. ”
Morales, on the other hand, coincides with the importance of using resources in prevention: "every inverted euro is many euros of savings for the health system."In addition, he points out the need to develop in Spain a National Obesity Plan that covers from childhood to old age: "We need a long -term political consensus to change this trend in the future."
In that national plan, the endocrinologist also highlights the importance of investing in early diagnosis, treatments and formation of patients.“These patients who have type 2 diabetes from young people are very high risk.We must educate them therapeutically from minute one, since they have to be aware of the importance of changing their life habits, especially to lose weight, ”says Morales.
Professor Fan Wang, from a more global perspective, points to the importance of developing countries to implant in their territories some public health interventions already implemented in countries with the highest socio -economic level and that have proven to be effective, such as the taxto cigarettes and the regulation of air quality.
“Countries in the stage of rapid socioeconomic change can learn from these successful initiatives.As for the less developed countries socioeconomically, measures are recommended to improve household conditions and the availability, accessibility and affordability of healthy foods ”.
The author of the study finally indicates the need to consider the gender differences shown by the study in the formulation of public policies."According to what our study shows, effective prevention and control of type 2 diabetes in women under 30 years of age should be strengthened, especially in the least developed regions," he concludes.
