Abstract
Changes in human behaviour and lifestyle over the last century have resulted in a dramatic increase in the incidence of diabetes worldwide. The epidemic is chiefly of type 2 diabetes and also the associated conditions known as 'diabesity' and 'metabolic syndrome'. In conjunction with genetic susceptibility, particularly in certain ethnic groups, type 2 diabetes is brought on by environmental and behavioural factors such as a sedentary lifestyle, overly rich nutrition and obesity. The prevention of diabetes and control of its micro- and macrovascular complications will require an integrated, international approach if we are to see significant reduction in the huge premature morbidity and mortality it causes.
“Man may be the captain of his fate, but he is also the victim of his blood sugar” Wilfrid Oakley [Trans. Med. Soc. Lond. 78, 16 (1962)]
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 51 print issues and online access
196,21 € per year
only 3,85 € per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout




Similar content being viewed by others
References
Zimmet, P. Globalization, coca-colonization and the chronic disease epidemic: can the doomsday scenario be averted? J. Intern. Med. 247, 301–310 (2000).
Amos, A., McCarty, D. & Zimmet, P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabetic Med. 14, S1–S85 (1997).
King, H., Aubert, R. & Herman, W. Global burden of diabetes, 1995–2025. Prevalence, numerical estimates and projections. Diabetes Care 21, 1414–1431 (1998).
Astrup, A. & Finer, N. Redefining type 2 diabetes: 'diabesity' or 'obesity dependent diabetes mellitus'? Obesity Rev. 1, 57–59 (2000).
Shafrir, E. Development and consequences of insulin resistance: lessons from animals with hyperinsulinaemia. Diabetes Metab. 22, 131–148 (1997).
World Health Organization. Definition, Diagnosis and Classification of Diabetes mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus (Department of Noncommunicable Disease Surveillance, Geneva, 1999).
Zimmet, P. Diabetes epidemiology as a trigger to diabetes research. Diabetologia 42, 499–518 (1999).
Hennekens, G. & Buring, J. Epidemiology in Medicine (Little, Brown, Boston, 1987).
American Diabetes Association. Economic consequences of diabetes mellitus in the U.S. in 1997. Diabetes Care 21, 296–309 (1998).
Fagot-Gampagna, A. et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J. Pediatr. 136, 664–672 (2000).
Fagot-Campagna, A. & Narayan, K. Type 2 diabetes in children. Br. Med. J. 322, 377–387 (2001).
Songer, T. The economic costs of NIDDM. Diabetes/Metabol. Rev. 8, 389–404 (1992).
Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 329, 977–986 (1993).
United Kingdom Prospective Diabetes Study Group (UKPDS). Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 33). Lancet 352, 837–853 (1998).
Reichard, P., Nilsson, B.-Y. & Rosenqvist, U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N. Engl. J. Med. 329, 304–309 (1993).
Heart Outcomes Prevention Evaluation (HOPE) Study. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 355, 253–259 (2000).
Ohkubo, Y. et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res. Clin. Pract. 28, 103–117 (1995).
Pyörälä, K., Pedersen, T., Kjeksus, J., Faergerman, O. & Olsson, A. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes Care 20, 614–620 (1997).
Sacks, F., Pfeffer, M. & Moye, L. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial Investigators. N. Engl. J. Med. 335, 1001–1009 (1996).
Zimmet, P. The pathogenesis and prevention of diabetes in adults. Genes, autoimmunity, and demography. Diabetes Care 18, 1050–1064 (1995).
Pan, X. et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20, 537–544 (1997).
Tuomilehto, J. et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med. 344, 1343–1350 (2001).
Eastman, R., Javitt, J., Herman, W., Dasbach, E. & Harris, M. in Diabetes Mellitus: A Fundamental and Clinical Text (eds Le-Roith, D., Taylor, S. & Olefsky, J.) 621–630 (Lippincott-Raven, New York, 1996).
World Health Organization. Diabetes Mellitus: Report of a WHO Study Group (WHO, Geneva, 1985).
Harris, M. & Zimmet, P. in International Textbook of Diabetes Mellitus 2nd edn (eds Alberti, K., Zimmet, P. & DeFronzo, R.) 9–23 (Wiley, Chichester, 1997).
Shaw, J., Hodge, A., de Courten, M., Chitson, P. & Zimmet, P. Isolated post-challenge hyperglycaemia confirmed as a risk factor for mortality. Diabetologia 42, 1050–1054 (1999).
DECODE Study Group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. Br. Med. J. 317, 371–375 (1998).
Tominaga, M. et al. Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care 22, 920–924 (1999).
Perry, R. & Baron, A. Impaired glucose tolerance. Why is it not a disease? Diabetes Care 22, 883–884 (1999).
Zimmet, P. & Alberti, K. The changing face of macrovascular disease in non-insulin dependent diabetes mellitus in different cultures: an epidemic in progress. Lancet 350, S1–S4 (1997).
Alberti, K. G. M. M. Impaired glucose tolerance—fact or fiction. Diabetic Med. 13, 6–8 (1996).
American Diabetes Association Expert Committee. Report of the Expert Committee. Diabetes Care 20, 1183–1197 (1997).
Shaw, J. et al. Impaired fasting glucose or impaired glucose tolerance. What best predicts future diabetes in Mauritius. Diabetes Care 22, 399–402 (1999).
Groop, L. The molecular genetics of non-insulin dependent diabetes mellitus. J. Intern. Med. 241, 95–110 (1997).
Haffner, S. M., Stern, M. P., Hazuda, H. P., Mitchell, B. D. & Patterson, J. K. Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset on clinical diabetes? J. Am. Med. Assoc. 263, 2893–2898 (1990).
Reaven, G. Role of insulin resistance in human disease. Diabetes 37, 1595–1607 (1988).
Zimmet, P., Boyko, E., Collier, G. & de Courten, M. in The Metabolic Syndrome X Vol. 892 (eds Hansen, B., Saye, J. & Wennogle, L.) 25–44 (New York Academy of Sciences, New York, 1999).
Isomaa, B. et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24, 683–689 (2001).
Rosenbloom, A., Joe, J., Young, R. & Winter, W. Emerging epidemic of Type 2 diabetes in youth. Diabetes Care 22, 345–354 (1999).
American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 23, 381–389 (2000).
Ehtisham, S., Barrett, T. & Shaw, N. Type 2 diabetes mellitus in UK children—an emerging problem. Diabetic Med. 17, 867–871 (2000).
Kitagawa, T., Owada, M., Urakami, T. & Yamanchi, K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese school children correlates with an increased intake of animal protein and fat. Clin. Pediatr. 37, 111–116 (1998).
Dowse, G., Zimmet, P., Finch, C. & Collins, V. Decline in incidence of epidemic glucose intolerance in Nauruans: implications for the thrifty genotype. Am. J. Epidemiol. 133, 1093–1104 (1991).
Zimmet, P., Turner, R., McCarty, D., Rowley, M. & Mackay, I. Crucial points at diagnosis—NIDDM or slow IDDM. Diabetes Care 22, B59–B64 (1999).
de Courten, M., Bennett, P. H., Tuomilehto, J. & Zimmet, P. in International Textbook of Diabetes Mellitus 2nd edn (eds Alberti, K. G. M. M., Zimmet, P., DeFronzo, R. A. & Keen, H.) 143–170 (Wiley, Chichester, 1997).
Ramachandran, A., Snehalatha, C., Latha, E., Vijay, V. & Viswanathan, M. Rising prevalence of NIDDM in an urban population in India. Diabetologia 40, 232–237 (1997).
O'Dea, K. Westernisation, insulin resistance and diabetes in Australian Aborigines. Med. J. Aust. 155, 258–264 (1991).
Zimmet, P., Dowse, G., Finch, C., Serjeantson, S. & King, H. The epidemiology and natural history of NIDDM—lessons from the South Pacific. Diabetes/Metabol. Rev. 6, 91–124 (1990).
Tan, C., Emmanuel, S., Tan, B.-Y. & Jacob, E. Prevalence of diabetes and ethnic differences in cardiovascular risk factors. Diabetes Care 22, 241–247 (1999).
Chou, P., Chen, H. & Hsiao, K. Community-based epidemiological study on diabetes in Pu-Li, Taiwan. Diabetes Care 15, 81–89 (1992).
Pan, X.-R., Yang, W.-Y., Li, G.-W. & Liu, J. Prevalence of diabetes and its risk factors in China. National Diabetes Prevention and Control Cooperative Group. Diabetes Care 20, 1664–1669 (1997).
Zimmet, P. Kelly West Lecture 1991. Challenges in diabetes epidemiology—from West to the Rest. Diabetes Care 15, 232–252 (1992).
Neel, J. Diabetes mellitus: a thrifty genotype rendered detrimental by “progress”? Am. J. Hum. Genet. 14, 353–362 (1962).
Dowse, G. & Zimmet, P. The thrifty genotype in non-insulin-dependent diabetes. The hypothesis survives. Br. Med. J. 306, 532–533 (1993).
Collier, G. et al. Beacon: A novel gene involved in the regulation of energy balance. Diabetes 49, 1766–1771 (2000).
Hales, C. N. & Barker, D. J. P. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia 35, 595–601 (1992).
Harding, J. The nutritional basis of the fetal origins of adult disease. Int. J. Epidemiol. 30, 15–23 (2001).
Hattersley, A. & Tooke, J. The fetal insulin hypothesis: an alternative explanation of the association of low birthweight with diabetes and vascular disease. Lancet 353, 1789–1792 (1999).
Joseph, K. & Kramer, M. Review of the evidence on fetal and early childhood antecedents of adult chronic disease. Epidemiol. Rev. 18, 158–174 (1996).
Zimmet, P. & Lefebvre, P. The global NIDDM epidemic. Treating the disease and ignoring the symptom. Diabetologia 39, 1247–1248 (1996).
Zimmet, P. & Chitson, P. Non-Communicable Diseases in Health in the Commonwealth 74–80 (Kensington Publications, London, 2000).
The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care 22, 623–634 (1999).
Larkin, M. Diet and exercise delay onset of type 2 diabetes, say US experts. Lancet 358, 565 (2001).
UKPDS. Overview of 6 years' therapy of type II diabetes: a progressive disease (UKPDS 16). Diabetes 44, 1249–1258 (1995).
Sicree, R., Zimmet, P., King, H. & Coventry, J. Plasma insulin response among Nauruans: prediction of deterioration in glucose tolerance over 6 yrs. Diabetes 36, 179–186 (1987).
Mann, J. Stemming the tide of diabetes mellitus. Lancet 356, 1454–1455 (2000).
Bloom, B. Public-health priorities in the industrialised world. Lancet 356 (Suppl. 1), 50–51 (2000).
Bonetta, L. Scientists battle obesity overload. Nature Med. 7, 387 (2001).
McKinlay, J. & Marceau, L. US public health and the 21st century: diabetes mellitus. Lancet 356, 757–761 (2000).
Harrison, L., Kay, T., Colman, P. & Honeyman, M. in Diabetes in the New Millennium (eds Turtle, J. & Osato, S.) 85–100 (The Endocrinology and Diabetes Research Foundation of the University of Sydney, Sydney, 1999).
Atkinson, M. & Maclaren, N. The pathogenesis of insulin-dependent diabetes mellitus. N. Engl. J. Med. 331, 1428–1436 (1994).
Karvonen, M., Tuomilehto, J., Libman, I. & LaPorte, R. A review of the recent epidemiological data on the worldwide incidence of Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 36, 883–892 (1993).
Tuomilehto, J. et al. Epidemiology of childhood diabetes mellitus in Finland—background of a nationwide study of type 1 diabetes (insulin dependent) diabetes mellitus. Diabetologia 36, 70–76 (1992).
Tuomilehto, J. et al. Comparison of the incidence of insulin dependent diabetes mellitus among five Baltic populations during 1983–1988. Int. J. Epidemiol. 21, 518–527 (1992)
Tuomilehto, J. et al. Comparison of incidence of IDDM in childhood between Estonia and Finland, 1980–1988. Diabetes Care 14, 982–988 (1991).
Tuomilehto, J., Tuomilehto-Wolf, E., Zimmet, P., Alberti, K. & Knowler, W. in International Textbook of Diabetes Mellitus 2nd edn (eds Alberti, K., Zimmet, P., DeFronzo, R. & Keen, H.) 1799–1827 (Wiley, Chichester, 1997).
Myers, M., Mackay, I., Rowley, M. & Zimmet, P. Dietary microbial toxins and Type 1 diabetes—a new meaning for seed and soil. Diabetologia 44, 1199–1200 (2001).
Herold, K., Bloch, T., Vezys, V. & Sun, Q. Diabetes induced with low doses of streptozotocin is mediated by V beta 8.2+ cells. Diabetes 44, 354–359 (1995).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zimmet, P., Alberti, K. & Shaw, J. Global and societal implications of the diabetes epidemic. Nature 414, 782–787 (2001). https://doi.org/10.1038/414782a
Issue Date:
DOI: https://doi.org/10.1038/414782a
This article is cited by
-
Associations between type 1 diabetes and pulmonary tuberculosis: a bidirectional mendelian randomization study
Diabetology & Metabolic Syndrome (2024)
-
Type 1 diabetes, its complications, and non-ischemic cardiomyopathy: a mendelian randomization study of European ancestry
Cardiovascular Diabetology (2024)
-
Credibility of ChatGPT in the assessment of obesity in type 2 diabetes according to the guidelines
International Journal of Obesity (2024)
-
Ti3C2/Ni/Sm-based electrochemical glucose sensor for sweat analysis using bipolar electrochemistry
Microchimica Acta (2024)
-
Diabetische Nephropathie 2023 – Beginn eines neuen Zeitalters
Die Diabetologie (2024)