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Risk factors for type 2 diabetes mellitus

Authors
David K McCulloch, MD
R Paul Robertson, MD
Section Editor
David M Nathan, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

Type 2 diabetes mellitus is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion. Its pathogenesis is poorly understood, but is heterogeneous and both genetic factors affecting insulin release and responsiveness and environmental factors, such as obesity, are important.

The prevalence of and risk factors for type 2 diabetes will be reviewed here. The pathogenesis, including genetic susceptibility, and the diagnostic criteria for diabetes are discussed elsewhere. (See "Pathogenesis of type 2 diabetes mellitus" and "Clinical presentation and diagnosis of diabetes mellitus in adults".)

LIFETIME RISK/PREVALENCE

It is estimated that diabetes affects 387 million people worldwide [1]. Among adults in the United States, the estimated overall prevalence of diabetes ranges from 12 to 14 percent, depending on the criteria used [2]. An analysis of data from the National Health Interview Survey found a doubling in the prevalence of type 2 diabetes from 1990 to 2008, with no significant change during 2008 to 2012 [3]. Other national databases, such as the National Health and Nutrition Examination Survey (NHANES), have reported an increase in the prevalence of diabetes over two decades (from 9.8 to 12.4 percent), but have confirmed the relatively stable (approximately 12 percent) prevalence between 2008 and 2012 [2,4]. Given the marked increase in childhood obesity, there is concern that the prevalence of diabetes will continue to increase substantially. (See "Definition; epidemiology; and etiology of obesity in children and adolescents", section on 'Epidemiology'.)

The prevalence of diabetes is higher in certain populations. Using data from a national survey for people aged 20 years or older, the prevalence of type 2 diabetes in the United States (2010 to 2012) was 7.6 percent in non-Hispanic whites, 9.0 percent in Asian Americans, 12.8 percent in Hispanics, 13.2 percent in non-Hispanic blacks, and 15.9 percent in American Indians/Alaska Natives [5]. In an analysis of data from the 2011 to 2014 Behavioral Risk Factor Surveillance System, the prevalence of self-reported diabetes was higher among Asians (9.9 percent) and Native Hawaiians or other Pacific Islanders (14.3 percent) than in white individuals (8 percent) [6]. Outside the United States, type 2 diabetes is most prevalent in Polynesia and other Pacific islands (approximately 25 percent) [1,7]. In a 2010 cross-sectional survey of almost 100,000 adults in China, the prevalence of diabetes was estimated to be 11.6 percent, whereas the prevalence of prediabetes (impaired glucose tolerance [IGT], impaired fasting glucose [IFG], or A1C between 5.7 and 6.4 percent) was 50 percent [8].

ABNORMAL GLUCOSE METABOLISM

Although the lifetime risk of type 2 diabetes is high, our ability to predict type 2 diabetes in the general population is limited. However, abnormal glucose metabolism can be documented years before the onset of overt diabetes. Although the risk of developing type 2 diabetes follows a continuum across all levels of abnormal glycemia, when classified categorically, the individuals demonstrably at highest risk include those with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or a glycated hemoglobin (A1C) level of 5.7 to 6.4 percent (39 to 46 mmol/mol) (table 1) [9,10]. The criteria for defining diabetes and impaired glucose regulation are reviewed in greater detail separately. (See "Clinical presentation and diagnosis of diabetes mellitus in adults".)

                                            

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