Cockram C S
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Hong Kong Med J. 2000 Mar;6(1):43-52.
The Asia-Pacific region is at the forefront of the current epidemic of diabetes. There are currently more than 30 million people with diabetes in the Western Pacific region alone. The World Health Organization predicts that this number will rise dramatically by the year 2025, by which time India and China may each face the problem of dealing with 50 million affected individuals. The problem in the region results from a combination of large population size with rapidly rising prevalence rates, particularly of type 2 diabetes mellitus. Although much heterogeneity exists, rising prevalence rates are being seen throughout the region and appear to be closely associated with westernisation, urbanisation, and mechanisation. The risk for diabetes appears to result from a combination of genetic predisposition and lifestyle change. The most important lifestyle changes relate to changes in dietary habits and physical activity and diabetes risk, particularly in younger individuals, is associated with the development of obesity and particularly central obesity. In some populations, for example Chinese, the relationship between diabetes and weight gain begins to appear at levels of body weight that would not be conventionally regarded as representing obesity. The increasing trend for type 2 diabetes to develop in young people is of particular concern. In children and adolescents in some parts of the region, type 2 diabetes now outnumbers type 1 diabetes by a ratio of 4:1. In view of the severity of the long-term complications of diabetes, the health consequences of this epidemic will become increasingly devastating and threaten to overwhelm the health care systems in the most vulnerable countries. There is an urgent need for prioritisation of diabetes as a key issue by governments throughout the region. Diabetes prevention programmes can be justified on economic, as well as humanitarian grounds. At the level of primary prevention, such programmes can be linked to other non-communicable disease prevention programmes which also target lifestyle-related issues.
亚太地区处于当前糖尿病流行的前沿。仅西太平洋地区目前就有超过3000万糖尿病患者。世界卫生组织预测，到2025年这个数字将大幅上升，届时印度和中国可能各自面临应对5000万受影响个体的问题。该地区的问题是由于人口众多加上患病率迅速上升，尤其是2型糖尿病。尽管存在很大的异质性，但整个地区的患病率都在上升，而且似乎与西方化、城市化和机械化密切相关。糖尿病风险似乎是遗传易感性和生活方式改变共同作用的结果。最重要的生活方式改变与饮食习惯和身体活动的变化有关，糖尿病风险，尤其是在年轻人中，与肥胖尤其是中心性肥胖的发展有关。在一些人群中，例如中国人，糖尿病与体重增加之间的关系在传统上不被视为肥胖的体重水平时就开始显现。2型糖尿病在年轻人中发病的上升趋势尤其令人担忧。在该地区一些地方的儿童和青少年中，2型糖尿病现在与1型糖尿病的比例为4:1。鉴于糖尿病长期并发症的严重性，这种流行病对健康的影响将越来越具有破坏性，并有可能压垮最脆弱国家的医疗保健系统。该地区各国政府迫切需要将糖尿病作为一个关键问题予以优先考虑。糖尿病预防计划在经济和人道主义方面都是合理的。在一级预防层面，此类计划可与其他也针对与生活方式相关问题的非传染性疾病预防计划联系起来。
