Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, MS-F75, Atlanta, GA, 30341, USA.
Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
Diabetologia. 2019 Jan;62(1):3-16. doi: 10.1007/s00125-018-4711-2. Epub 2018 Aug 31.
In recent decades, large increases in diabetes prevalence have been demonstrated in virtually all regions of the world. The increase in the number of people with diabetes or with a longer duration of diabetes is likely to alter the disease profile in many populations around the globe, particularly due to a higher incidence of diabetes-specific complications, such as kidney failure and peripheral arterial disease. The epidemiology of other conditions frequently associated with diabetes, including infections and cardiovascular disease, may also change, with direct effects on quality of life, demands on health services and economic costs. The current understanding of the international burden of and variation in diabetes-related complications is poor. The available data suggest that rates of myocardial infarction, stroke and amputation are decreasing among people with diabetes, in parallel with declining mortality. However, these data predominantly come from studies in only a few high-income countries. Trends in other complications of diabetes, such as end-stage renal disease, retinopathy and cancer, are less well explored. In this review, we synthesise data from population-based studies on trends in diabetes complications, with the objectives of: (1) characterising recent and long-term trends in diabetes-related complications; (2) describing regional variation in the excess risk of complications, where possible; and (3) identifying and prioritising gaps for future surveillance and study.
近几十年来，几乎全球所有地区的糖尿病患病率都大幅上升。糖尿病患者人数或糖尿病病程延长的人数增加，可能会改变全球许多人群的疾病特征，特别是由于糖尿病特异性并发症（如肾衰竭和外周动脉疾病）的发病率更高。与糖尿病经常相关的其他疾病（包括感染和心血管疾病）的流行病学也可能发生变化，对生活质量、对卫生服务的需求和经济成本产生直接影响。目前对糖尿病相关并发症的国际负担和变化的了解甚少。现有数据表明，随着死亡率的下降，糖尿病患者的心肌梗死、中风和截肢率也在下降。然而，这些数据主要来自少数几个高收入国家的研究。其他糖尿病并发症（如终末期肾病、视网膜病变和癌症）的趋势则研究得较少。在这篇综述中，我们综合了基于人群的研究中关于糖尿病并发症趋势的数据，目的是：（1）描述糖尿病相关并发症的近期和长期趋势；（2）尽可能描述并发症的过度风险的区域差异；（3）确定并优先考虑未来监测和研究的差距。
