Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
Diabetologia. 2022 Jan;65(1):3-13. doi: 10.1007/s00125-021-05585-2. Epub 2021 Nov 27.
International trends in traditional diabetes complications (cardiovascular, renal, peripheral vascular, ophthalmic, hepatic or neurological diseases) and mortality rates are poorly characterised. An earlier review of studies published up to 2015 demonstrated that most data come from a dozen high-income countries (HICs) in North America, Europe or the Asia-Pacific region and that, in these countries at least, rates of acute glycaemic fluctuations needing medical attention and amputations, myocardial infarction and mortality were all declining over the period. Here, we provide an updated review of published literature on trends in type 2 diabetes complications and mortality in adults since 2015. We also discuss issues related to data collection, analysis and reporting that have influenced global trends in type 2 diabetes and its complications. We found that most data on trends in type 2 diabetes, its complications and mortality come from a small number of HICs with comprehensive surveillance systems, though at least some low- and middle-income countries (LMICs) from Africa and Latin America are represented in this review. The published data suggest that HICs have experienced declines in cardiovascular complication rates and all-cause mortality in people with diabetes. In parallel, cardiovascular complications and mortality rates in people with diabetes have increased over time in LMICs. However, caution is warranted in interpreting trends from LMICs due to extremely sparse data or data that are not comparable across countries. We noted that approaches to case ascertainment and definitions of complications and mortality (numerators) and type 2 diabetes (the denominator) vary widely and influence the interpretation of international data. We offer four key recommendations to more rigorously document trends in rates of type 2 diabetes complications and mortality, over time and worldwide: (1) increasing investments in data collection systems; (2) standardising case definitions and approaches to ascertainment; (3) strengthening analytical capacity; and (4) developing and implementing structured guidelines for reporting of data.
国际上传统糖尿病并发症（心血管、肾脏、周围血管、眼科、肝脏或神经系统疾病）和死亡率趋势的特征描述较差。对截至 2015 年发表的研究进行的早期综述表明，大多数数据来自北美、欧洲或亚太地区十几个高收入国家（HICs），至少在这些国家，需要医疗关注的急性血糖波动、截肢、心肌梗死和死亡率的发生率在这期间都呈下降趋势。在这里，我们对 2015 年以来成年人 2 型糖尿病并发症和死亡率的已发表文献进行了更新综述。我们还讨论了与数据收集、分析和报告相关的问题，这些问题影响了 2 型糖尿病及其并发症的全球趋势。我们发现，大多数关于 2 型糖尿病、其并发症和死亡率趋势的数据来自少数具有综合监测系统的 HICs，但至少有一些来自非洲和拉丁美洲的低收入和中等收入国家（LMICs）也参与了这项研究。已发表的数据表明，HICs 经历了心血管并发症发生率和糖尿病患者全因死亡率的下降。与此同时，随着时间的推移，糖尿病患者的心血管并发症和死亡率在 LMICs 中不断上升。然而，由于数据极其稀疏或各国之间的数据不可比，因此在解释来自 LMICs 的趋势时需要谨慎。我们注意到，病例确定方法以及并发症和死亡率（分子）和 2 型糖尿病（分母）的定义差异很大，这影响了对国际数据的解释。我们提出了四项关键建议，以更严格地记录全球范围内 2 型糖尿病并发症和死亡率的趋势：（1）增加对数据收集系统的投资；（2）标准化病例定义和确定方法；（3）加强分析能力；（4）制定和实施数据报告的结构化指南。
