Hi, I am Thorkild I. A.

Sorensen and I am
Professor of Metabolic and Clinical
Epidemiology at the Faculty of Health and
Medical Sciences at the University of
Copenhagen.
I'm also head of an institute of preventive medicine
based at one of the hospitals in
Copenhagen.
I'm trained as an MD and specialised in
Internal Medicine.
But since 1989 I have worked only in
Epidemiological Research.
In this introductory lecture, I will tell
you
about some basic aspects of the epidemiology
of diabetes.
More specifically, I'll try to give
answers to the following questions:
What is epidemiology?
How many suffer from diabetes?
Why is diabetes such a serious disease?
What are the biological mechanics of the
disease?
How is diabetes defined?
Which types of diabetes are there?
How is the distribution of diabetes?
By type?
Geographical regions?
By ethnicity?
By gender?
By age?
What is the global diabetes epidemic?
Which are the most important risk factors?
I'll encourage you to visit the
website of the International Diabetes
Federation, idf.org.
Where you may find a lot of useful and
important information.
And with regard to the epidemiology,
especially the
'Diabetes Atlas' which is very frequently
updated, is helpful,
what you find here on this website.
idf.org/diabetesatlas.
Parts of what I'm showing you comes from
this website
from the 2012 version and part of the 2013
version.
So, what is epidemiology?
Epidemiology of a disease is about the
occurrence of the disease in the
populations.
About what determines the occurrence,
and what the effects and impacts of the
disease are.
How many and who are suffering from the
disease.
What characterises them in comparison to
the rest of the population.

What are the possibilities for prevention

of the disease.
And what are the consequences of the
disease with respect to its prognosis.
Including co-morbidities and mortality.
These are the questions addressed in
epidemiology.
This, of course, overlapping with the
clinical aspects of the disease,
which is about how to diagnosis the
disease in the individual patients.
And how to improve their prognosis by
treatment.
Hence, these latter aspects, often called
clinical epidemiology.
How many sufferers from diabetes?
Let's make it clear, that there's no doubt
that diabetes is very common and very
serious disease.
It now affects between 350 and 400 million
people worldwide and the numbers are still
increasing,
and are expected to increase even further
in the future.
Approximately one in ten adult people
worldwide suffer from diabetes.
Unfortunately, about half of them do not
know it.
Why is diabetes such a serious disease?
It is because it's a chronic condition
that
leads to a risk of several other diseases.
Many of which are debilitating and also
followed by increased risk of dying.
Damages of the blood vessels, both the
bigger ones and the more peripheral,
smaller arteries.
And hence the organs and tissues receiving
blood via these vessels are frequent.
This may affect the eyes, the brain, the
heart, the kidney and the foot.
More recently it has become clear that
also
the risk of getting cancer and dementia is
increased.
Treatment of diabetes followed by
reduction in the risk
of these co-morbidities is feasible, but
also difficult, demanding and expensive.
The many patients with diabetes who don't
know they have
the disease may develop the co-morbidities
as a first manifestation.
You will hear more about this in subsequent
lectures.
But here I think we can make it clear that
we, from a
worldwide point of view, need to find out
how we best can prevent it.
This will require detailed knowledge of

the epidemiology of the disease.

What are the biological mechanisms of the
disease?
How do we define diabetes?
To do this properly and understand the
definition, we need
to know some basic biological mechanisms
about glucose and insulin.
This figure shows that glucose is an
essential energy of source for the body.
And in parts of the body, it is a main
source, for example the brain.
Your body needs insulin to transform
glucose into energy.
What is insulin?
It's a peptide hormone produced by and
secreted from the
so called beta cells in the small islets
of the pancreas.
Which you will learn much more about
later.
As shown here, insulin is crucial to get
the wheels running.
Insulin helps getting the glucose into the
cells, where the transformation to energy
takes place.
Keeping the cell alive and functioning.
Keeping the system running appropriately
is called glucose homeostasis.
If this is not working, you
may get diabetes.
On this background, we can now define the
disease and justify the definition
by knowledge about the biology of glucose
homeostasis and the role of insulin.
So, how is diabetes defined?
So here is the IDF definition.
Diabetes mellitus, or simply diabetes, is
a chronic
disease that occurs when the pancreas is
no longer
able to make insulin, or when the body
cannot make good use of the insulin it
produces.
Insulin is a hormone made by the pancreas,
that
acts like a key to the glucose originating
from the
food that we eat pass from the blood
stream into the cells in the body to
produce energy.
All carbohydrate foods are broken down
into glucose in the the blood.
Insulin helps glucose get into the cells.
Not being able to produce insulin or use
it effectively
leads to raised glucose levels in the
blood, known as hyperglycemia.
Over the long term high glucose levels are
associated with

damage to the body and failure of various

organs and tissues.
The measurements needed for making the
diagnosis of diabetes in
the individual patients will be dealt with
in later lectures.
Which types of diabetes are there?
As indicated in the definition, there are
several ways in which the system may fail.
You see here three major ways of
malfunctioning
that ends up in three different types of
diabetes.
Type one diabetes to the left.
Type two diabetes to the right.
And gestational diabetes at the bottom.
In type one diabetes, the pancreas does
not produce insulin.
In type two diabetes, the pancreas does
not
produce enough insulin or the insulin
cannot be processed.
Gestational diabetes is specific to
pregnant women, occurs
when the insulin is less effective than
otherwise.
However, these three main types can be
further subdivided in subtypes of
each of them, which you will learn more
about in later lectures.
Moreover, the delineation made between
them here is not clear cut.
For example, patients who eventually
develop
type one diabetes, may experience
intermittent secretion
of insulin in the beginning of the disease
until the secretion eventually stops.
Type two diabetes is also in the very late
stage like type one.
With a respect to how much insulin is
produced.
These type two patients are almost unable
to produce insulin in the final stages.
Several other rare types of diabetes are
defined by specific genetic defects.
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