Examples from EUCID data: diabetes prevalence and incidence, overweight and diabetes mortality

This section focuses on data collected in the general population. In total, five indicators are included in this category:

• Prevalence of diabetes
• Incidence of diabetes age 0-14 years
• BMI (body mass index)
• Impaired fasting glucose
• Mortality due to diabetes

As examples, data are reproduced here on the prevalence and incidence of diabetes, on overweight, and on diabetes mortality.

Prevalence of diabetes ranges 3.3% - 7.3%

The population prevalence of diabetes ranges from 3.3% to 7.3% and from 2.6% to 7.6% when age-standardized. Three different data sources were used. See Prevalence of diagnosed diabetes in the general population, all ages per 1000 individuals and Prevalence of diagnosed diabetes in the general population, all ages, standardized, per 1000 individuals.

The prevalence rates shown in the EUphact on Diabetes, derived from the estimates of the IDF, range roughly between 5% and 10%. This is substantially higher than the values found by EUCID. The reason is that the IDF data are based on the oral glucose tolerance test and thus include previously undiagnosed diabetics.

Annual incidence in ages 0-14 ranges from 15 to 60 per 100,000 of the population

For the annual incidence ages 0-14, see ‘Crude annual incidence rate of diabetes /100.000 population 0-14 years and Standardised annual incidence rate of diabetes /100.000 population 0-14 years.

12 Countries were able to provide data on the incidence of diabetes in children 0 to 14 years of age in the EUCID project. There is a wide variation in the incidence of diabetes in children reported amongst the countries. After standardisation, the countries that are historically known for high incidence are Finland and Sweden, but Scotland and Romania as having a high incidence came as a surprise. When subdivided, the data show an increase in incidence with age until 10-14 years old. Scotland had the highest incidence in the group of 10-14 years of age.

Only 5 countries were able to provide data specifically for type 2 diabetes in children. The increase in type 2 diabetes in children is reported to be a growing problem.

Prevalence of overweight, including obesity, ranges 38% - 59%

For the data on overweight and obesity, see Crude prevalence of overweight and obesity in the general population aged 25-74 years and Standardized prevalence of overweight and obesity in the general population aged 25-74 years.

9 Countries were able to provide data for the EUCID project that could be used for the comparison. Data are shown for Body Mass Index (BMI), defined as body weight divided by the square of body length (kg/m2). On average almost 40% of the population has a BMI>25.0. Notably for overweight (BMI 25.0-29.9), the prevalence was higher for men than for women. This health problem is one of the most important risk factors for the development of type 2 diabetes. It is the only risk factor for diabetes that can be influenced, although this is very difficult. Most of the data provided was taken from Health Interview Surveys, which often lead to an underestimation of obesity and overweight. Only two countries provided data that originated from Health Examination Surveys, which do not appear to be outliers.

The prevalence rates shown in the EUphact on Overweight are derived from the IOTF. There is not too much consistency between the two data sets, but it should be noted that in the IOTF database the age ranges are not standard, and that for some countries the sources are different (self-reported versus measured). Notably the IOTF overweight figures for England, Germany and Luxemburg are quite a lot higher than the EUCID figures for these countries. For Germany and Luxemburg, this may be due to the IOTF data being based on actual measurement, as opposed to the self-report data collected by EUCID. Both databases do, however, show that overweight is more frequent in men than in women.

Mortality from diabetes is difficult to assess

Standard mortality statistics are based on the registered primary cause of death. For diabetes this gives a severe underestimation of the impact of the disease on mortality, since in many deaths from other causes, such as cardiovascular disease, diabetes plays a role and is registered as the ‘secondary cause of death’. Therefore, EUCID has collected data on mortality for diabetes as a primary and/or secondary cause of death.

Ten countries were able to provide data on this indicator for the EUCID project, as shown in Standardized Mortality Rates for Diabetes. For comparison, the table shows the Standardized Death Rates (SDR) for diabetes as a primary cause of death, from Eurostat.

The table shows that in most countries the addition of secondary causes of death leads to a (up to eight times) higher SDR, but that the impact of this addition varies per country. This variance is due to inconsistent ways of recording secondary causes of death. Diabetes may, for example, sometimes not be recorded as a secondary cause of death, due to a lack of awareness. The different levels of reimbursement offered for hospital expenses if a second diagnosis is present can also influence recording habits. The only way to obtain reliable data for this indicator would be to connect a national diabetes database with the national death register. The DARTS project in Scotland has the possibility to do this, as do some Scandinavian countries and France.