African Mexican Asian Pima Native
is undiagnosed in one-third of all people with diabetes (13). The lifetime risk of developing diabetes mellitus is 40 percent if there is one parent with type 2 diabetes mellitus, 80 percent to 100 percent if there are two affected parents, 35 percent if there is an affected sibling, and 70 percent to 80 percent among monozygotic twins (11). Only 5 percent to 10 percent of type 2 diabetes mellitus cases are due to slowly progressive beta-cell dysfunction (11). Approximately 10 percent to 15 percent of people diagnosed with type 2 diabetes mellitus after the age of 40 have positive islet cell cytoplasmic antibodies and GaD65 autoantibodies, which actually represent a subgroup of type 1 diabetes mellitus, also known as latent autoimmune diabetes (11).
Although classically thought to primarily affect adults, type 2 diabetes mellitus also affects youths (14). In a recent analysis, prevalence was 15.9 per 1000 among 15- to 19-year-old Pima Indians, 4.5 per 1000 for all U.S. American Indians, and 2.3 per 1000 for Canadian Cree and Ojibway Indians in Manitoba (14). Thirty-three percent of all cases of diabetes mellitus among 10- to 19-year-old African Americans and Caucasians in Ohio were type 2 diabetes (14). These individuals tended to be obese, have a family history of type 2 diabetes, have acanthosis nigricans, belong to minority populations, and were more likely girls than boys (14).
The Strong Heart Study looking at diabetes among American Indian tribes and communities showed age-adjusted diabetes rates to be 65 percent in men and 72 percent in women in tribes and communities in Arizona; 38 percent in men and 42 percent in women in Oklahoma; and 33 percent in men and 40 percent in women in South Dakota and North Dakota (15). Diabetes rates were positively associated with age, level of obesity, amount of Indian ancestry, and parental diabetes status
(15). Rate of impaired glucose tolerance was 14 percent to 17 percent, which is similar to rates among the general U.S. population (15).
Compared to their Caucasian counterparts, African American men are 20 percent to 50 percent more likely and African American women 100 percent more likely to have or develop diabetes (16). They are also at much higher risk for end-stage renal disease, lower-extremity amputation, and blindness (16).
A cross-sectional study of three Mexican communities showed a higher prevalence in men compared to women (17). In younger adults, prevalence was 16.7 percent versus 9.5 percent in men compared to women; it was 30.8 percent versus 22.8 percent in older adults (17). Variables associated independently with diabetes in older people were gender (male sex: odds ratio [OR] = 2.1, p < 0.009); diminished carbohydrate intake (OR = 0.77, p < 0.03); central distribution of adiposity (OR = 1.9, p < 0.03); and functional disability (OR = 2.3, p < .01) (17). There seemed to be a higher prevalence of diabetes in urban versus rural populations (17).
Approximately 52 percent of all persons aged > 20 years with diabetes are women (18). A study looking at the socioeconomic status of women with diabetes suggests that women with diabetes were more likely to have a low socioeconomic status (18). Twenty-five percent of women with diabetes aged > 25 years had low-level formal education, and 40 percent lived in low-income households (18). Women with diabetes (40.4 percent [95 percent confidence interval [CI] = 38.1 percent -42.6 percent]) were twice as likely as women without diabetes (22 percent [95 percent CI = 21.5 percent - 22.5 percent]) to have an annual household income < $25,000 (18).
Diabetes prevalence continues to increase quite rapidly. A 16 percent increase in prevalence was noted between 1980 and 1994, and a 33 percent increase between 1990 and 1998 (19, 20). The prevalence of diabetes seems highly correlated with the prevalence of obesity (21). On the basis of age, sex, and race, it is estimated that there will be a 225 percent projected increase in diabetes between 2000 and 2050, which means an increase from approximately 12 million to 39 million people diagnosed with diabetes in the U.S. (13). Other studies have estimated an increase ranging between 12 million to 29 million (19). Diagnosis of diabetes is expected to increase 460 percent in people 75 years of age or older, 241 percent among those 65 to 74 years old, 159 percent among those 45 to 64 years old, 125 percent among those 20 to 44 years old, and 97 percent among those 0 to 19 years old (13). Due to expected demographic changes, prevalence, and population growth, prevalence is expected to increase 149 percent among Hispanics, 118 percent among African Americans, and 104 percent among Caucasians (13).
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