Diabetes in South and Central America: an update.
The estimated population of the South and Central America (SACA) Region is 467.6 million and 64% is in the age range of 20-79 years but the population pyramid and age distribution are changing. The average prevalence of diabetes in the Region is 8.0% and is expected to reach 9.8% by the year 2035. Prevalence is much lower in rural settings than in urban and the differences attributed to lifestyle changes may be a target for intervention. The indigenous population is a particularly vulnerable group needing special attention. On average, 24% of the adult cases with diabetes are undiagnosed but in some countries this is still as high as 50%. Health expenditure due to diabetes in the Region is around 9% of the global total. Inadequate glycemic control, defined as HbA1c >7%, is a strong predictor of chronic complications which increase resource use in the Region and less than half of the patients enrolled in diabetes care programmes are at target. Fifty percent or more of the adult population is overweight/obese and around one third of the adult population has metabolic syndrome using regional cutoffs for waist circumference. The number of people with IGT is almost equal to those with diabetes presenting an additional challenge for prevention. Children with type 1 diabetes represent only 0.2% of the total population with diabetes but the incidence may be increasing. In many places they have limited access to insulin, and even when available, it is not used appropriately. The available epidemiological data provide the background to act in developing national diabetes programmes which integrate diabetes care with cardiovascular prevention and promote diabetes prevention as well.
Javeriana University School of Medicine and San Ignacio University Hospital, Bogotá, Colombia. Electronic address: paschner@cable.net.co.
Pablo
P
Aschner
National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
Carlos
C
Aguilar-Salinas
Chilean Diabetes Association, Adich-OPS, Santiago de Chile, Chile.
Loreto
L
Aguirre
Ribeirão Preto School of Medicine, São Paulo University, Riberão-Preto, Brazil.
Laercio
L
Franco
Center for Experimental and Applied Endocrinology (CENEXA) and PAHO/WHO Collaborating Center for Diabetes, UNLP-CONICET, La Plata, Argentina.
Juan Jose
JJ
Gagliardino
Nordeste National University School of Medicine, Corrientes, Argentina.
Sylvia Gorban
SG
de Lapertosa
Diabetes, Hypertension and Lipids Unit, Peruvian University Cayetano Heredia, Lima, Peru.
Segundo
S
Seclen
University of Costa Rica School of Medicine, San José, Costa Rica.
Mary
M
Vinocour
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002489:Central America / Q000453:epidemiology; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D013020:South America / Q000453:epidemiology; D055815:Young Adult
D001786:Blood Glucose
Diabetes; Glycemic control; HbA1c; Impaired Glucose Tolerance; Prevalance; South and Central America