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Changes in human behavior and lifestyle associated with globalization have resulted in a dramatic increase in the prevalence and incidence of type 2 diabetes globally.
If anyone had predicted 30 years ago that diabetes mellitus would be one of the biggest public health problems facing the human race in 2010, they would not have been taken seriously. In an earlier review article on the global epidemiology of diabetes published in Medicographia in 1987,5 I pointed out that the mounting problems of chronic noncommunicable disease, and in particular diabetes, raised the important challenge of noncommunicable disease prevention, a 21st-century parallel to the prevention of infectious disease at the turn of the 19th century. The most recent global predictions by the Baker IDI Heart and Diabetes Institute for the International Diabetes Federation (IDF) suggest that currently there are 285 million people with diabetes worldwide.6 This is set to escalate to 438 million by 2030, a 54% increase. Table I illustrates the dramatic rises in diabetes prevalence in several Asian nations compared to the prevalence in the USA. We, and others, have reviewed the epidemiology of type 2 diabetes in great detail elsewhere.9,10 Rather than provide a repeat of these earlier papers, this review focuses on more recent studies which underline the dramatic escalation in the number of cases of diabetes in both developed and developing nations. A similar large secular increase in diabetes has occurred in India and, indeed, other Asian nations.6,11,14 India once led the world with the largest number of diabetic subjects. There is now a major emerging global phenomenon that reveals a new perspective of the global diabetes epidemic.
The risk determinants for type 2 diabetes in children and adolescents are similar to those seen in adults, with obesity almost always being present.29 In-utero exposure to hyperglycemia now appears to be an additional risk factor to having a family history of diabetes,30 and suggests that better management of diabetes in pregnancy and prevention of gestational diabetes may reduce the risk of diabetes developing in the offspring. Type 2 diabetes is common and serious, but often asymptomatic in the early stages, which sometimes last up to five years or more.
Screening programs should begin with simple tools that are effective in identifying those at highest risk, but which can be used by the general public.33 Those found to be at high risk should undergo further screening and diagnostic blood glucose testing to accurately characterize their glucose tolerance status, and these people should commence a lifestyle intervention program (relevant whether they have diabetes or are at risk of it in the future). The authors used person-specific data from a representative sample of the US population to create a simulated population of 325 000 people aged 30 years without diabetes. When looking for an opportunity to prevent type 2 diabetes, risk factors should be viewed in terms of being either modifiable, eg, sedentary behavior, or nonmodifiable, eg, genetic, age, or gender (Table III). An important new area becoming the focus of more attention is the intrauterine environment. Diabetes is a chronic disease that through its complications can seriously impact the quality of life of individuals and their families through premature illness and death. A strategy has been proposed by Diabetes Australia to combat type 2 diabetes which is set to become the countries biggest health burden in the next five years.
Currently the disease costs the country 14.6 billion dollars but experts say that this will blow out to 30 billion in the next 12 years. People that suffer with the disease are know to have a much higher rate of heart disease and strokes.
The strategy outlines improved ways to manage the disease, more effective ways of diagnosing people and ways to help people prevent developing the disease.
It is estimated that there are 2 million Australians with pre-diabetes who are at risk of developing the disease.
Studies have shownA  that the elimination of these foods and the return to a whole foods plant based diet has been shown to arrest and even reverse the condition.A  They have also shown that populations who consume a plant based unprocessed food diet have a much lower rate of developing the disease. He new proposed strategy will now need to be supported by the government of the day before it can be implemented. Australian scientists have shown that brown fat - a special type of fat that burns energy to produce heat - may also help to keep blood sugar steady in adults.
Researchers at Sydney's Garvan Institute of Medical Research measured brown fat activity and blood glucose continuously in real time in study participants, and found that individuals with more brown fat had smaller fluctuations in blood sugar. The incidence of type 2 diabetes, which is characterised by high blood sugar, is reaching epidemic proportions worldwide.
Now, researchers at Garvan have shown that brown fat may help to minimise fluctuations in blood sugar (blood glucose) concentration in adults.
Unlike white fat, which primarily stores energy, brown fat burns energy - often in remarkably large amounts. Dr Paul Lee and Associate Professor Jerry Greenfield, of Garvan's Diabetes and Metabolism Division, have long been interested in whether brown fat might have a role beyond keeping us cosy. Dr Lee says, "Brown fat takes up so much glucose that we wondered whether brown fat could affect the concentration of glucose in the blood - and whether, therefore, brown fat-targeted therapies might help control diabetes. Importantly, participants who had larger deposits of brown fat had less fluctuation in blood glucose - and blood glucose fell after each peak of brown fat activity surge.
In contrast, brown fat activity rose only in response to an increase in blood glucose among those with less brown fat, and interestingly, their glucose fluctuations were greater.
Dr Lee says, "It looks like the more brown fat one has, the more influence it has on blood glucose.
The study used a simple and non-invasive technique to measure brown fat activity: a small thermometer placed over the collarbone of participants.
The researchers also made an intriguing observation: brown fat activity rose at dawn, around the time volunteers were waking from sleep. Dr Lee says that brown fat-based therapies are potentially promising in the fight against diabetes in the future, but also urges caution.
A newly identified signaling pathway that stimulates glucose uptake in brown fat cells might be useful for treating type 2 diabetes and obesity, according to a study in The Journal of Cell Biology. Mild stress stimulates the activity and heat production by brown fat associated with raised cortisol, according to a study published today in Experimental Physiology. Control over obesity and diabetes may be one step closer thanks to a Hiroshima University study in fat tissue. Increasing the blood flow in brown fat causes it to burn more calories in mice and may help treat obesity, a new study in the Journal of Applied Physiology reports. The number of overweight people is increasing worldwidea€”and thus the risk of developing diabetes or cardiovascular disease.

A handful of large studies of cancer risk factors have found that working the night shift, as nearly 15 percent of Americans do, boosts the chances of developing cancer.
In their mission to design new biomaterials that promote tissue regeneration, Drexel University researchers have identified how inflammation, when precisely controlled, is crucial to bone repair. New research by University of Iowa scientists helps explain how a hormone system often targeted to treat cardiovascular disease can also lower metabolism and promote obesity.
A low-intensity type of laser treatment may offer a non-invasive, drug-free treatment for thrombocytopenia - a potentially life-threatening shortage of the blood cells called platelets that are essential to blood clotting.
Researchers at Johns Hopkins Medicine report they have identified a biochemical pathway linking oxidative stress and the amino acid cysteine in Huntington's disease. Until recently, there was a strong emphasis on genetic susceptibility, and on environmental and behavioral factors such as a sedentary lifestyle, overly rich nutrition, and obesity (particularly central adiposity). Yet, in 1977, when we published the prevalence of diabetes in the Pacific island nation of Nauru,1 the writing was on the wall. Prevention of diabetes is a major challenge that faces nearly every nation and it is now being recognized by the international community. Figure 1 shows these data from the 2009 IDF Diabetes Atlas6 with the expected increases in the next 20 years to 2030 by geographic region and the global total.
Its multiethnic population of some 1.3 million inhabitants predominantly comprises Asian Indians, Creoles (mainly African), and Chinese.
Consequently, the results from this small island population have suggested that modernization could have a very serious impact on diabetes rates in both India and China, in terms of the impact on both health as well as on the national economy.8 Indeed, this has turned out to be the case. It had earned the dubious distinction of being the world “capital” for diabetes, a title that now more appropriately belongs to China! Interventions are available that reduce morbidity and mortality, as well as the risk of developing diabetes,31,32 a compelling argument for screening the population for those at highest risk.
Nevertheless, it should be recognized that absolute evidence for the benefit of screening is not yet available. A very recent study from the USA34 used a mathematical model (the Archimedes model) to estimate the cost-effectiveness of several screening strategies. They found that compared with no screening, all simulated screening strategies reduced the incidence of myocardial infarction (3-9 events prevented per 1000 people screened) and diabetes-related microvascular complications (3-9 events prevented per 1000 people).
Use of a preliminary screening tool such as FINDRISK (FINnish Diabetes RISK score)35 or AUSDRISK (AUStralian type 2 Diabetes RISK assessment tool)36 (Table II, page 19).
All those identified as being at high risk should enter a lifestyle intervention program and have blood glucose testing.
Fasting plasma glucose (FPG) is the initial blood glucose screening test for those at high risk, according to the preliminary screening tool. Because diabetes now affects much of the workforce, it has a major effect on both individual health and national productivity. Wenying Y, Juming L, Jianping W, et al; China National Diabetes and Metabolic Disorders Study Group. Ramachandran A, Snehalatha C, Kapur A, et al; Diabetes Epidemiology Study Group in India (DESI). Alberti KGMM, Zimmet P, Shaw J, Bloomgarden Z, Kaufman F, Silink M; Consensus Workshop Group. But the focus on her blonde-pinup looks sometimes overshadowed what was a very good golf game.While a teenager, Stephenson won five consecutive New South Wales Schoolgirl Championships in Australia, beginning in 1964, and followed that up with three straight wins in the New South Wales Junior Championship. They are also at risk of kidney failure, blindness and for many the amputation of toes is common.A  There are many other complications as diabetes destroys blood vessels which supply nutrients to every part of the body.
That's why Australia needs to put in place a national prevention programa€? said Professor Colagiuri from the University of Sydney. There is a need for new insights into how blood sugar levels can be controlled, beyond mechanisms actioned by currently available therapies. Sitting just above the collarbone and in the neck, brown fat acts like a heat generator, helping to keep us warm by burning sugar and fat.
They found that blood glucose levels and heat production by brown fat were closely related, tracking together over time. Notably, individuals with no detectable brown fat had the widest fluctuations in blood glucose. The scan detects a glucose tracer, which is visible in the most metabolically active organs. So, measuring skin temperature at the collarbone can allow us to estimate brown fat activity. If we can pinpoint what switches brown fat's activity on and off during the day, we may identify new targets in drug design. For this reason, many dream of an active substance which would simply melt off fat deposits.
More recently, focus has shifted to the potential contribution of the maternal environment and the impact of in-utero influences, ie, the role of epigenetics. This United Nations resolution recognized that tackling diabetes is likely to be one of the most important challenges for the global public health community in the 21st century. Many of these cases of diabetes will remain undiagnosed, and indeed untreated, particularly in developing nations (Figure 1).
This distribution of ethnic groups in Mauritius reflects approximately two-thirds of the world population,4 providing a microcosm of the global picture.
This, evidence that the prevalence of type 2 diabetes doubled in Singaporean Chinese between 1984 and 1992,16 and the high prevalence of diabetes in Taiwan17 have provided alarming indicators of the size of a potential future epidemic in the People’s Republic of China. In an urban national study reported in 2001, the age standardized prevalence of type 2 diabetes was 12.1%.

Type 2 diabetes has already been reported in children from Japan and other Asian nations, the USA, the Pacific Islands, Hong Kong, Australia, and the United Kingdom.4 In Japan, type 2 diabetes is already more common in children than type 1 diabetes. They concluded that in the USA population, screening for type 2 diabetes is cost effective when started between the ages of 30 years and 45 years, with screening repeated every 3-5 years.
The socioeconomic consequences of diabetes are likely to significantly impact the economies of many developing nations in addition to their devastating impact on the economies of developed nations, such as the USA, UK, and Australia. High prevalence of NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians.
High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. High prevalence of impaired fasting glucose and type 2 diabetes in Pehghu Islets, Taiwan: evidence of a rapidly emerging epidemic? Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population: the Shanghai Diabetes Studies, a cross-sectional 3-year follow-up study in Shanghai urban communities. Risk factors associated with the dramatic increase in the prevalence of diabetes in the adult Chinese population in Qingdao, China.
High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.
High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India.
Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population-based study of Qatar. Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, UAE.
Birth weight, type 2 diabetes, and insulin resistance in Pima Indian children and young adults. Increased incidence of non-insulin dependent diabetes mellitus among Japanese school children correlates with an increased intake of animal protein and fat.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis. AUSDRISK: an Australian Type 2 Diabetes Risk Assessment Tool based on demographic, lifestyle and simple anthropometric measures. Higher brown fat abundance correlates with lesser glycemia variability, suggestingthat brown fat may help buffer glucose fluctuations and maintain whole-body glucose homeostasis over time. This may be an important factor in the very high prevalences of type 2 diabetes now being seen in nations such as India and China, two countries that numerically bear the main brunt of the epidemic. In age- and sex-adjusted models, glycated hemoglobin (HbA1c) was a predictor of diabetes in the whole population, in those with normoglycemia and in those with IGT or IFG at baseline. Type 2 diabetes accounts for 80 percent of cases of diabetes in childhood in that country.28 This is certainly an emerging public health problem of significant proportions as the fall in the age of onset of type 2 diabetes is an important factor influencing the future burden of the disease. With diabetes being one of the greatest threats to public health in the 21st century, the rationale for strengthening efforts to prevent and control this menacing chronic disease is surely impelling.
Stephenson joined the LPGA Tour in 1974 and was named Rookie of the Year.Her first LPGA victory was the 1976 Sarah Coventry Naples Classic. Type 2 diabetes is appearing increasingly in children and adolescents, and the frequency of diagnosis of pediatric type 2 diabetes is outstripping that of type 1 diabetes in some countries already. The incidence of diabetes was 10-20 times greater in those with IGT or IFG than in those with normoglycemia at baseline.
It was higher, at 25%, in citizens from the United Arab Emirates than in expatriates (with a prevalence of 13%-19%, depending on their original country of origin). The prevention of diabetes and control of its micro- and macrovascular complications will require a major integrated approach directed at societal and individual behavioral change if we are to see significant reduction in the huge premature morbidity and mortality it causes. The AUSDIAB data reflect, in general, the status of diabetes in developed nations with a predominantly white population. The authors stated that prompt action would be needed in order to avert a major public health crisis. What is also noteworthy is the more pronounced earlier age of onset of type 2 diabetes in the AUSDIAB cohort. The results indicate that diabetes has become a major public health problem in China and that strategies aimed at the prevention and treatment of diabetes are needed. She had big hair, bright makeup and eye-catching outfits, and she urged the LPGA Tour to fully embrace her approach to marketing. This is likely to be a significant understatement of the profound impact this will have on their health system, especially as modernization and industrialization gather pace. Shortly before that event, she caused controversy with comments bemoaning the influx of Asian golfers to the LPGA Tour.Stephenson is among the few women in the course design business, and produced an exercise video for people with arthritis.
Her many charitable efforts include being an honorary chairman of the National Multiple Sclerosis Society.

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