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Diabetes Mellitus: Fact Sheet with Country Data

Diagnosis Criteria and Classification
Values for Diagnosis of Diabetes Mellitus & Other Categories of Hyperglycemia
Etiological Classification of Glycemia Disorders
Prevalence of Type 2 Diabetes in the Americas
Characteristics of Population Studies
Results of the Population-Based Surveys in Latin America and the Caribbean
References for Population-Based Studies (by country)
The number of people with diabetes in the Americas was estimated at almost 35 million in 2000, 19 million (54%) of whom lived in Latin America1 (King H, Aubert RE, Herman WH. Global Burden of Diabetes, 1995-2025. Diabetes Care 1998; 21:1414-1431). Moreover, projections indicates that the prevalence of diabetes is expected to increase to 64 million by 2025, of which 40 million (62%) will correspond to Latin America. Diabetes represents a major burden to society because it increases premature mortality and disability, due to a high risk of heart diseases, nephropathy, lower extremity amputation and blindness.

By definition, diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia and by disturbances of carbohydrate, fat and protein metabolism. Diabetes Mellitus is associated with absolute or relative deficiency in the secretion and/or action of the hormone insulin.

Diagnosis Criteria and Classification
Values for Diagnosis of Diabetes Mellitus and Other Categories of Hyperglycemia

 
Glucose concentration, mmol/litre (mg/dl)

 
Whole blood
Plasma

 
Venous
Capillary
Venous
Capillary
Diabetes Mellitus
Fasting or
2 hrs after glucose loada
³ 6.1 (³ 110)
³ 10.0 ³ 180)
³ 6.1 (³ 110)
³ 11.1 (³ 200)
³ 7.0 (³ 126)
³ 11.1 (³ 200)
³ 7.0 (³ 126)
³ 12.2 (³ 220)
Impaired Glucose Tolerance (IGT)
Fasting value (if measured)
2 hrs after glucose loada
<6.1 (<110)
³ 6.7 (³ 120)
<6.1 (<110)
³ 7.8 (³ 140
<7.0 (<126)
³ 7.8(³ 140)
< 7.0 (<126)
³ 8.9 (³ 160)
Impaired Fasting Glycemia (IFG)
Fasting or
2 hrs after glucose load (if measured)		 ³ 5.6 (³ 100) <6.1 (<110)
<6.7 (<120)
³ 5.6 (³ 100)
<6.1 (<110)
<7.8 (<140)
³ 6.1 (³ 110)
<7.0 (<126)
<7.8 (<140)

³ 6.1 (³ 110)
<7.0 (<126)
<8.9 (<160)

a For epidemiological or population screening purposes, the two-hour value after 75g oral glucose may be used alone. For clinical purposes, the diagnosis of diabetes should always be confirmed by repeating the test on another day, unless is unequivocal hyperglycemia with acute metabolic decompensation or obvious symptoms.
Glucose concentration should not be determined on serum unless red cells are immediately removed; otherwise, glycolysis will result in an unpredictable under-estimation of the true concentration. It should be stressed that glucose preservatives do not totally prevent glycolysis. If whole blood is used, the sample should be kept at 0-4oC, centrifuged immediately, or assayed immediately.
Reproduced with permission from WHO (World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Geneva, 1999. WHO/NCD/NCS 99.2). Data is property of WHO but can be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commericial purposes.

Etiological Classification of Glycemia Disorders
Type 1 Diabetes
Beta-cell destruction, usually leading to absolute insulin deficiency
Autoimmune
Idiopathic

Type 2 Diabetes
May range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance.

Other specific types
Genetic defect of beta-cell function
Genetic defect in insulin action
Diseases of the exocrine pancreas
Endocrinopathies
Drug- or chemical –induced
Infections
Uncommon forms of immune-mediated diabetes
Other genetic syndromes sometimes associated with diabetes
Gestational Diabetes Mellitus

Reproduced with permission from WHO (World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation. Geneva, 1999. WHO/NCD/NCS 99.2). Data is property of WHO but can be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale nor for use in conjunction with commericial purposes.


Prevalence of Type 2 Diabetes in the Americas
Characteristics of Population Studies
Country
Population
Year
Sample Size
Age (Years)
Diagnostic Test
Glucose Load*
Criteria
North America

Canada

 Natives,
River Desert1		 1995 131 30-64 OGTT 75 gms WHO 1980-85
Natives,
Lac Simon1		 1995 168 30-64 OGTT 75 gms WHO 1980-85
Mexico Mexico City3 1992 646 35-64 OGTT 75 gms WHO 1980-85
Mexico City4 1994 805 20-90 FGT - 140 mg dl
United States General population4 1988-94 2,844 40-74 OGTT 75 gms WHO 1980-85
Pima Indians 5, 6 1982-90 3,733 25+ OGTT 75 gms WHO 1980-85
Caribbean
Barbados Bridgetown7 1993 464 40-79 FGT - 140 mg dl
Cuba Santiago de Cuba8 1987 500 15+ OGTT 75 gms WHO 1980-85
Habana9 1998 250 25+ OGTT 75 gms WHO 1980-85
Guadeloupe Guadeloupe10 1989 1,049 18+ OGTT 75 gms WHO 1980-85
Jamaica Jamaica11 1995 2,109 15+ OGTT 75 gms WHO 1980-85
Spanish Town12 1999 1,303 25+ OGTT 75 gms WHO 1980-85
Trinidad & Tobago St. James13 1985 2,516 35-69 OGTT 75 gms WHO 1980-85
South America
Argentina La Plata14 1987 809 20-74 OGTT 50 gms WHO 1980-85
Avellaneda15 1979 596 20-69 OGTT 50 gms 150 mg dl
Bolivia Four cities16 1998 2,500 25+ OGTT 75 gms WHO 1980-85
Brazil Nine cities 17 1986-88 21,847 30-69 OGTT 75 gms WHO 1980-85
Rio de Janeiro18 1986-88 2,051 30-69 OGTT 75 gms WHO 1980-85
S Paulo, Issei19 1996 238 40-79 OGTT 75 gms WHO 1980-85
S Paulo, Nisei19 1996 292 40-79 OGTT 75 gms WHO 1980-85

Chile

 Santiago20 1979 1,110 20+ OGTT 50 gms 150 mg dl
Valparaiso21 1997 3,120 25-64 OGTT

75 gms

 WHO 1980-85
Mapuche Indians22 1983 510 20+ OGTT 75 gms WHO 1980-85
Mapuche Indians23 1998 319 20+ OGTT 75 gms WHO 1980-85
Aymara Indians24 >1998 196 20+ OGTT 75 gms WHO 1980-85
Colombia Urbana25 1993 670 30+ OGTT 75 gms WHO 1980-85
Paraguay Urban26 1992 1,094 20-74 OGTT 75 gms WHO 1980-85
Peru Urban-Rural27 1997 302 30+ OGTT 75 gms WHO 1980-85
Suriname 4 groups 28 1985 1,218 30+ OGTT 50 gma 180 mg dl
Uruguay Urban-Rural29 1966 484 30+ OGTT * 150 mg dl
Venezuela Urban29 1966 480 30+ OGTT * 150 mg dl

Urban30

 1997 669 30+ OGTT 75 gms 135 mg dl
Mérida31 1980 398 30-69 FGT - 140 mg dl

*Glucose load : 1gm/Kg of body weight.   OGTT: Oral Glucose Tolerance Test.   FGT: Fasting Glucose Test.


Results of Population-Based Surveys in Latin America and the Caribbean
Country
Population
% Crude Rate (95%-CI)
% Adjusted * (95%-CI) **
Male
Female
Both
Male
Female
Both
North America

Canada

 

 Natives,
River Desert1		 17.6 16.3 - 16.3
(7.9-24.7)		 16.3
(9.0-23.6)

 
Natives,
Lac Simon1		 22.2 44.3 - 23.9
(12.9-34.9)		 48.6
(38.4-58.8)

 

Mexico

Mexico City2 10.6 14.8 13.0 11.9
(8.0-17.2)		 17.9
(13.5-23.5)		 14.9
(11.9-18.6)
Mexico City3 6.6 11.0 8.7 8.7
(5.7-12.8)		 12.0
(8.6-16.4)		 10.4
(8.1-13.3)

USA

 Total 4 14.8 13.8 14.3 14.7
(12.8-16.5)		 13.1
(11.4-14.8)		 13.9
(12.6-15.2) ₤
White 4 - - - 13.9
(11.3-16.5)		 11.5
(9.1-13.9)		 12.7
(11.0-14.5) ₤
Black4 - - - 19.5
(15.3-23.7)		 20.1
(15.9-24.4)		 19.8
(16.8-22.8₤
Mexican-American4 - - - 24.0
(19.4-28.6)		 27.5
(22.6-32.3)		 25.7
(22.4-29.1) ₤
Pima I5, 6 - - - 50.2
(47.8-52.7)		 52.6
(50.3-54.9)		 51.4
(49.7-53.1)₤
Caribbean
Barbados Bridgetown7 15.0 18.0 17.0 15.9
(10.6-22.9)		 16.9
(12.5-22.3)		 16.4
(13.1-20.5)

Cuba

 Santiago de Cuba8 1.5* 6.6* 4.6
(1.2-8.0)		 - - -
Havana9 - - 14.8 - - 11.8
(8.3-16.3)

Guadeloupe

 General 10 - - 5.8
(4.4-7.2)		      

Jamaica

Jamaica11 - - 17.9 - - 11.1
(9.7-12.3) ¢
Spanish Town12 9.8
(7.2-12.4)		 15.7
(13.1-18.3)		 13.4
(11.5-15.2)		 9.5
(7.0-12.0)		 15.7
(13.2-18.3)		 12.6
(10.8-14.4) ₤

Trinidad & Tobago

 St. James13 11.9 14.9 13.2 11.6
(9.8-13.3)		 13.9
(11.8-16.1)		 12.7
(11.4-14.1) ₤
South America

Argentina

 

 La Plata14     5.0 - - -
Avellaneda15 10.1 7.4 8.1 - - 7.6
(5.6-10.1) ¢

Bolivia

 4 cities16 6.8
(6.2-8.3)		 7.6
(6.3-8.9)		 7.2
(6.2-8.3)		 8.2
(6.5-9.9)		 9.1
(7.6-10.5)		 8.6
(7.5-9.7) ₤

Brazil

 9 cities17 7.5@ 7.6@ 7.6@ - - -
Rio de Janeiro18 5.7 9.9 7.6 5.7
(4.2-7.3)		 9.4
(7.8-11.1)		 7.6
(6.4-8.7) ₤
São Paulo, Issei19     12.8@ - - -
São Paulo, Nisei19     16.2@    

-

Chile

 Santiago20 5.8 7.7 6.5 8.4
(5.6-12.1)		 5.7
(4.0-7.7)		 7.0
(5.5-8.9)
Valparaiso21 4.0 3.8 3.9 - - -
Mapuche Indians22 0.4 1.4 1.0 - - -
Mapuche Indians23 3.2
(0.7-9.0)		 4.5
(2.2-8.1)		 4.1
(2.2-6.9)		 - - -
Aymara Indians24     1.5
(0.3-4.5)		 - - -

Colombia

 Urban25 7.3 7.4 - 7.7
(4.2-13.0)		 8.7
(4.8-14.6)		 8.2
(5.4-12.0)

Paraguay

Urban26 5.5 6.5 6.5 7.2
(4.9-10.6)		 7.1
(5.6-9.1)		 7.2
(5.9-8.8)

Peru

Urban-Rural27 - - 4.8
(3.2-7.0)		 - - -

Suriname

 4 groups28 - - - 7.5
(4.6-11.6)		 9.9
(6.6-14.3)		 8.7
(6.4-11.6)
Creoles28 7.0 4.0 - 6.3
(3.1-11.3)		 13.3
(9.1-19.6)		 9.8
(7.0-13.3)
Indians28 11.0 11.0 - 12.1
(7.1-19.4)		 13.3
(8.7-19.6)		 12.7
(9.2-17.2)
Indonesian28 2.0 3.0 - 4.2
(1.3-9.8)		 3.0
(1.2-6.1)		 3.6
(1.9-6.3)

Uruguay

 Urban-Rural29 6.8 6.9 6.9 - - -

Venezuela

 Urban30 4.5 9.4 7.3

 

 

 
Urban30 - - 4.4 - - -
Mérida31 - - 3.8 - - -

*Standardized using the world population as standard.      @Adjusted by the authors.      ¢Adjusted by age.
** 95% Confidence Intervals according the Poisson Distribution.     §95% confidence intervals based in the normal distribution.


References for Population-Based Studies (by country)
Country
References
North America
Canada
  1. Delisle HF, Rivard M, Ekoe JM. Prevalence Estimates of Diabetes and other Cardiovascular Risk Factors in the Two Largest Algonguin Community of Quebec. Diabetes Care 1995; 18 (9): 1255-1259.
Mexico
  1. Stern MP, González C, Mitchell BD. Villapando E, Haffner SM, Hazuda HP: Genetic and Environmental Determinants of Type II Diabetes in Mexico City and San Antonio. Diabetes 1992; 41: 484-92.
  2. Posadas-Romero C, Yamamoto-Kimura L, Lerman-FGTrber I, Zamora-Gonzalez J, Fajardo-Gutierrez A, Velazquez L, Cardoso-Saldaana G.The prevalence of NIDDM and associated coronary risk factors in Mexico City. Diabetes Care 1994; 17(12):1441-8
USA
  1. Harris MI, FleFGTl KM, Cowie CC, Eberhard MS, Goldstein D, Little RR, Wiedmeyer HM, Byrd DD. Prevalence of diabetes, impaired Fasting Glucose, and Impaired Glucose Tolerance in US Adults. The Third National Health and Nutrition Examination Survey, 1998-1994. Diabetes Care 1998; 21 (4) 518-24.
  2. Knowler WC, Bennett PH, Hamman RP, Miller M. Diabetes Incidence and prevalence in Pima Indians: a 19-Fold Greater Incidence than in Rochester, Minnesota. Am J Epidemiol 1978;108(6)497-505.
  3. Knowler WC, Saad MF, Petitt DJ, Nelson RG, Bennett PH.. Determinants of Diabetes Mellitus in the Pima Indians. Diabetes Care 1993; 16 (1): 216-227.
Caribbean
Barbados
  1. Foster C; Rotimi C, Fraser H, Sundarum C, Liao Y, Gibson E, Holder Y, Hoyos M, Mellanson-King R. Hypertension, diabetes, and obesity in Barbados: findings from a recent population-based survey. Ethn Dis 1993; 3 (4): 404-12.
Cuba
  1. Salvador Alvarez, MJ, Pérez Paz HM. Prevalencia de diabetes mellitus en la población adulta de un área de salud del municipio Santiago de Cuba. Revista Cubana de Epidemiología 1987; 25 (21): 205-213.
  2. Díaz-Díaz O, Hernández M, Collado F, Seuc A, Márquez A. Prevalencia de diabetes mellitus y tolerancia a la glucosa alterada, sus cambios en 20 años en una comunidad de Ciudad de la Habana. (Resumen) Primera reunión científica conjunta GLED/EDEG. Programa Científico. Buenos Aires, Argentina 1999.
Guadeloupe
  1. Mouter JP, KanFGTmbeza-Nouvier P, Donnet JP, Pileire B, Echvege E, Patterson AW. Diabetes Mellitus and Public Health in Guadeloupe. W I Med J 1990; 39: 139-143.
Jamaica
  1. Raggobirsingh D, Lewis-Fuller E, Morrison E Y St. A. The Jamaican Diabetes Study. A Protocol for the Caribbean. Diabetes Care 1995; 18 (9): 1277-1279.
  2. Wilks R, Rotimi C, Bennett F, McFarlane-Anderson N, Kaufman JS, Anderson SG, Cooper RS, Cruickshank JK, Forrester T. Diabetes in the Caribbean: results of a population survey from Spanish Town, Jamaica. Diabetic Medicine 1999; 16: 875-883.
Trinidad & Tobago
  1. Beckles, GLA. Diabetes Mellitus and hypertension: prevalence and mortality risk in urban Trinidad (The St. James cardiovascular survey 1977-85). In: Caribbean Workshop on Standardization of Diabetes Mellitus and Hypertension in the Community. The control of hypertension in the Caribbean community. Bridgetown, Pan American Health Organization, 1988. pp. 38-53.
South America
Argentina
  1. Hernández RE, Cardonet LJ, Libman C, FGTgliardino JJ. Prevalence of Diabetes in an Urban Population of Argentina. Diabetes 1984; 81: 18-20
  2. De Sereday M, Di Toro C, Correa A, Nusinovich B, Kapelushnik D. Encuesta de prevalencia de diabetes: metodología y resultados. Bol Of Sanit Panam 1979; 86: 293-305.
Bolivia
  1. Barceló A, Daroca MC, Rivera R, Duarte E, Zapata A. Diabetes in Bolivia. Pan American Journal of Public Health 2001; 10 (5): 318-322.
Brazil
  1. Malerbi DA, Franco LJ. The Brazilian Cooperative Group on The Study of Diabetes Prevalence. Multicenter Study of the Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in the Urban Brazilian Population Aged 30-69 yr. Diabetes Care 1992;15 (11) 1509-16.
  2. Oliveira JEP, Milech A, Franco LJ. The Prevalence of diabetes in Rio de Janeiro, Brazil. Diabetes Care 1996; 19 (6): 663-5.
  3. Franco LJ: Diabetes in Japanese-Brazilian: influence of the acculturation process. Diabetes Research and Clinical Practice 1996; 34 (Suppl): s51-S55.
Chile
  1. Mella I, García de los Ríos M, Parker M, Covarrubias A. Prevalencia de la diabetes mellitus: una experiencia en grandes ciudades. Bol Of Sanit Panam 1983; 94 (2): 157-165.
  2. Jadue L, VeFGT J, Ecobar MC, DelFGTdo I, FGTrrido C, Lastra P, Espejo F, PeruFGT A. Factores de riesgo para las enfermedades no transmidibles: Metodología y resultados globales de la encuesta de base CARMEN. Revista Médica de Chile 1999; 127: 1004-1013.
  3. Larenas G, Arias G, Espinosa O, Charles M, Lan-Daeta O, Villanueva S, Espinoza A. Prevalencia de diabetes mellitus en una comunidad Mapuche de la IX región, Chile. Rev Me Chile 1985;113:1121-5.
  4. Pérez-Bravo F, Carrasco E, Santos JL, Calvillan M, Larenas G, Albala C. Prevalence of Type 2 Diabetes and Obesity in Rural Mapuche Population from Chile. Nutrition 2001; 236-238.
  5. Santos JL, Perez Bravo F, Carrasco E, Calvillan M, Albala C. Low prevalence of type 2 diabetes despite a high average Body Mass Index in the Aymara Natives from Chile. Nutrition 2001; 17: 305-309.
Colombia
  1. Aschner P, King H, Triana de Torrado M, Marina Rodriguez B. Glucose Intolerance in Colombia. A population-based survey in an urban community. Diabetes Care 1992; 16 (1): 90-.
Paraguay
  1. Jiménez JT, Palacios M, Cañete F, Barrio Canal LA, Medina U, Figueredo R, Martínez S, MelFGTrejo MV, Weik S, Kiefer R, Alberti KGMM, Moreno-Azorero R. Prevalence of Diabetes Mellitus and Associated Cardiovascular Risk Factors in an Adult Urban Population in Paraguay. Diabetic Medicine 1998; 15: 334-8.
Peru
  1. Seclen S, Leey J, Villena A, Herrera B, menacho JC, Carrasco A, VarFGTs R. Prevalencia de diabetes mellitus, hipertensión arterial, hipercolesterolemia y obesidad, como factores de riesgo coronario y cerebrovascular en población adulta de la costa, sierra y selva del Perú. Lima, Peru, 1997.
Suriname
  1. Schaad JDG, Terpstra J, Oemrawsingh I, Nieuwenhuijzen Kruseman AC, Bouwhuis-Hoogerwerf MI. Diabetes prevalence in the three main ethnic groups in Suriname (South America): a population survey. Neth J Med 1985; 28: 17-20.
Uruguay
  1. West KJ, Kalbfleisch JM. Glucose Tolerance, Nutrition and Diabetes in Uruguay, Venezuela, Malasya and East Pakistan. Diabetes 1966 ;15: 9-18.
Venezuela
  1. Nucete HJ, Mendoza SG, Romero P, Somoza B, Zerpa A. Diabetes Mellitus en algunas poblaciones del estado de Mérida, Venezuela. Acta Científica Venezolana 1980; 31: 588-92.
  2. Perez Carrillo JC, Cortes Mogollon MP, Henrriquez Villalba FM, Lira Cabrera C, Chacin Alvarez LF. Prevalencia de Diabetes Mellitus y otros factores de riesgo cardiovascular en la region central de Venezuela. Archivo del Hospital Vargas 1997 ;39 (3-4): 123-128.