Diabetes: A serious public health problem in Italy
Maria Fenicia Vescio (1), Simona Giampaoli (1) and Diego Vanuzzo (2) for the Cardiovascular Epidemiology Observatory Working Group*
(1) Laboratory of Epidemiology and Biostatistics, ISS
(2) Cardiovascular Disease Cente, Local Health Authority, Medio Friuli,Udine
There are two types of diabetes, Type I, which is found more frequently in children and adolescents, and Type 2, which is found most commonly among those 40 years of age and over. This latter group constitutes 90-95% of all diabetes cases. Persons with diabetes have a reduced capacity to produce insulin, or may have a decreased ability to use it. Insulin facilitates the entry of glucose into cells and the transformation of foods into energy.
Screening to identify undiagnosed diabetes has been supported by a wide variety of organizations including the World Health Organization (1-3). It has often been suggested that such screening be conducted as part of health care visits made for other purposes. One such opportunity in Italy has been the screening of the population enrolled as part of the Cardiovascular Epidemiology Observatory (4), a national project designed to study cardiovascular disease and cardiovascular risk factors in 80 centers throughout the country. As part of the screening of the study population, information on history of diabetes and a fasting blood sugar were obtained.
The purpose of this article is to describe, in a representative sample of the adult Italian population, the prevalence of diabetes and of glucose intolerance.
Because sampling and enrollment procedures for the study have been described in detail elsewhere (4), only the methods used to gather information on diabetes history and obtain blood glucose values are provided. Blood glucose determination was based on a capillary sample obtained after at least a 12-hour fast. Information on whether the individual had been previously diagnosed with diabetes, treatment with insulin or an oral antidiabetic agent, and diet were obtained via questionnaire administered at the time of the visit by specially trained personnel. Accutrend glucose strips on which samples of whole blood had been placed were read using a Reflotron device.
Persons were considered to have diabetes if they had a blood sugar of 126 mg/dl or higher or if at the time of the interview they were being treated for diabetes (insulin or oral agents). They were considered to have glucose intolerance if their blood sugar was between 110 and 125 mg/dl.
In our study population, which consisted of 8030 individuals (4032 men and 3998 women) ranging in age from 35-74 years, 9.2% of the men and 6.6% of the women met the diabetes case definition; the proportion of these individuals who were under treatment was 53%, and 35% stated that they didn’t know they had diabetes. A total of 8.2% of the men and 4.2% of the women were glucose-intolerant. The table demonstrates the distribution by 10-year age groups and sex. Diabetes appears to increase with age and is more frequent in males.
These data provide important public health information since this study represents because they represent one of the few sources of recent population-based data on diabetes in Italy. Previous population-based studies, conducted specifically to study diabetes, published in the early 1990s are limited to specific geographic areas: the city of Cremona in northern Italy reported by Gallus (5) and that conducted in Naples by Riccardi (6)
It is not possible to compare our study with these previous studies to evaluate temporal trends because the methodology and case definitions used for diabetes and glucose intolerance differed. We used the definitions proposed by the American Diabetes Society (1).
Type 2 diabetes is a chronic degenerative disease related to overweight and physical inactivity that can lead to serious consequences, including blindness, renal insufficiency, amputation of extremities, pregnancy complications, and pulmonary infections, all of which may increase health costs. For this reason, it is essential to carry out efforts designed to identify diabetic individuals and those with glucose intolerance through opportunistic health screening, and to conduct primary prevention through promotion of physical activity and a diet that is less rich and more healthy.
* For the members of the research group, please see reference 6.
1. American Diabetes Association. Clinical practice recommendations 2000: screening for type 2 diabetes. Diabetes Care 2000;23:S20-S23.
2. Expert Committee on the Diagnoses and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnoses and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183-97.
3. World Health Organization Study Group on Prevention of Diabetes Mellitus. Prevention of Diabetes Mellitus. Tech.Rep.Ser. 1994;844.
4. Giampaoli S, Vanuzzo D, e il gruppo di ricerca dell'Osservatorio Epidemiologico Cardiovascolare. I fattori di rischio cardiovascolare in Italia: una lettura in riferimento al Piano Sanitario Nazionale 1998-2000. Giornale Italiano di Cardiologia 1999;29:1463-71.
5. Gallus G,.Garancini P. Dati epidemiologici sul diabete mellito in Italia. Epidemiologia e Prevenzione 1991;48-49:55-8.
6. Vaccaro O, Imperatore G, Ferrara A, Palombino R, Riccardi G. Epidemiology of diabetes mellitus in southern Italy: a case-finding method based on drug prescriptions. Journal of Clinical Epidemiology 1992;45:835-9.