2021年 · 第101卷第16期

The prevalence of diabetes has increased dramatically over the past few decades. So far, there is no systematic review of trends in diabetes onset. Therefore, Magliano et al. conducted a systematic review of studies related to trends in adult diabetes incidence from 1980 to 2017 according to PRISMA guidelines to assess the proportion of studies reporting rising, stable, or declining trends in diabetes incidence. Data were sourced from reference lists for Medline, Embase, and related publications. Literature inclusion criteria: Administrative and health insurance database studies including open cohorts, diabetes registries, long-term trends in the incidence of adult diabetes or type 2 diabetes. Poisson regression analysis was used to establish models by age group and year. Forty-seven studies were included, providing data on 121 different gender or ethnic groups. From 1960 to 1989, the incidence of diabetes in 36% (8/22) of the population showed an upward trend, 55% (12/22) showed a stable trend, and 9% (2/22) showed a downward trend. From 1990 to 2005, the incidence of diabetes in 66% (33/50) of the population showed an upward trend, 32% (16/50) showed a stable trend, and 2% (1/50) showed a downward trend. From 2006 to 2014, only 33% (11/33) of the population showed an upward trend, while 30% (10/33) and 36% (12/33) showed a stable or downward trend. The study suggests that the incidence of clinically diagnosed diabetes has continued to rise in only a small number of populations since 2006, with more than 1/3 of the population showing a decline in incidence during this time. Prevention strategies may have contributed to the decline in diabetes incidence in recent years. Data are limited in low-and middle-income countries, where trends in diabetes incidence may differ.

Diabetes is a costly public health problem worldwide, with high morbidity, disability and mortality, and causes a decrease in the quality of life of patients. The vast majority of diabetic patients have type 2 diabetes, and the main strategy to reduce complications of type 2 diabetes is intensive glycemic control. However, substantial evidence suggests that intensive (compared to moderate glycemic control) glycemic control has no meaning for microvascular and macrovascular prognosis in patients, except for a reduced incidence of nonfatal myocardial infarction, but intensive glycemic control increases the risk of severe hypoglycemia, and that multidrug therapy, side effects, and medical costs impose an additional burden. Furthermore, data from the Cardiovascular Outcomes Trial show that cardiovascular, renal, and mortality outcomes can be improved with the use of specific classes of hypoglycemic drugs. Therefore, providing patient-centered evidence-based care to patients with type 2 diabetes requires a change in paradigm and a departure from the main idea of glucose-centered diabetes management. Instead of making intensive glycemic control a priority, focus should be placed on ensuring access to adequate diabetes care, adjusting glycemic measures to the patient's goals and circumstances, minimizing short-and long-term complications, reducing the burden of treatment, and improving quality of life.