5.4.3 Data description and analysis
Comparable data on the human and economic burden of diabetes and its
complications, remain scarce both in the EU and worldwide.
Here we will present EU diabetes data mainly referring to the latest
indicators results published in the field by the IDF Atlas 2006 and the core
and secondary indicators published in the final EUCID report.
incidence of diabetes in children (0-14 year). Standardised incidence shows a ten-fold variation,
ranging between 6 (Luxembourg) and 60 (Finland) cases per 100,000 per year. The
median value is 18 (Romania). Relative
to Type 1, other sources confirm the existence of a North-South gradient in Europe, with a much higher incidence in the Nordic countries (Lancet, 2000). These data
allowed further hypotheses on possible risk factors for T1DM, some of which are
currently being studied (TRIGR study group. 2007). A steady increase of the
incidence has been observed in almost all EU countries over ten years,
corresponding to 3.2% annually. When pooled over centres and sexes, the rates
of increase were 6.3% (4.1-8.5%) for children aged 0-4 years, 3.1% (1.5-4.8%)
for 5-9 years, and 2.4% (1.0-3.8%) for 10-14 years (Green, 2001).
Prevalence of diabetesStandardized values reported by EUCID range between
26/1000 (Finland) and 76/1000 (Cyprus), with a median of 30.5/1000.
According to the IDF data 2006, the absolute number of diabetics in the
EU-27 will rise from approximately 31 million in 2006 to over 37 million in 2025. In 2006, approximately 8.7% of the adult (20-79 years) EU-27 population was diagnosed with
diabetes (type 1 and type 2).
Annual incidence of blindness due to diabetic retinopathy. EUCID found
that the percentage for this indicator varied from 2% (Turkey) to 15% (Germany) amongst the four countries that could provide data.
Annual incidence of dyalisis and/or transplantation. EUCID found a variation across 9 countries
from 4 (Cyprus) to 149 (Scotland) per 100,000, with a median of 79 (Denmark). The indicator decreases before the age band of 75-84 years of age.
Prevalence (stock) of dialysis/transplantation per 100.000 diabetic population. Across 11 countries, the indicators varied
between 3 (Belgium) and 632 (Scotland), with a median of 304 every 100,000
diabetics, corresponding to the value of Austria. Apart form the ages below 25
there is no clear age band effect.
Mortality. According to EUCID, standardised data show that
mortality ranges between 7 (Luxembourg) and 199 (Portugal) per 100,000 in 10 countries delivering accurate data. The median value is 31/100,000, corresponding to France. According to the IDF, in 2007 a total of over 300,000 deaths are attributable to
diabetes across Europe.
In terms of clinical management in diabetes, parameters include blood glucose management, blood
pressure, blood lipids, kidney functions and microalbuminuria. The complete set is difficult to obtain,
thus it is important to concentrate on the most relevant factors.
Impaired glucose tolerance. The IDF Atlas 2006 reports an average of
9% for the European Region for ages between 20-79, with Poland (15%) and
Denmark (12%) showing the highest values. According to the above estimates, the
number of people currently affected by IGT in Europe is over 60 millions, and
will approach 70 millions in 2025.
Measurement of glycated haemoglobin (HbA1c) in the last
12 months. OECD data
(Armesto et al, 2006) show results for 7 EU countries ranging between 77.4% (Spain) and 98% (Finland).
Level of HbA1c>7.0%. According to EUCID crude percentages, there is an
almost three-fold variation across Europe of poor management, with Ireland being the most performing (32%) and Cyprus being the least satisfactory (83%). The median
value across 11 countries is 60.5%, corresponding to Austria and England. The percentage decreases substantially with age.
Measurement of total cholesterol in the last 12 months. EUCID crude data from 12 countries are
consistent with the variability shown by HbA1c, presenting a range between 45%
(Ireland) and 99% (Netherlands), with a median value of 87%.
Total cholesterol level>5 mmol/l. In EUCID databases this risk factor was
found in crude percentages of 14% (Ireland) to 68% (Cyprus) of the population,
with a median value of 42.5%. Age did not seem to have a major influence on the
Measurement of LDL cholesterol in the last 12 months. The EUCID indicator varies between
countries from 5% (Scotland) to 94% (Cyprus), with a median value of 75% (Sweden). The lowest percentage was in Scotland where the treatment of elevated cholesterol
is based on total and HDL cholesterol. The decrease in patients above 75 may
reflect a decline in the quality of care, despite the existing recommendations
LDL cholesterol level >2.6 mmol/l. Crude percentages published by EUCID vary
from 16% (Ireland) to 84% (Scotland), with a median value of 59%, corresponding
to Netherlands and France. Apart from children that have lower figures, there
does not seem to be any significant age effect.
Measurement of HDL cholesterol in the last 12 months. The EUCID indicator varies in 11 countries
between 44% (Ireland) and 99% (Netherlands), with a median value of 85% (Austria). The lowest percentages were found in children and people above 65.
HDL cholesterol level <1.0 mmol/l for men and <1.25 mmol/l for women. Crude percentages published by EUCID on 11
countries vary from 6% (Scotland) to 42% (Cyprus), with a median value of 30%,
corresponding to Sweden and Finland. The percentage is lower in men than in
women. The influence of age is not consistent amongst countries.
Measurement of triglycerides in the last 12 months. EUCID crude data from 11 countries present
a range between 45% (Ireland) and 99% (Netherlands), with a median value of 80%
Triglycerides level >2.3 mmol/l. In EUCID databases this risk factor was found across
11 countries in crude percentages of 11% (Ireland) to 51% (Scotland) of the population, with a median value of 24% for Sweden.
Microalbuminuria. The percentage varies in the different databases
collected by 10 countries from 25% (Finland) to 97% (Netherlands), with a
median of 64.5%. The percentages are lower in children and people above 75.
An abnormal level of albuminuria and proteinuria. The EUCID project measured this value over
9 countries, showing a percentage of abnormal protein concentrations in the
urine between 9%(Finland) and 41% (England), with a median of 28%,
corresponding to Belgium. The percentage increases in the age groups above 65.
Blood pressure control. In EUCID, 11 countries provided data with a
percentage varying between 32% (Finland) and 100% (Cyprus).
Level of blood pressure. The percentage assessed by EUCID varies between 17%
(France) and 46% (Sweden) across 12 countries, with a median of 30% for Denmark and Austria. There is a clear age band effect: the older the population, the higher the
Smoking. Crude percentages from 11 EUCID countries report
values between 10% for Ireland and 37% for Denmark, with a median value of 21
for France. Important variations between countries have been observed and may
reflect the impact of the different public health policies.
Levels of BMI among diabetics. In EUCID 12 countries provided data; the
percentage of people with BMI above 25 is between 59% (Finland) and 83% (Ireland).
The median value is 80%. The percentage above 30 ranges from 35% (Belgium) to
49% (Ireland), with median 46%. The percentage of people with BMI between 20
and 25 does not vary with age, but the percentage of people with BMI above 30
decreases with age.
Fundus inspection. In EUCID there were 10 countries contributing data,
showing a variation between 12% (Ireland) and 84% (Netherlands). The median is
57%. Only three countries reported percentages above 80%. These values were
lower in young people and in people above 85 compared to other age bands. OECD
collected data on 7 EU countries, with retinal examination ranging from 45.1
(France) to 83.4% (UK).
Proliferative retinopathy is defined as the percentage of diabetic
population that had their eye fundus inspected in the last 12 months and were
diagnosed with a proliferative retinopathy. In the EUCID report, only
four countries contributed data, ranging between 1% and 14%.
Indicator on timely laser treatment of retinopathy. For
this indicator, data is even more scarce than for the previous one: in fact, in
EUCID only Germany provided a figure of 52%.
Control of serum creatinine ths. In EUCID 11 countries provided figures,
ranging between 42% (Finland) and 99% (Netherlands), with a median of 92%,
corresponding to Sweden and Scotland. A total of 7 countries reported values
above 90%. There is no clear difference among age bands.
Renal failure. In EUCID only 8 countries provided data, with figures
between 0.1% (Netherlands, Sweden) and 4% (Cyprus). The median is 1.2%.
The annual incidence of major amputations. This indicator,
measured by EUCID across 9 countries, varies from 78 (Scotland) to 574 (Spain) per 100,000 diabetes patients, with a median of 226, corresponding to Denmark. The trend increases with age. Results reported by OECD from 13 EU countries lead
to a median equal to 40 (Portugal), ranging between 10 (Italy) and 1380 (Slovak Republic).
The annual incidence of stroke. In EUCID, a total of 10
countries reported a range between 37 (Cyprus) and 2,675 (Germany), with a median of 669 per 100,000. There is a clear influence of age on the
indicator: the older the individual, the higher the incidence.
The annual incidence of any myocardial infarction. A total of 10 EUCID collaborators reported
an incidence between 21 (Cyprus) and 2135 (Austria), with a median equal to
654.5. The indicator is age dependant with a rising incidence above middle age.