Mauritius is the first country to show it is reversing the type 2 diabetes epidemic using gold standard testing across four decades

·       Prevalence increased between 1987 and 2009 before stabilising and falling from 2015 to 2021

 

·       In seven population surveys spanning four decades, the gold standard method of the two-hour glucose tolerance test

was used to accurately determine population prevalence of type 2 diabetes

·       The decrease in prevalence in this multi-ethnic country was seen in

all ethnic groups – Asian Indian, African Creole, and Chinese

 

·       Study offers hope to all countries that policies to target type 2 diabetes can reverse the pandemic

 

 

New research to be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy (Sept 28 – Oct 2) and published in The Lancet Diabetes & Endocrinology shows that the small island nation of Mauritius is the first country in the world to prove it is reversing the type 2 diabetes epidemic using the objective gold standard testing method of the 2-hour oral glucose tolerance test (2 hour OGTT).

 

The authors – who include Professor Jaakko Tuomilehto, Department of Public Health, University of Helsinki, Finland – say the achievement offers hope to all countries worldwide battling the huge human and economic cost of type 2 diabetes.

 

The prevalence of type 2 diabetes has been increasing globally for decades. Estimates are primarily based on population surveys conducted in some countries and routine administrative data sources, while no survey data are available for most countries. Only a few countries have conducted repeated, longitudinal diabetes surveys over many years. Moreover, survey methodologies have varied across countries, and most studies have not followed the standards recommended by WHO – the 2-hour OGTT. In studies that have not relied on OGTTs, prevalence estimates of diabetes and intermediate hyperglycaemia (also called prediabetes) have likely been biased and underestimated. Today, including in many high-income countries, type 2 diabetes is tested for, at least in the first instance, by testing for fasting plasma glucose or glycated haemoglobin (HbA1c) in the blood – but these tests have been shown to miss many asymptomatic cases that can be detected by 2-hour OGTT.

 

 

In the OGTT, fasting is required – not eating or drinking anything except water for at least 8 to 10 hours before the test. A healthcare professional will then take a blood sample to test your fasting blood sugar level. The person then drinks a sweet liquid that contains a specific amount of glucose, usually 75 grams for adults, and additional blood samples are taken, typically at one hour and two hours after finishing the drink. It is necessary to remain sedentary, avoid any eating and drinking, smoking, and exercising before blood sampling after two hours.

 

 

The island nation of Mauritius, located in the Indian Ocean east of Madagascar and with a population of 1.2 million has recently undergone a profound socioeconomic transition, changing living conditions and lifestyles, leading to a shift in its disease burden from infectious to chronic non-communicable diseases (NCDs), including type 2 diabetes. In this, Mauritius is similar to many other island nations, including those in the Pacific Ocean, that have seen obesity and type 2 diabetes surge since the 1980s.

 

 

However, unlike other nations, Mauritius has monitored this transition and diabetes prevalence through seven cross-sectional surveys conducted since 1987. Prof. Paul Zimmet (currently Professor of Diabetes, Monash University, Melbourne, Australia), initiated the surveys, which were conducted by staff of the Ministry of Health and Wellness. Teams led by Prof. Zimmet, Prof. Tuomilehto, and Prof. Sir George Alberti from the UK supported the surveys, and more recently Prof. Stefan Söderberg from Umeå, Sweden.

 

 

In each survey, type 2 diabetes and intermediate hyperglycaemia have been assessed using the OGTT. Mauritius is the only country in the world that has systematically used the OGTT to monitor type 2 diabetes and intermediate hyperglycaemia over time. In this study, the authors investigated long-term changes in the prevalence of type 2 diabetes and intermediate hyperglycaemia using population-based data from OGTTs. The results for each year were as follows (and see table 1 full paper)

 

·       1987 – overall 14.7% ; women 14.0%, men 15.3%

·       1992 – overall 17.3% ; women 16.6%, men 18.0%

·       1998 – overall 20.2%; women 19.3%, men 21.1%

·       2004 – overall 18.6%; women 18.3%, men 18.7%

·       2009 – overall 23.3%; women 22.0%, men 24.7%

·       2015 – overall 23.1%; women 23.7%; men 22.6%

·       2021 – overall 19.9%; women 18.1%; men 21.7%

 

 

Type 2 diabetes prevalence increased between 1987 and 2009 by 61% in men and by 56% in women. Between 2009 and 2021, prevalence decreased, by 11% in men and 16% in women.

 

 

The authors analyse several possible reasons for Mauritius’s success. They say the results highlight the potential effect of initiatives to prevent and manage type 2 diabetes in Mauritius. Examples of these multisectoral approaches include: (1) Prevention: creating an action plan; policy (including advocacy and legislation); NCD risk factor screening (including mobile clinics); and community engagement and participation (including national action plans for nutrition, physical activity, and tobacco control). (2) A national integrated NCD action plan: a roadmap to improve health and wellbeing across the life-course. (3) A national service framework for NCDs: a policy set to define standards of care for NCDs within a service protocol with appropriate quality standards.  And public sector health services are free of charge, including essential medicines.

 

The authors conclude: “Mauritius is the first country to show a sustained decrease in the prevalence of type 2 diabetes and prediabetes,

based on long-term data using the WHO-recommended gold standard oral glucose tolerance test-based diagnostic criteria. It is encouraging to learn that the continuous increase in type 2 diabetes occurring in almost all countries all around the world could be halted and even reversed. Previous experiences with other major public health problems, such as cardiovascular diseases and lung cancer, have shown that it is possible to tackle chronic NCD epidemics.”

 

 

Conflict of interest:

Prof Tuomilehto shares in Orion Pharma, Aktivolabs, and Digostics.

_________________________

 

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Första landet att vända trenden för typ 2-diabetes
Umeå universitet | Pressmeddelande

 

Mauritius är det första landet i världen som lyckats minska förekomsten av typ 2-diabetes efter decennier av ökning,

visar en ny studie från bland annat Umeå universitet. Minskningen syns i samtliga befolkningsgrupper och bland både kvinnor och män.

Stefan Söderberg är professor i internmedicin vid Institutionen för folkhälsa och klinisk medicin vid Umeå universitet.
– Våra resultat visar att det finns hopp för alla länder runtom i världen som kämpar med de humanitära och ekonomiska kostnaderna för typ 2-diabetes,

säger Stefan Söderberg, professor vid Institutionen för folkhälsa och klinisk medicin vid Umeå universitet.

 

Förekomsten av typ 2-diabetes har ökat stadigt i hela världen de senaste decennierna. Mauritius, en önation i Indiska oceanen med ungefär 1,2 miljoner invånare, har liksom många liknande länder sett en dramatisk ökning av både obesitas och typ 2-diabetes sedan 1980-talet.

 

Vad som gör Mauritius unikt är att de har följt utvecklingen sedan 1987 med hjälp av ett oralt glukostoleranstest, OGTT.

– I många länder använder man sig av tester som riskerar att missa fall av typ 2-diabetes och prediabetes där personerna inte upplever några symtom. Därför är det troligtvis många studier som underskattar den sanna förekomsten, säger Stefan Söderberg.

 

Systematiskt arbete kan vända negativ utveckling
OGTT innebär att man kontrollerar blodsockret när personen har fastat i minst 8 timmar. Därefter får personen får dricka en lösning med en specificerad mängd 75 g glukos, och sedan kontrolleras blodsockret igen efter två timmar.

Mauritius är det enda landet i världen som systematiskt använt sig av den här metoden för att övervaka och uppskatta förekomsten av typ 2-diabetes och prediabetes.

 

Forskarna har nu kunnat visa att förekomsten av typ 2-diabetes i landet

• ökade med 61% bland män och 56% bland kvinnor mellan 1987 och 2009.

• Mellan 2009 och 2021 minskade förekomsten i stället med 11% bland män och med 16% bland kvinnor.

 

– Mauritius har arbetat systematiskt för att förebygga och behandla typ 2-diabetes, både genom lagstiftning, policy och samverkan med lokalsamhällen. Tidigare erfarenheter har också visat att det är möjligt att vända en negativ utveckling på folkhälsoområdet, som man till exempel gjort med hjärt-kärlsjukdomar, säger Stefan Söderberg.

 

Om studien
Jaakko Tuomilehto, Sudhirsen Kowlessur, Paul Zimmet, Jaysing Heecharan, Noorjehan Joonas, Per Liv, Jonathan E Shaw, Dianna J Magliano, Stefan Söderberg. Trends in prevalence of type 2 diabetes and intermediate hyperglycaemia in Mauritius from 1987 to 2021 based on results from the oral glucose tolerance test: a repeated cross-sectional study.

 

 

 

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