《柳叶刀》文章，2011年7月

自1980年来，国家、区域和全球的空腹血糖和糖尿病患病变化趋势：对共计370国家年（共计270万名参与者）的健康调研和流行病学研究进行系统分析。

人员名单（此处略，详见原文），来自于全球慢性疾病代谢危险因素负荷协作组(血糖方面研究)

文章摘要

背景资料
要理解血糖和糖尿病患病的变化趋势需要先清楚人群饮食和生活习惯的影响效应, 评价干预效果, 做好健康服务计划. 现时没有公认的全球趋势性分析可供参照.我们对199个国家和地区年龄不小于25岁的成人平均空腹血糖(FPG)和糖尿病患病的趋势进行预测以及评价其影响因素。

方法
数据来源于健康调研和流行病学研究(370国家年；270万参与者)，并对不同血糖指标间进行系统科学换算。利用贝叶斯等级模型对两性平均FPG进行预测以及年龄、国别、年份因素对预测值准确度的影响，判断一个研究是否具有国家、国内区域或社区代表性。

调查发现
2008年，全球年龄标化FPG男性为5•50 mmol/L (95%可信区间为5•37—5•63)，女性为5•42 mmol/L (5•29—5•54) ，每10年分别上升 0•07 mmol/L和0•09 mmol/L。2008年年龄标化患病率：男性9•8% (8•6—11•2)，女性9•2% (8•0—10•5)，较1980年患病率男性8•3% (6•5—10•4)，女性 7•5% (5•8—9•6)有所上升。人群中糖尿病患病人数从1980年的1.53亿 (1.27—1.82)增加至2008年的3.47亿(3.14—3.82)。根据记录显示，同期东欧、中欧以及东南亚平均FPG无明显变化。相比之下大洋洲升幅最大,平均FPG(男性6•09 mmol/L, 5•73—6•49;女性 6•08 mmol/L, 5•72—6•46)和糖尿病患病率(男性15•5%, 11•6—20•1;女性15•9%, 12•1—20•5)的峰值出现在2008年。南亚、拉丁美洲和加勒比海地区，以及中亚、北非和中东地区2008年的平均FPG和糖尿病患病率也较往年高。撒哈拉以南非洲地区、东南亚和亚太发达地区的平均FPG在2008年降至最低。在发达地区,西欧升幅最小，每10年升幅男性为0•07 mmol/L ，女性0•03 mmol/L；北美升幅最大，每10年升幅男性为0•18 mmol/L，女性0•14 mmol/L。

结论
人口增长和老龄化以及特定年龄组的患病率升高促使全球性的血糖水平和糖尿病患病率上升。行之有效的预防干预措施非常必要，卫生部门应为糖尿病人的监测和管理以及并发症、后遗症的处理做好充分准备。

资金来源
比尔&梅琳达•盖茨基金会 和 世界卫生组织

                          （原文请参考本文页3-4，如翻译有误请指出，谢谢！）李正添 译
中山市第二人民医院
中山市慢性病防治中心

原文：
The Lancet, Volume 378, Issue 9785, Pages 31 - 40, 2 July 2011

doi:10.1016/S0140-6736(11)60679-X Cite or Link Using DOI
This article can be found in the following collections: Endocrinology (Diabetes)
Published Online: 25 June 2011
Copyright © 2011 Elsevier Ltd All rights reserved.

National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2•7 million participants

Goodarz Danaei MD a *, Mariel M Finucane PhD b *, Yuan Lu MSc c, Gitanjali M Singh PhD c, Melanie J Cowan MPH d, Christopher J Paciorek PhD b f, John K Lin AB c, Farshad Farzadfar MD c, Prof Young-Ho Khang MD g, Gretchen A Stevens DSc e, Mayuree RaoBA c, Mohammed K Ali MBChB h, Leanne M Riley MSc d, Carolyn A Robinson MSc i, Prof Majid Ezzati PhD j k, on behalf of the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose) †

Summary
Background
Data for trends in glycaemia and diabetes prevalence are needed to understand the effects of diet and lifestyle within populations, assess the performance of interventions, and plan health services. No consistent and comparable global analysis of trends has been done. We estimated trends and their uncertainties in mean fasting plasma glucose (FPG) and diabetes prevalence for adults aged 25 years and older in 199 countries and territories.

Methods
We obtained data from health examination surveys and epidemiological studies (370 country-years and 2•7 million participants). We converted systematically between different glycaemic metrics. For each sex, we used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative.

Findings
In 2008, global age-standardised mean FPG was 5•50 mmol/L (95% uncertainty interval 5•37—5•63) for men and 5•42 mmol/L (5•29—5•54) for women, having risen by 0•07 mmol/L and 0•09 mmol/L per decade, respectively. Age-standardised adult diabetes prevalence was 9•8% (8•6—11•2) in men and 9•2% (8•0—10•5) in women in 2008, up from 8•3% (6•5—10•4) and 7•5% (5•8—9•6) in 1980. The number of people with diabetes increased from 153 (127—182) million in 1980, to 347 (314—382) million in 2008. We recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6•09 mmol/L, 5•73—6•49 for men; 6•08 mmol/L, 5•72—6•46 for women) and diabetes prevalence (15•5%, 11•6—20•1 for men; and 15•9%, 12•1—20•5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Africa, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0•07 mmol/L per decade for men and 0•03 mmol/L per decade for women; North America had the largest rise, 0•18 mmol/L per decade for men and 0•14 mmol/L per decade for women.

Interpretation
Glycaemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences. Effective preventive interventions are needed, and health systems should prepare to detect and manage diabetes and its sequelae.

Funding
Bill & Melinda Gates Foundation and WHO.