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4. Epidemiology and sanitary impact
of type 2 diabetes mellitus
4.1. Epidemiology of DM 2
The epidemiologic situation of type 2 diabetes mellitus (DM 2) in Spain has recently been reviewed
in the report Estrategia en diabetes del Sistema Nacional de Salud (Strategy on diabetes
of the National Health System) from the Ministry of Health and Consumer Affairs (1). According
to this report, the prevalence of DM 2 is around 6.5% for the population between 30 – 65 years
old, though this figure may vary between 6% and 12% (1; 3; 4) depending on the different studies,
groups of population and methods used for diagnosis. The National Health Survey states that
in the period 1993-2003, the prevalence of diabetes mellitus (DM) declared by the respondents
increased from 4.1% to 5.9%, 16.7% in the age range between 65 and 74 and 19.3% for those
over 75. (1)
This prevalence increase can be due to several causes; on the one hand, the change in the
DM diagnosis criterion (reduction from 140 mg/dl to 126 mg/dl) (5), and, on the other, the gradual
ageing of the population as well as the changes in lifestyle, characterised by less physical activity
and diabetic habits with pathologies such as obesity (1; 6).
The data from different prevalence studies in Spain state that the use of diagnostic criteria
based on blood glucose (ADA, 1997) instead of on the Oral Glucose Tolerance Test (OGTT)
(WHO, 1999) undervalue the prevalence of diabetes. It is believed that the prevalence of unknown
diabetes is similar to that of the known diabetes (6%-10%) (4).
The DM 2 mortality rate ranges between 12.75 and 30.37 deaths for every one thousand inhabitants,
according to the different Autonomous Communities. 75% of the diabetic patients die
from cardiovascular disease, mainly due to coronary disease (1).
Diabetic microangiopathy (retinopathy, nephropathy and neuropathy) is mainly determined
by the level of glycemic control, while the development of macrovascular complications (coronary
heart disease, stroke and peripheral arteriopathy) is attributed to the existence of risk factors
in the diabetic patient (hypertension, dislypemia, smoking and obesity).
Macroangiopathy or macrovascular disorder has an earlier start, a more aggressive evolution
and it affects women more. The diabetic population has a greater adjusted risk than the nondiabetic
(2.6 in the case of women and 1.7 in the case of men) to suffer coronary heart disease
(angina, silent ischemic cardiopathy, acute myocardial infarction (AMI) or sudden death) (2).
The prevalence of macroangiopathy in type 2 diabetics ranges between 22% and 33% in
the different studies. It is worth highlighting: 30% of electrocardiogram alterations; 12.4% of
coronary heart disease; 9.8 % of stroke; 14.1% with signs of peripheral arteriopathy; 8% of intermittent
claudication and, , 1.4% of amputations, according to a study carried out in the Basque
Country (3).
Up to 20% of type 2 diabetics present diabetic retinopathy when diagnosed. In the GEDAPS
study from the year 2000, retinopathy prevalence was 31% and that of amaurosis, 3%. After 20
years of evolution, 60% of DM 2 patients have diabetic retinopathy (1).
CLINICAL PRACTICE GUIDELINE ON TYPE 2 DIABETES 31