New cases of diabetes mellitus in England and Wales, 1994–1998: Database study
Introduction
Diabetes mellitus is a major public health problem. About 2% of the population are currently known to have diabetes and its prevalence is increasing.1 However, it is unclear whether the increase in prevalence is due to improved survival in people with diabetes (i.e. people with diabetes are living longer) or to an increase in the rate at which new cases of diabetes are being diagnosed, e.g. through increased screening. Some sections of the UK population are at an increased risk of developing diabetes, particularly older adults, people who are obese, and adults of South Asian and Afro-Caribbean origin.2 Changes in the number and proportion of the population made up by these groups, the distribution and prevalence of risk factors in the population, and the detection of diabetes are all likely to affect the number and rate of new cases that are diagnosed each year.
It is important to monitor the number of new cases that are diagnosed and the rate at which they are diagnosed in the population to assist in planning future services for people with diabetes. Sex- and age-specific rates also highlight groups that are at higher risk of being diagnosed with diabetes than the general population. Now that an increasing number of general practices are holding their clinical data in computerized format, primary care data are one possible source of this information.
There is, however, no widespread routine reporting of diagnoses of diabetes, and even large population-based surveys capture too few new cases to allow precise age-specific rates to be estimated.3 Furthermore, local studies cannot easily be generalized to the national population because the risk of diabetes is influenced by various factors including socio-economic status and the distribution and prevalence of risk factors in the population.4, 5 Our aim was to use routine data from primary care to estimate the number and rate of new cases of diabetes mellitus that were diagnosed in England and Wales over a 5-year period.
Section snippets
Methods
We used data from 208 general practices in England and Wales that contributed up-to-standard data to the General Practice Research Database continually from 1994 to 1998. The distribution and coverage of these practices has been described previously.6 We excluded three of the practices used in this earlier publication because of queries about their data. Inner city areas and single-handed practices were under-represented.
We counted the number of cases arising and the population at risk in each
Results
We estimate that the rate of diagnosis of new cases of diabetes in England and Wales was 19.1 [95% confidence intervals (CI) 17.8–20.4] per 10,000 person-years in males and 15.9 (95%CI 14.7–17.1) per 10,000 person-years in females in 1994, and that this increased to 23.9 (95%CI 22.6–25.3) per 10,000 person-years in males and 20.3 (95%CI 19.0–21.5) per 10,000 person-years in females in 1998 (Table 1). The rate was between 12 and 20% higher in males than females in each study year.
The rate of
Discussion
From 1994 to 1998, we estimate that the rate of diagnosis of new cases of diabetes in England and Wales increased by 25% in males and 28% in females. We estimate that the number of new cases of diabetes that were diagnosed each year in England and Wales also increased by one-quarter over the same period, from about 88,000 in 1994 to about 111,000 in 1998. In 1998, the rate was highest in people aged 65–74 years, and half of the new cases were people who were aged between 55 and 74 years.
Acknowledgements
We would like to thank the Health & Care Division at the Office for National Statistics for their support for this study. The data was paid for using a Primary Care Senior Scientist Award from the Department of Health held by AM. The data extraction and analysis was carried out while RR was employed by, and AN was on placement with, the Office for National Statistics.
References (22)
- et al.
The Poole Diabetes Study: how many cases of type 2 diabetes are diagnosed each year during normal health care in a defined community?
Diabetes Res Clin Pract
(2001) Is there really an epidemic of type 2 diabetes?
Lancet
(2003)- et al.
Rising prevalence of diabetes: evidence from a Danish pharmaco-epidemiological database
Lancet
(2003) - et al.
Prevalence of diagnosed diabetes mellitus in general practice in England and Wales, 1994 to 1998
Health Stat Q
(2002) - et al.
Health survey for England: the health of minority ethnic groups’99
(2003) - Erens B, Primatesta P. Health survey for England: cardiovascular disease’98. 2003...
- et al.
The annual incidence of diabetes and diabetic complications: a population-based study in Tayside, Scotland
(2003) - Office for National Statistics. In: Key health statistics from general practice 1998. Series MB6 No. 2. London: Office...
Sources, uses, strengths and limitations of data collected in primary care in England
Health Stat Q
(2004)The general practice research database: quality of morbidity data
Population Trends
(1997)
The general practice research database
Q J Med
Cited by (13)
The Lancet Commission on diabetes: using data to transform diabetes care and patient lives
2020, The LancetCitation Excerpt :Stabilisation of incidence has also been reported from a consortium of 11 integrated health-care delivery systems with electronic medical records in ten states across the USA during 2006–11,501 and that of the Scottish National Register in 2004–13.502 By contrast, studies from England and Wales (1994–98),503 Portugal (1992–2015),504 and Canada (1995–2007)505 reported increases in diabetes incidence. The first attempt to systematically collate published data on the trends of diabetes incidence in adults (mainly due to type 2 diabetes) showed that most studies came from administrative data sources, rather than health surveys.
Incidence of type 1 and type 2 diabetes in adults and children in Kronoberg, Sweden
2008, Diabetes Research and Clinical PracticeCitation Excerpt :The Framingham Heart Study, Massachusetts, USA showed a much higher incidence of type 2 than we found, with a doubling over the past 30 years, for women from 2000 to 3700, for men from 2700 to 5800 [44]. A British records study of a 1.3 million population, found an incidence of all diabetes of 221, which was a 25% increase from 1994 to 1998 concluding it an actual increase in incidence and neither due to the increase of elders in the population nor to better screening [46]. From Finland an alarming increase in the incidence of type 2 diabetes in young adults was recently reported to have occurred during the 1990's, reporting figures not so different from Kronoberg if time of registration, reported yearly increase, and amount of unclassified diabetes, are considered, and similarly increasing with age [34].
Incidence of diabetes in patients with schizophrenia: A population-based study
2011, Canadian Journal of Psychiatry