Abstract
Type 2 diabetes rates vary significantly across geographic regions. These differences are sometimes assumed to be entirely driven by differential distribution of environmental triggers, including obesity and insufficient physical activity (IPA). In this review, we discuss data which conflicts with this supposition. We carried out a secondary analysis of publicly available data to unravel the relative contribution of obesity and IPA towards diabetes risk across different populations. We used sex-specific, age-standardized estimates from Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) on diabetes (1980–2014) and obesity (1975–2016) rates, in 200 countries, and from WHO on IPA rates in 168 countries in the year 2016. NCD-RisC and WHO organized countries into nine super-regions. All analyses were region- and sex-specific. Although obesity has been increasing since 1975 in every part of the world, this was not reflected in a proportional increase in diabetes rates in several regions, including Central and Eastern Europe, and High-income western countries region. Similarly, the association of physical inactivity with diabetes is not homogeneous across regions. Countries from different regions across the world could have very similar rates of diabetes, despite falling on opposite ends of IPA rate spectrum. The combined effect of obesity and IPA on diabetes risk was analyzed at the worldwide and country level. The overall findings highlighted the larger impact of obesity on disease risk; low IPA rates do not seem to be protective of diabetes, when obesity rates are high. Despite that, some countries deviate from this overall observation. Sex differences were observed across all our analyses. Overall, data presented in this review indicate that different populations, while experiencing similar environmental shifts, are apparently differentially subject to diabetes risk. Sex-related differences observed suggest that males and females are either subject to different risk factor exposures or have different responses to them.
Highlights
Type 2 diabetes (T2D) is a complex metabolic disorder with worryingly increasing rates in several regions in the world
Diabetes risk was defined on the basis of the tertile split, i.e., countries that fell in the first tertile were coded as low risk, and those that fell in the second and third tertiles, were coded as moderate and high risk, respectively
Based on our analysis of noncommunicable diseases (NCDs)-RisC data, in 2014, agestandardized diabetes prevalence was high in Oceania among both males (15.8%) and females (14.4%) (Fig. 1A, B)
Summary
Type 2 diabetes (T2D) is a complex metabolic disorder with worryingly increasing rates in several regions in the world. The development of T2D reflects a complex interplay of adverse lifestyle exposures with potentially increased genetic predisposition. The rapid worldwide increase in T2D rates is primarily a consequence of ageing in most populations, and the increase of obesity levels and lack of physical activity [1]. Various measures of being overweight have repeatedly been shown to strongly associate with increased risk of T2D [3–6]. The impact of physical activity on preventing and managing T2D has been established through cross-sectional and prospective studies. Overall, these studies have demonstrated the [1] independent association of physical inactivity with T2D risk, [2] association of increased sedentary behaviors
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
