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Diabetes in Denmark -- An Epidemic?

Henrik Støvring, Research Unit of General Practice, University of Southern Denmark

Based on a recently published paper (1) I want to discuss the popular claim of a current epidemic of diabetes in Denmark. The word epidemic is often not clearly defined and I will show how our results can be used to both support and reject the claim of an epidemic depending on the chosen definition. More interestingly, I will present some results that did not find room in the published paper. They illustrate the fundamental epidemiologic mechanisms that must be appreciated to understand why the prevalence of pharmacologically treated diabetes increased dramatically in the 1990s, even though the incidence rate of pharmacologically treated diabetes was nearly constant in the same period. During the presentation I will discuss weaknesses and strengths of the chosen pharmaco-epidemiologic approach in comparison to alternative epidemiologic strategies.  Further, I will comment on some flawed interpretations of our study put forward by others, but also emphasize some conclusions and implications which so far have been ignored in the debate, cf (2). Finally, I will discuss how our Danish results may be of interest for the situation in the US, even though the situations in the two countries are quite different.

Although the presentation is primarily epidemiologic in its scope, I intend to show how a statistical point of view enables a better understanding of the population dynamics of chronic diseases with long durations.

[1] Henrik Støvring, Morten Andersen, Henning Beck-Nielsen, Anders Green, and Werner Vach. Rising prevalence of diabetes: evidence from a Danish pharmaco-epidemiological
. The Lancet, 362:537–38, 2003.
[2] Edwin Gale. Is there really an epidemic of type 2 diabetes? The Lancet, 362:503–504, 2003.


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