European Association for the Study of Diabetes Annual Meeting, 2000

Pathogenesis of Type 2 Diabetes

The Aharon Cohen Memorial Lecture.

Paul Zimmet of Melbourne, Australia, opened the meeting with the Aharon Cohen Memorial Lecture. He described the global epidemic of diabetes as a “clash between genes and the environment” that has caused one of the major public health issues of the 21st century. Given the location of the meeting in Israel, Zimmet recalled the work of Maimonedes in the 12th century, noting that diabetes was more frequent in certain geographic areas than others. Zimmet discussed the development of diabetes in ethnic groups with migration, such as the Yemenite Jews and Bedouins, who had little diabetes with traditional dietary patterns but more on exposure to modern high-calorie foods. In Australia, as in many other developed countries, the frequency of diabetes has tripled over the past several decades. A further doubling is predicted around the world over the coming decade, particularly in Asia, in association with increasing levels of obesity. Further, the age of onset of diabetes has lowered from the mid-50s to the mid-30s.

Zimmet suggested that the glucose tolerance test is still relevant to the diagnosis of diabetes. He noted that impaired glucose tolerance (IGT; a blood glucose level of 140–199 mg/dl 2 h after an oral glucose load) occurs with similar frequency in men and women, but that impaired fasting glucose (IFG; fasting blood glucose 110–125 mg/dl) is more common in women. Furthermore, cardiovascular disease (CVD) mortality is greater for individuals with IGT than for those with IFG. Indeed, studies Zimmet performed in Mauritius, which showed a 40% increase in rates of diabetes over the past decade in individuals of …