The Epidemiologic Transition of Diabetes Mellitus in Taiwan: Implications for Reversal of Female Preponderance from a National Cohort

Diabetes prevalence studies show a female preponderance, especially in developed countries. This review summarizes the epidemiologic evidence for a possible transition in sexual preponderance in Taiwan. Major epidemiologic surveys of diabetes prevalence and studies on the incidence and mortality of diabetes in Taiwan over the past decades were reviewed. Diabetes prevalence increased from 5.1% in 1970 to 12.8% in 1996 with female preponderance. However, a 3-fold higher prevalence in men in the younger age of 19-44 years in contrast to a female preponderance in the older age was observed in the 1996 survey. The female preponderance could possibly be explained by a higher mortality due to higher prevalence of macrovascular complications and higher incidence of hypertension in the diabetic men. Although overall incidence of diabetes was higher in women ( 218.4 vs 187.1 per 100,000), age-specific incidence analyses suggested a higher incidence accompanied by obesity in men in the age groups below 45 years. In conclusions, increasing prevalence of diabetes with female preponderance had been observed for decades in Taiwan, which can be explained partly by the higher risk of morbidity and mortality in the diabetic men and an overall higher incidence in women of all ages. However , the sex preponderance in diabetes is expected to change from women to men rolling from the past decades to the future in Taiwan because of the increasing prevalence of obesity in the younger men.