Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

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Abstract

BACKGROUND: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS: In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION: Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

The Lancet

Topic

Diabetes, Cardiovascular Risks, and Lipoproteins

Field

Medicine

Canadian institutions

—

Funders

European and Developing Countries Clinical Trials PartnershipNational Institute for Occupational Safety and HealthFaculty of Medicine and Health, University of SydneyGastrointestinal and Liver Diseases Research CenterInstituto de Salud Carlos IIIRussian Academy of SciencesFundação para a Ciência e a TecnologiaNational Health and Medical Research CouncilMedical Research CouncilPenn State College of MedicineHorizon 2020 Framework ProgrammeNovartis PharmaUniversity of Veterinary and Animal SciencesNational Science and Technology CouncilNational Institutes of Biomedical Innovation, Health and NutritionNIHR Sheffield Biomedical Research CentreAlfaisal UniversityLaboratório Associado para a Química VerdeWestern Sydney UniversityMahatma Gandhi UniversityUniversidad Autónoma de SinaloaNational Institute for Research in TuberculosisUniversity of Asia PacificUniwersytet Śląski w KatowicachDepartment of Global Health and Population, Harvard T.H. Chan School of Public HealthImam Abdulrahman Bin Faisal UniversityLingnan UniversityAja University of Medical SciencesUniversitas Gadjah MadaLorestan University of Medical SciencesAlborz University of Medical SciencesXuzhou Medical UniversitySwedish Orphan BiovitrumRajarata University of Sri LankaICAR-Indian Veterinary Research InstituteAustralian Research CouncilMasarykova UniverzitaŚląski Uniwersytet Medyczny w KatowicachHawassa UniversityNational Center of Neurology and PsychiatryInternational Medical UniversityUniversity of ZanjanThe Wellcome Trust DBT India AllianceNanjing UniversityNational Nutrition and Food Technology Research InstituteIlam UniversityUniversidad de La SabanaShahid Beheshti University of Medical SciencesUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiUniversity of California, Los AngelesChina Medical UniversityTarbiat Modares UniversityYasuj University of Medical SciencesUmm Al-Qura UniversityUniversidad de la República UruguayDipartimento di Medicina Sperimentale e Clinica, Università degli Studi di FirenzeBahir Dar UniversityBaqiyatallah University of Medical SciencesShahrekord University of Medical SciencesUniversidad Nacional Autónoma de MéxicoMonash UniversityUniversità degli Studi del Piemonte OrientaleGuilan University of Medical SciencesUniversitair Medisch Centrum GroningenZanjan University of Medical SciencesUniversity of GondarUnited Arab Emirates UniversityJazan UniversityAhvaz Jundishapur University of Medical SciencesSocial Science Foundation of Jiangsu ProvinceUniversità di BolognaTaibah UniversityAsia UniversityCentral University of KeralaAstellas PharmaShiraz UniversityKing Abdulaziz City for Science and TechnologyUniversidade Federal do Rio Grande do SulShahrekord UniversityNational Institute on AgingChinese University of Hong KongZhejiang UniversityUniversity of California, San DiegoHamadan University of Medical SciencesUniversitetet i BergenMinistarstvo Prosvete, Nauke i Tehnološkog RazvojaChina Scholarship CouncilUniversity College LondonUniversiti Kebangsaan MalaysiaKuwait UniversityChinese Center for Disease Control and PreventionTabriz University of Medical SciencesShiraz University of Medical SciencesUniversity of Cape TownKhalifa University of Science, Technology and ResearchUniversity of WollongongKing Abdulaziz UniversityOffice of the Secretary of TransportationKarolinska InstitutetIsfahan University of Medical SciencesNanyang Technological UniversityFundação de Amparo à Pesquisa do Estado de Minas GeraisHaramaya UniversityMinistry of Health and Medical EducationNational Research Foundation of KoreaKorea Institute for Advancement of TechnologyConselho Nacional de Desenvolvimento Científico e TecnológicoLilly DeutschlandImperial College LondonUniversity of TorontoMinistero della SaluteMinistry of Trade, Industry and EnergyBundesministerium für Bildung und ForschungGovernment of Jiangsu ProvinceGuangzhou University of Chinese MedicineUniversidad Nacional de ColombiaFaculdade de Medicina do ABCNational Natural Science Foundation of ChinaJames Cook UniversityDebre Tabor UniversityUniversiteit UtrechtFlinders UniversityWashington University in St. LouisMount Sinai Health SystemDeutsche ForschungsgemeinschaftIlam University of Medical SciencesShandong UniversityUniversidad de ChileDepartment of Biotechnology, Ministry of Science and Technology, IndiaCapital Medical UniversityLa Trobe UniversityApplied Molecular Biosciences UnitPublic Health Foundation of IndiaSemnan University of Medical Sciences and Health ServicesTehran Heart CenterFresenius Medical Care North AmericaAustralian Catholic UniversitySydney Medical SchoolNewcastle UniversityIndian Council of Medical ResearchUniversity of CanberraAmerican University of SharjahCancer Institute NSWUniversitas PadjadjaranMashhad University of Medical SciencesMassachusetts General HospitalKorean Diabetes AssociationIndian Council of Agricultural ResearchDongguk UniversityBritish Heart FoundationUniversità di CataniaNational Research FoundationNational Institute for Health and Care ResearchSalahaddin University-ErbilUniversity of RochesterArizona State UniversityMacquarie UniversityMadras Diabetes Research FoundationJSS Academy of Higher Education and ResearchKasturba Medical College, ManipalKrishna Institute Of Medical Sciences Deemed To Be UniversityUmeå UniversitetUniversitätsklinikum EssenAlexandria UniversityMcGill UniversityUniversity of KufaMadda Walabu UniversityKerman University of Medical SciencesPublic Health Agency of CanadaHøgskulen på VestlandetFujita Health UniversityAksum UniversityHealth Research Council of New ZealandPennsylvania State UniversityUniversität BaselDeutsches KrebsforschungszentrumAmicus TherapeuticsQueen's UniversityIran University of Medical SciencesAcademy of Scientific Research and TechnologyAmerican Diabetes AssociationNational Defense Medical CollegeAmarin CorporationAmgenSanofiUniversity of OxfordWellcome TrustChandigarh UniversityShaqra UniversityJimma UniversityYale UniversityLebanese American UniversityTrường Đại học Duy TânJohns Hopkins UniversityMcMaster UniversityDeakin UniversityNovo NordiskDirectorate for Biological SciencesSaveetha Dental CollegeUniversity of WaterlooBrody School of MedicineNovo Nordisk PharmaUniversity of Health and Allied SciencesNational Institute of Biomedical InnovationMarga und Walter Boll-StiftungNanjing University of Science and TechnologyPublic Health AgencyEli Lilly and CompanyOttawa Hospital Research InstituteTokyo Medical and Dental UniversityTehran University of Medical Sciences and Health ServicesUniversity of Technology SydneyZahedan University of Medical SciencesUniversity of AberdeenHarvard UniversityIdorsia PharmaceuticalsGeneralitat de CatalunyaU.S. Department of Veterans AffairsMinistry of EducationUniversity of Science and Technology of ChinaUniversity of PennsylvaniaGuangzhou UniversitySemnan UniversityEast Carolina UniversityChina Medical University, TaiwanCooperativa de Ensino Superior Politécnico e UniversitárioDaiichi Sankyo EuropeFred Hollows FoundationUniversity of SydneyCase Western Reserve UniversityQatar UniversityMinistry of Higher Education, MalaysiaAsian Institute of Medicine, Science and TechnologyAlexion PharmaceuticalsHamad Medical CorporationBrigham and Women's HospitalFlorida International UniversityCleveland Clinic FoundationUniversity of GlasgowTaipei Medical UniversityCleveland ClinicNazarbayev UniversityWuhan UniversityAteneo de Manila UniversityUniversity of Oklahoma Health Sciences CenterHögskolan DalarnaRijksuniversiteit GroningenAlberta Health ServicesMinistry of Business, Innovation and EmploymentBelgian American Educational FoundationUniversity of TabrizEuropean CommissionUniversity of OklahomaNational Heart, Lung, and Blood InstituteAstraZenecaUniversity of South FloridaCilagScience and Technology Development FundUniversità degli Studi di FirenzeCharles Sturt UniversityUniversidade do PortoAustralian GovernmentUniversiti Sains MalaysiaCurtin University of TechnologyPfizerBill and Melinda Gates FoundationUniversity of New South WalesUniversità ta' MaltaNational Heart Foundation of AustraliaComunidad de MadridAddis Ababa UniversitySultan Qaboos UniversityDanoneUniversity of Bern

Keywords

Burden of diseaseMedicineDiabetes mellitusDiseaseDisease burdenMEDLINEEnvironmental healthGlobal healthIntensive care medicinePublic healthInternal medicinePolitical sciencePathology

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