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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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.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | The Lancet |
| Vol/bind | 402 |
| Udgave nummer | 10397 |
| Sider (fra-til) | 203-234 |
| Antal sider | 32 |
| ISSN | 0140-6736 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
This study is funded by the Bill & Melinda Gates Foundation. A Ahmad acknowledges support from the Deanship of Scientific Research at Shaqra University for supporting this work. S M Aljunid acknowledges support from the Department of Community Medicine, School of Medicine, International Medical University, Malaysia and Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. T Astell-Burt acknowledges support from an Australian Research Council (ARC) Future Fellowship (FT220100857). A Badawi acknowledges support from the Public Health Agency of Canada. R Bai acknowledges support in part by the National Natural Science Foundation of China (grant number 72204112) and the Social Science Fund of Jiangsu Province (grant number 21GLD008). O C Baltatu acknowledges support by the National Council for Scientific and Technological Development (CNPq, 304224/2022-7) and Anima Institute - AI (research professor fellowship). L Belo acknowledges support from from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. D A Bennett acknowledges support from the Medical Research Council Population Research Unit at the University of Oxford. A N Bhat acknowledges support from the Manipal Academy of Higher Education. M Carvalho acknowledges support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. S B Chidambaram acknowledges the administrative support provided by JSS Academy of Higher Education & Research, Mysuru, India. S Cuschieri acknowledges support from the University of Malta. B B Duncan acknowledges support in part by the Brazilian National Council for Scientific and Technological Development (CNPq, research fellowship), and the Institute for Health Technology Assessment (IATS; 465518/2014-1). H A Edinur acknowledges support from the Ministry of Higher Education Malaysia (Fundamental Research Grant Scheme: FRGS/1/2020/STG03/USM/03/5). A Fatehizadeh acknowledges support from the Department of Environmental Health Engineering of Isfahan University of Medical Sciences, Isfahan, Iran. S Gaihre acknowledges support from the Institute of Applied Health Sciences (IAHS), School of Medicine, Medical Sciences and Nutrition (SMMSN), University of Aberdeen for providing time and necessary resources to work on this manuscript. R K Gautam acknowledges the work to their organization Department of Pharmacology, Indore Institute of Pharmacy, IIST Campus, Rau, Indore, 453331 (M.P.), India. V K Gupta acknowledges funding support from National Health and Medical Research Council (NHMRC), Australia. S Haque acknowledges support from Jazan University, Saudi Arabia for providing the access of Saudi Digital Library for this study. J Haubold acknowledges support from The Clinician Scientist Program of the Clinician Scientist Academy (UMEA) of the University Hospital Essen, funded by the German Research Foundation (DFG) (FU 356/12-2), provided Johannes Haubold with financial support. B-F Hwang acknowledges support from China Medical University, Taiwan (province of China) (CMU111-MF-55). N Ikeda acknowledges support from the National Institutes of Biomedical Innovation, Health and Nutrition, Japan. I M Ilic acknowledges support from project No 175042 supported by Ministry of Education, Science and Technological Development, Republic of Serbia, 2011-2023. M D Ilic acknowledges support from the Ministry of Science, and Technological Development and Innovation of the Republic of Serbia (no. 451-03-47/2023-01/200111). S M S Islam acknowledges support from the National Health and Medical Research Council of Australia (NHMRC) and has received funding from the National Heart Foundation of Australia. N E Ismail acknowledges AIMST University, Malaysia for institutional support. N Joseph acknowledges support from Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India in this research work. H Kandel acknowledges support from a Kornhauser Research Fellowship at the University of Sydney. M Kivimäki acknowledges support from the Wellcome Trust (221854/Z/20/Z), Medical Research Council (R024227), National Institute on Aging (R01AG062553), and Academy of Finland, Finland (350426). K Krishan acknowledges non-financial support from UGC Centre of Advanced Study, Phase II, awarded to the Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. K Latief received funding from Taipei Medical University for Doctoral Education during the conduct of this review. M Lee acknowledges support from the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2021R1I1A4A01057428) and Bio-convergence Technology Education Program through the Korea Institute for Advancement Technology (KIAT) funded by the Ministry of Trade, Industry and Energy (No. P0017805). M-C Li acknowledges support from the National Science and Technology Council in Taiwan (province of China) (NSTC 111-2410-H-003-100-SSS). G Lopes acknowledges support from national funds through the Fundação para a Ciência e a Tecnologia (FCT) under the Scientific Employment Stimulus - Individual Call (CEECIND/01768/2021). S Lorkowski acknowledges institutional support from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant agreement number 01EA1808A). G Lucchetti is a Research Productivity Grantee of the Brazilian National Council for Scientific and Technological Development (CNPq) - type 1C. M A Mahmoud acknowledges the support from Taibah University to participate in this research project. D C Malta acknowledges support from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), FAPEMIG - Fundação de Amaparo a Pesquisa de Minas Gerais. H R Marateb acknowledges support from the Beatriu de Pinós post-doctoral programme from the Office of the Secretary of Universities and Research from the Ministry of Business and Knowledge of the Government of Catalonia program (#2020 BP 00261). E Mathews acknowledges support from the DBT/Wellcome Trust India Alliance Fellowship (grant number IA/CPHE/17/1/503345) and would like to thank Central University of Kerala, India. L Monasta acknowledges support from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. U Mons acknowledges support from Marga and Walter Boll Foundation, Kerpen, Germany. U O Mueller acknowledges funding by the German National Cohort Study. A Ortiz acknowledges Comunidad de Madrid en Biomedicina P2022/BMD-7223, CIFRA_COR-CM. Instituto de Salud Carlos III (ISCIII) RICORS program to RICORS2040 (RD21/0005/0001) funded by European Union – NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR). J R Padubidri acknowledges Manipal Academy of Higher Education, Manipal and Kasturba Medical College, Mangalore for their support towards collaborative research. V C F Pepito acknowledges institutional support from the Ateneo de Manila University. I Qattea acknowledges support from Nassau University Medical Centers and Cleveland Clinic Foundation. E M M Redwan acknowledges support from King Abdulaziz University (DSR), Jeddah, and King Abdulaziz City for Science & Technology (KACSAT), Saudi Arabia; and Science & Technology Development Fund (STDF), and US-Egypt Science & Technology joint Fund, The Academy of Scientific Research & Technology (ASRT), Egypt. L F Reyes acknowledges support from Universidad de La Sabana. M Rodrigues was supported by the Centre of Studies in Geography and Spatial Planning, funded by national funds through the Foundation for Science and Technology (FCT) under the reference UIDB/04084/2020. U Saeed acknowledges support from The International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. A Schuermans acknowledges support from the Belgian American Educational Foundation. N S Shah was supported by National Heart, Lung, and Blood Institute grant number K23HL157766. L M L R Silva was supported by the project code CENTRO-04-3559-FSE-000162, Fundo Social. M Tabish acknowledges support from the Deanship of Scientific Research at Shaqra University for this work. M Tonelli acknowledges support from the David Freeze Chair in Health Services Research. M R Tovani-Palone acknowledges Saveetha Institute of Medical and Technical Sciences for supporting this study. Z Wang acknowledges financial support from Fonds de recherche du Québec - Santé, China Scholarship Council, and McGill University Global Health Scholars Program. Mr Wang has also received consulting fees from the Fred Hollows Foundation. X Xu is supported by Heart Foundation Post-doctoral Fellowship funded by the Heart Foundation of Australia (Award No. 102597), and Scientia Program at the University of New South Wales, Australia. S B Zaman acknowledges receiving a scholarship from the Australian Government Research Training Program (RTP) in support of his academic career. A Zumla acknowledges support from the Pan African Network for Rapid Research, Response, and Preparedness for Infectious Diseases Epidemics Consortium (PANDORA-ID-NET), European and Developing Countries Clinical Trials Partnership the EU Horizon 2020 Framework Programme (EDCTP-RIA2016E-1609).
Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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