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

GBD 2021 Diabetes Collaborators, Kanyin Liane Ong, Lauryn K. Stafford, Susan A. McLaughlin, Edward J. Boyko, Stein Emil Vollset, Amanda E. Smith, Bronte E. Dalton, Joe Duprey, Jessica A. Cruz, Hailey Hagins, Paulina A. Lindstedt, Amirali Aali, Yohannes Habtegiorgis Abate, Melsew Dagne Abate, Mohammadreza Abbasian, Zeinab Abbasi-Kangevari, Mohsen Abbasi-Kangevari, Samar Abd ElHafeez, Rami Abd-RabuDeldar Morad Abdulah, Abu Yousuf Md Abdullah, Vida Abedi, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Eman Abu-Gharbieh, Ahmed Abu-Zaid, Tigist Demssew Adane, Denberu Eshetie Adane, Isaac Yeboah Addo, Oyelola A. Adegboye, Victor Adekanmbi, Abiola Victor Adepoju, Qorinah Estiningtyas Sakilah Adnani, Rotimi Felix Afolabi, Gina Agarwal, Zahra Babaei Aghdam, Marcela Agudelo-Botero, Constanza Elizabeth Aguilera Arriagada, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Danish Ahmad, Rizwan Ahmad, Sajjad Ahmad, Aqeel Ahmad, Ali Ahmadi, Keivan Ahmadi, Ayman Ahmed, Ali Ahmed, Luai A. Ahmed, Syed Anees Ahmed, Marjan Ajami, Rufus Olusola Akinyemi, Hanadi Al Hamad, Syed Mahfuz Al Hasan, Tareq Mohammed Ali AL-Ahdal, Tariq A. Alalwan, Ziyad Al-Aly, Mohammad T. AlBataineh, Jacqueline Elizabeth Alcalde-Rabanal, Sharifullah Alemi, Hassam Ali, Tahereh Alinia, Syed Mohamed Aljunid, Sami Almustanyir, Rajaa M. Al-Raddadi, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Sohrab Amiri, Ganiyu Adeniyi Amusa, Catalina Liliana Andrei, Ranjit Mohan Anjana, Adnan Ansar, Golnoosh Ansari, Alireza Ansari-Moghaddam, Anayochukwu Edward Anyasodor, Jalal Arabloo, Aleksandr Y. Aravkin, Demelash Areda, Hidayat Arifin, Mesay Arkew, Benedetta Armocida, Johan Arnlov, Anton A. Artamonov, Judie Arulappan, Raphael Taiwo Aruleba, Ashokan Arumugam, Zahra Aryan, Mulu Tiruneh Asemu, Mohammad Asghari-Jafarabadi, Elaheh Askari, Daniel Asmelash, Thomas Astell-Burt, Mohammad Athar, Seyyed Shamsadin Athari, Maha Moh d.Wahbi Atout, Leticia Avila-Burgos, Ahmed Awaisu, Sina Azadnajafabad, B. B. Darshan, Hassan Babamohamadi, Muhammad Badar, Alaa Badawi, Ashish D. Badiye, Nayereh Baghcheghi, Nasser Bagheri, Sara Bagherieh, Sulaiman Bah, Saeed Bahadory, Ruhai Bai, Atif Amin Baig, Ovidiu Constantin Baltatu, Hamid Reza Baradaran, Martina Barchitta, Mainak Bardhan, Noel C. Barengo, Till Winfried Barnighausen, Mark Thomaz Ugliara Barone, Francesco Barone-Adesi, Amadou Barrow, Hamideh Bashiri, Afisu Basiru, Sanjay Basu, Saurav Basu, Abdul Monim Mohammad Batiha, Kavita Batra, Mulat Tirfie Bayih, Nebiyou Simegnew Bayileyegn, Amir Hossein Behnoush, Alehegn Bekele Bekele, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Luis Belo, Derrick A. Bennett, Isabela M. Bensenor, Kidanemaryam Berhe, Alemshet Yirga Berhie, Sonu Bhaskar, Ajay Nagesh Bhat, Jasvinder Singh Bhatti, Boris Bikbov, Faiq Bilal, Bagas Suryo Bintoro, Saeid Bitaraf, Veera R. Bitra, Vesna Bjegovic-Mikanovic, Virginia Bodolica, Archith Boloor, Michael Brauer, Javier Brazo-Sayavera, Hermann Brenner, Zahid A. Butt, Daniela Calina, Luciana Aparecida Campos, Ismael R. Campos-Nonato, Yin Cao, Chao Cao, Josip Car, Marcia Carvalho, Carlos A. Castaneda-Orjuela, Ferran Catala-Lopez, Ester Cerin, Joshua Chadwick, Eeshwar K. Chandrasekar, Gashaw Sisay Chanie, Jaykaran Charan, Vijay Kumar Chattu, Kirti Chauhan, Huzaifa Ahmad Cheema, Endeshaw Chekol Abebe, Simiao Chen, Nicolas Cherbuin, Fatemeh Chichagi, Saravana Babu Chidambaram, William C.S. Cho, Sonali Gajanan Choudhari, Rajiv Chowdhury, Enayet Karim Chowdhury, Dinh Toi Chu, Isaac Sunday Chukwu, Sheng Chia Chung, Kaleb Coberly, Alyssa Columbus, Daniela Contreras, Ewerton Cousin, Michael H. Criqui, Natalia Cruz-Martins, Sarah Cuschieri, Bashir Dabo, Omid Dadras, Xiaochen Dai, Albertino Antonio Moura Damasceno, Rakhi Dandona, Lalit Dandona, Saswati Das, Ana Maria Dascalu, Nihar Ranjan Dash, Mohsen Dashti, Claudio Alberto Davila-Cervantes

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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.

Original languageEnglish
Pages (from-to)203-234
Number of pages32
JournalThe Lancet
Volume402
Issue number10397
DOIs
StatePublished - Jul 15 2023

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