Executive Summary Diabetes has become a global crisis that is increasing exponentially and will have lasting effects on global health for generations to come . Diabetes inequity is accelerating this global crisis, causing outsized impacts on outcomes. Structural inequity, comprised of structural racism and geographic inequity, is deeply embedded in geopolitical, economic, healthcare, and social structures, and creates important differences in upstream social determinants of health, such as socioeconomic position. and the availability of resources. These differences negatively and differentially influence downstream social determinants of health, such as access to high-quality care and education, as well as diabetes prevalence, morbidity, and mortality. Diabetes will be a defining disease of this century. How the healthcare community addresses diabetes over the next two decades will determine population health and life expectancy over the next 80 years. The world has failed to understand the social nature of diabetes and has underestimated the true scale and threat posed by the disease. The GBD 2021 estimates and the Lancet Global Inequity in Diabetes series are an urgent call to correct course. |
Global, regional and national burden of diabetes from 1990 to 2021, with prevalence projections to 2050: a systematic analysis for the Global Burden of Disease Study 202 1
Background
Diabetes is a leading cause of death and disability worldwide, affecting people regardless of country, age group or gender . Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries and Risk Factors (GBD) Study, we produce location-, age- and sex-specific estimates of the prevalence and burden of diabetes 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 diabetes prevalence projections through 2050.
Methods
Estimates of the prevalence and burden of diabetes were calculated in 204 countries and territories, in 25 age groups, for men and women separately and combined; these estimates comprised years of healthy life lost, measured in disability-adjusted life years (DALYs, defined as the sum of years of life lost [YLL] and years lived with disability [YLD]). We used the Cause of Death Ensemble Model (CODEm) approach to estimate diabetes deaths, incorporating 25,666 location years of data from vital registration and verbal autopsy reports into a separate total (including type 1 and type 2 diabetes ) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modeled.
The prevalence of type 1 and total diabetes was estimated by using a Bayesian meta-regression modeling tool, DisMod-MR 2.1, analyzing 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; Type 2 diabetes estimates were calculated by subtracting type 1 diabetes from the total estimates.
Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLL, YLD, and DALY. Where appropriate, we extrapolated estimates to a hypothetical population with a standardized age structure to allow comparison in populations with different age structures.
We used the comparative risk assessment framework to estimate the risk-attributable burden of type 2 diabetes for 16 risk factors included in risk categories, including environmental and occupational factors, tobacco use, heavy alcohol consumption, body mass index ( high BMI, dietary factors, and low physical activity. Using a regression framework,
Results
In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the total age-standardized global diabetes prevalence was 6.1% (5, 8–6,5).
At the superregion level, the highest age-standardized 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 highest age-specific diabetes prevalence in the world, at 76.1% (73.1-79.5) in people aged 75 to 79 years.
The overall prevalence of diabetes, 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% (94.8%) of diabetes cases. .9–95.9) of diabetes DALYs worldwide.
In 2021, 52.2% (25.5–71.8) of global type 2 diabetes DALYs were attributed to high BMI.
The contribution of high BMI to type 2 diabetes DALYs increased 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 total age-standardized diabetes prevalence rates expected to be greater than 10% in two superregions: 16.8% (16.1–17.6%) in North Africa and the Middle East and 11.3% (10·8–11·9) in Latin America and the Caribbean.
By 2050, 89 (43.6%) of 204 countries and territories will have an age-standardized rate greater than 10%. 16·8% (16·1–17·6) in North Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and the Caribbean.
By 2050, 89 (43.6%) of 204 countries and territories will have an age-standardized rate greater than 10%. 16·8% (16·1–17·6) in North Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and the Caribbean. By 2050, 89 (43.6%) of 204 countries and territories will have an age-standardized rate greater than 10%.
Figure : Global age-standardized prevalence of type 1 and type 2 diabetes from 1990 to 2050 forecasts. The shaded area represents 95% uncertainty intervals. Total diabetes is the sum of type 1 and type 2 diabetes.
Interpretation
Diabetes remains a major public health problem. Type 2 diabetes, which makes up the majority of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and treated early in the course of the disease. However, all evidence indicates that the prevalence of diabetes is increasing worldwide, primarily due to an increase in obesity caused by multiple factors.
Prevention and control of type 2 diabetes remains an ongoing challenge. Better understanding disparities in risk factor profiles and diabetes burden across populations is essential to inform strategies to successfully manage diabetes risk factors in the context of multiple and complex factors.
Implications of all available evidence
Policymakers and public health officials around the world are increasingly concerned about the rising prevalence rates of diabetes and its implications for health care systems and societies.
At the current rate, we project that more than 1.31 billion people will be living with diabetes by 2050, the majority of whom will have type 2 diabetes.
Addressing the increasing challenges to diabetes prevention and barriers to managing the disease and its complications will become a necessary component of healthcare delivery worldwide. There is an urgent need to address adverse trends in the prevalence of type 2 diabetes risk factors, particularly obesity. Without new and far-reaching approaches that address not only the risk factors but also the social and logistical barriers that limit access to treatment and health care.
Funding: Bill and Melinda Gates Foundation.
