Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025

Xiling Lin, Yufeng Xu, Xiaowen Pan, Jingya Xu, Yue Ding, Xue Sun, Xiaoxiao Song, Yuezhong Ren, Peng-Fei Shan, Xiling Lin, Yufeng Xu, Xiaowen Pan, Jingya Xu, Yue Ding, Xue Sun, Xiaoxiao Song, Yuezhong Ren, Peng-Fei Shan

Abstract

Diabetes mellitus is a leading cause of mortality and reduced life expectancy. We aim to estimate the burden of diabetes by type, year, regions, and socioeconomic status in 195 countries and territories over the past 28 years, which provide information to achieve the goal of World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2025. Data were obtained from the Global Burden of Disease Study 2017. Overall, the global burden of diabetes had increased significantly since 1990. Both the trend and magnitude of diabetes related diseases burden varied substantially across regions and countries. In 2017, global incidence, prevalence, death, and disability-adjusted life-years (DALYs) associated with diabetes were 22.9 million, 476.0 million, 1.37 million, and 67.9 million, with a projection to 26.6 million, 570.9 million, 1.59 million, and 79.3 million in 2025, respectively. The trend of global type 2 diabetes burden was similar to that of total diabetes (including type 1 diabetes and type 2 diabetes), while global age-standardized rate of mortality and DALYs for type 1 diabetes declined. Globally, metabolic risks (high BMI) and behavioral factors (inappropriate diet, smoking, and low physical activity) contributed the most attributable death and DALYs of diabetes. These estimations could be useful in policy-making, priority setting, and resource allocation in diabetes prevention and treatment.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Global burden of diabetes mellitus from 1990 to 2025. (A) Incidence number; (B) Age-standardized incidence rate; (C) Prevalence number; (D) Age-standardized prevalence rate; (E) Death number; (F) Age-standardized mortality rate; (G) DALYs number; (H) Age-standardized DALYs rate. DALYs: disability-adjusted life-years.
Figure 2
Figure 2
Global map of health burden of diabetes mellitus in 2017. (A) Prevalence number; (B) Death number; (C) DALYs number. DALYs: disability-adjusted life-years. Maps was based on EChart which is an open-source visualization library (under an Apache 2.0 license: https://github.com/apache/incubator-echarts/blob/master/LICENSE; URL of Echart: https://echarts.apache.org/zh/index.html), and implemented in Java (version JDK 1.8.0) using the software of IntelliJ IDEA Community Edition 2018.3.2.
Figure 3
Figure 3
Global burden of diabetes mellitus in different World Bank Income Level regions from 1990 to 2017: (A) Age-standardized incidence rate, (B) Age-standardized prevalence rate, (C) Age-standardized mortality rate; (D) Age-standardized DALYs rate. WBLI: World Bank low income; WBLMI: World Bank lower middle income; WBUMI: World Bank upper middle income; WBHI: World Bank high income.
Figure 4
Figure 4
Age-standardized mortality rate and DALYs rate of diabetes attributable to risks by SDI level in 2017. (A) Age-standardized mortality rate; (B) Age-standardized DALYs rate. SDI: Socio-demographic Index.

References

    1. Patterson CC, et al. Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989–2013: a multicentre prospective registration study. Diabetologia. 2019;62:408–417. doi: 10.1007/s00125-018-4763-3.
    1. Wang L, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA. 2017;317:2515–2523. doi: 10.1001/jama.2017.7596.
    1. Dwyer-Lindgren L, Mackenbach JP, Van Lenthe FJ, Flaxman AD, Mokdad AH. Diagnosed and undiagnosed diabetes prevalence by County in the U.S., 1999–2012. Diabetes Care. 2016;39:1556–1562. doi: 10.2337/dc16-0678.
    1. Cho NH, et al. IDF Diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res. Clin. Pract. 2018;138:271–281. doi: 10.1016/j.diabres.2018.02.023.
    1. Dabelea D, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311:1778–1786. doi: 10.1001/jama.2014.3201.
    1. Forouzanfar MH, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–1724. doi: 10.1016/S0140-6736(16)31679-8.
    1. Yang JJ, et al. Association of diabetes with all-cause and cause-specific mortality in Asia. JAMA Netw. Open. 2019;2:e192696. doi: 10.1001/jamanetworkopen.2019.2696.
    1. Bragg F, et al. Association between diabetes and cause-specific mortality in rural and urban areas of China. JAMA. 2017;317:280–289. doi: 10.1001/jama.2016.19720.
    1. Policardo L, et al. Effect of diabetes on hospitalization for ischemic stroke and related in-hospital mortality: a study in Tuscany, Italy, over years 2004–2011. Diabetes. Metab. Res. Rev. 2015;31:280–286. doi: 10.1002/dmrr.2607.
    1. Chen H, Chen G, Zheng X, Guo Y. Contribution of specific diseases and injuries to changes in health adjusted life expectancy in 187 countries from 1990 to 2013: retrospective observational study. BMJ. 2019;364:l969. doi: 10.1136/bmj.l969.
    1. James SL, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–1858. doi: 10.1016/S0140-6736(18)32279-7.
    1. World Health Organization . Global Action Plan for the Prevention and Control of NCDs 2013–2020. Cleveland: WHO Press; 2013.
    1. GBD 2017 Risk Factor Collaborators Global, regional, and national comparative risk assessment of 84 behavioral, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Stu. Lancet. 2017;392:1923–1994.
    1. Roth GA, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–1788. doi: 10.1016/S0140-6736(18)32203-7.
    1. Global Health Data Exchange. Institute for Health Metrics and Evaluation (IHME). . Accessed by 10 Apr 2019
    1. World Bank Country and Lending Groups (2019). . Accessed 10 April 2019.
    1. Kavasseri RG, Seetharaman K. Day-ahead wind speed forecasting using f-ARIMA models. Renew. Energy. 2009;34:1388–1393. doi: 10.1016/j.renene.2008.09.006.
    1. Longtin Y, et al. Effect of detecting and isolating clostridium difficile carriers at hospital admission on the incidence of C difficile infections: a quasi-experimental controlled study. JAMA Intern. Med. 2016;176:796–804. doi: 10.1001/jamainternmed.2016.0177.
    1. Foreman KJ, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet. 2018;392:2052–2090. doi: 10.1016/S0140-6736(18)31694-5.
    1. Lawrence JM, et al. Trends in incidence of type 1 diabetes among non-hispanic white youth in the U.S., 2002–2009. Diabetes. 2014;63:3938–3945. doi: 10.2337/db13-1891.
    1. Lean ME, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391:541–551. doi: 10.1016/S0140-6736(17)33102-1.
    1. Weng J, et al. Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet. 2008;371:1753–1760. doi: 10.1016/S0140-6736(08)60762-X.
    1. World Health Organiazation. The top 10 causes of death (Accessed 1 May 2019); (2018).
    1. Read SH, et al. Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015. Diabetologia. 2019;62:418–425. doi: 10.1007/s00125-018-4796-7.
    1. Tandon N, et al. The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990–2016. Lancet Glob. Heal. 2018;6:e1352–e1362. doi: 10.1016/S2214-109X(18)30387-5.
    1. Liu M, et al. Burden of diabetes, hyperglycaemia in China from to 2016: findings from the 1990 to 2016, global burden of disease study. Diabetes Metab. 2018;45:286–293. doi: 10.1016/j.diabet.2018.08.008.
    1. Moradi-Lakeh M, et al. Diabetes mellitus and chronic kidney disease in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study. Int. J. Public Health. 2018;63:177–186. doi: 10.1007/s00038-017-1014-1.
    1. Murray CJL, et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet. 2013;381:997–1020. doi: 10.1016/S0140-6736(13)60355-4.
    1. Gregg EW, et al. Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet. 2018;391:2430–2440. doi: 10.1016/S0140-6736(18)30314-3.
    1. Borch-Johnsen K. Improving prognosis of type 1 diabetes. Mortality, accidents, and impact on insurance. Diabetes Care. 1999;22:B1–B3. doi: 10.2337/diacare.22.1.1.
    1. Petrie D, et al. Recent trends in life expectancy for people with type 1 diabetes in Sweden. Diabetologia. 2016;59:1167–1176. doi: 10.1007/s00125-016-3914-7.
    1. Roze S, et al. Cost-effectiveness of sensor-augmented pump therapy versus standard insulin pump therapy in patients with type 1 diabetes in Denmark. Diabetes Res. Clin. Pract. 2017;128:6–14. doi: 10.1016/j.diabres.2017.02.009.
    1. Livingstone SJ, et al. Estimated life expectancy in a scottish cohort with type 1 diabetes, 2008–2010. JAMA. 2015;313:37–44. doi: 10.1001/jama.2014.16425.
    1. Ou HT, Yang CY, Wang JD, Hwang JS, Wu JS. Life expectancy and lifetime health care expenditures for type 1 diabetes: a nationwide longitudinal cohort of incident cases followed for 14 years. Value Heal. 2016;19:976–984. doi: 10.1016/j.jval.2016.05.017.
    1. International Diabetes Federation . Access to Medicines and Supplies for People with Diabetes: A Global Survey on Patients’ and Health Professionals’ Perspective. Brussels: International Diabetes Federation; 2016.
    1. Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr. Rev. 2016;37:278–316. doi: 10.1210/er.2015-1137.
    1. Diabetes Prevention Program Research Group 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677–1686. doi: 10.1016/S0140-6736(09)61457-4.
    1. Jenum AK, et al. Effects of dietary and physical activity interventions on type 2 diabetes risk in South Asians: individual participant data meta-analysis of randomised controlled trials. Diabetologia. 2018;61:S160.
    1. Popkin BM, Adair LS, Ng SW. Now and then: the global nutrition transition: the pandemic of obesity in developing countries. Nutrients. 2012;58:1–10.
    1. Rajagopalan S, Brook RD. Air pollution and type 2 diabetes: mechanistic insights. Diabetes. 2012;61:3037–3045. doi: 10.2337/db12-0190.

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