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

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.

Conflict of interest statement

Declaration of interests J Ärnlöv reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca and Novartis; and participation on a Data Safety Monitoring Board or Advisory Board with AstraZeneca, Astella, and Boehringer Ingelheim; all outside the submitted work. S Bhaskar reports leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Rotary Club of Sydney, Australia as Board Director, with Rotary District 9675, Australia as Chair of Diversity Equity & Inclusion, and with Global Health & Migration, Global Health Hub Germany as Founding Member and Chair; all outside the submitted work. E J Boyko reports grants or contracts from the U.S. Department of Veteran Affairs; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the Korean Diabetes Association, The Diabetes Association of the ROC (Taiwan; province of China), and the American Diabetes Association; support for attending meetings and/or travel from the Korean Diabetes Association, The Diabetes Association of the R.O.C. (Taiwan; province of China), and the International Society for the Diabetic Foot; all outside the submitted work. R M Islam reports support for attending meetings and/or travel from Lawley Pharmaceuticals for conference attendance outside the submitted work. N E Ismail reports unpaid leadership or fiduciary roles in board, society, committee, or advocacy groups with the Malaysian Academy of Pharmacy as Council Member and Bursar outside the submitted work. K Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. S Lorkowski reports grants or contracts paid to his institution from Akcea Therapeutics Germany; consulting fees from Danone, Novartis Pharma, Swedish Orphan Biovitrum (SOBI), and Upfield; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Akcea Therapeutics Germany, AMARIN Germany, Amedes Holding, AMGEN, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis Pharma, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, and SYNLAB Holding Deutschland & SYNLAB Akademie; support for attending meetings and/or travel from AMGEN; and participation on a data safety monitoring board or advisory board with Akcea Therapeutics Germany, AMGEN, Daiichi Sankyo Deutschland, Novartis Pharma, and Sanofi-Aventis; all outside the submitted work. A Ortiz has received grants from Sanofi; consultancy or speaker fees or travel support from Advicciene, Astellas, Astrazeneca, Amicus, Amgen, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Lilly, Alexion, Freeline, Idorsia, Chiesi, Otsuka, Novo-Nordisk, Sysmex, and Vifor Fresenius Medical Care Renal Pharma and is Director of the Catedra Mundipharma-UAM of diabetic kidney disease and the Catedra Astrazeneca-UAM of chronic kidney disease and electrolytes; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the European Renal Association; and stock or stock options from Telara Farma; all outside the submitted work. V C F Pepito reports grants or contracts from Sanofi Consumer Healthcare to do research on self-care in the Philippines and from International Initiative for Impact Evaluation (3ie) to propose research on primary care benefit packages in the Philippines; all outside the submitted work. M J Postma reports stock or stock options from Health-Ecore, Zeist (NL) (25%) and PAG BV, Groningen (NL) (100%) outside the submitted work. D P Rasali reports an unpaid leadership or fiduciary role in a board, society, committee, or advocacy group with Emotional Well Being Institute Canada as Director. L R Reyes reports grants or contracts from Merck and Pfizer; consulting fees, payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events, and payments for expert testimony from Merck, Pfizer and GSK; support for attending meetings and/or travel from GSK; and participation on a data safety monitoring board or advisory board with Merck; all outside the submitted work. M P Schlaich reports consulting fees, payment, or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events, paid to himself, and support for attending meetings and/or travel paid to his institution, from Medtronic and Abbot; and leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the World Hypertension League as Director; all outside the submitted work. C R Simpson reports research grants paid to his institution from Ministry of Business, Innovation and Employment (MBIE) (New Zealand), Health Research Council of New Zealand, Ministry of Health (New Zealand), Medical Research Council (UK), Health Data Research UK, and Chief Scientist Office (UK); all outside the submitted work. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant cCnsulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point communications, the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the speaker's bureau of Simply Speaking; support for attending meetings and/or travel from the steering committee of OMERACT; participation on a Data Safety Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory Committee; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with OMERACT as a steering committee member, with Veterans Affairs of Rheumatology Field Advisory Committee as a chair, and with UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as the editor and director; and stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals and Charlotte's Web Holdings, with previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals; all outside the submitted work. J Sundström reports stock or stock options from Anagram kommunikation AB and Symptoms Europe AB, outside the submitted work. D Trico reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events and support for attending meetings and/or travel from AstraZeneca, Eli Lilly, and Novo Nordisk; participation on a data safety monitoring board or advisory board with Amarin; and receipt of equipment, materials, drugs, medical writing, gifts or other services to their institution from PharmaNutra and Abbott; all outside the submitted work. M Zielińska reports other financial or non-financial interests as an AstraZeneca employee outside the submitted work. A Z reports other financial or non-financial interests in 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). Sir Zumla is a UK-NIHR Senior Investigator, and a Mahathir Science Award, Sir Patrick Manson Medal, and EU-EDCTP Pascoal Mocumbi Prize laureate; all outside the submitted work.

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1

Age-standardised total diabetes prevalence rates in 2021 ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. LCA=Saint Lucia. TTO=Trinidad and Tobago. Isl=Islands. FSM=Federated States of Micronesia. TLS=Timor-Leste.

Figure 2

Prevalence of total diabetes by age and GBD super-region in 2021 The shaded areas represent 95% uncertainty intervals. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.

Figure 3

Change from 1990 to 2021 in population attributable fraction for high BMI in relation to type 2 diabetes, by GBD super-region BMI=body-mass index. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.

Figure 4

Global age-standardised prevalence of type 1 and type 2 diabetes from 1990 through 2050 forecasts The shaded area represents 95% uncertainty intervals. Total diabetes is the sum of type 1 and type 2 diabetes.