Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants

Abstract

Background: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.

Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.

Findings: We used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.

Interpretation: Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries.

Funding: Wellcome Trust.

Conflict of interest statement

Declaration of interests ME reports a charitable grant from Youth Health Programme of AstraZeneca, outside the submitted work. JAR reports personal fees from Tres Montes Lucchetti and grants from Danone Mexico, outside the submitted work. All other members of the Pooled Analysis and Writing Group declare no competing interests.

Copyright © 2016 NCD Risk Factor Collaboration. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1

Trends in age-standardised and crude prevalence of diabetes for men by region The lines (solid for age-standardised and dashed for crude) show the posterior mean estimates; the shaded area shows the 95% credible intervals for age-standardised prevalence. For trends and numerical results by country see appendix pp 85–94, 103–170.

Figure 2

Trends in age-standardised and crude prevalence of diabetes for women by region The lines (solid for age-standardised and dashed for crude) show the posterior mean estimates; the shaded area shows the 95% credible intervals for age-standardised prevalence. For trends and numerical results by country see appendix pp 85–94, 103–170.

Figure 3

Age-standardised prevalence of diabetes in adult men by country in 1980 and 2014

Figure 4

Age-standardised prevalence of diabetes in adult women by country in 1980 and 2014

Figure 5

Comparison of age-standardised prevalence of diabetes in adults in 1980 and 2014

Figure 6

Probability of achieving the target of halting the rise of diabetes in adults by 2025 at its 2010 levels by sex and country if post-2000 trends continue

Figure 7

Trends in the number of adults with diabetes by region (A) and decomposed into the contributions of population growth and ageing, rise in prevalence, and interaction between the two (B) For results by region see appendix pp 101–102.

Figure 8

Ten countries with the largest number of adults with diabetes in 1980 and 2014 Colours for each country indicate its region.