The number of people aged 65 and older with type 1 diabetes (T1D) increased from 1.3 million in 1990 to 3.7 million in 2019, while mortality rates decreased by 25%, from 4.7 per 100,000 inhabitants in 1990 to 3.5 in 2019, according to an analysis of data from more than 200 people published on The BMJ.
Overall, the results show that more people with diabetes Type 1 live longer. However, mortality rates have declined 13 times faster in high-income countries than in low- and middle-income countries, indicating that substantial global inequalities in diabetes care still exist.
T1D is traditionally considered a disease that can severely reduce life expectancy, however recent studies have reported an increasing number of elderly individuals with T1D possibly due to improved treatments and care.
But accurate data on the impact of type 1 diabetes is still lacking in most countries and regions of the world.
To address this, Chinese researchers used data from the 2019 Global Burden of Disease and Risk Factors Study to estimate prevalence (number of people living with the condition), deaths, and disability-adjusted life years (DALYs). ), a combined measure of quantity and quality of life, due to T1D in individuals aged 65 years and older from 204 countries and regions between 1990 and 2019.
The data was analyzed at the global, regional and national levels for age, gender and sociodemographic index (SDI), a measure of social and economic development.
The team found that globally, the age-standardized prevalence rate of type 1 diabetes in older adults increased by 28% from 400 per 100,000 population in 1990 to 514 in 2019, while deaths decreased by 25% from 4 .74 per 100,000 inhabitants in 1990 to 3.54. in 2019.
Age-standardized DALYs due to T1D also decreased during the same period, but to a lesser extent, by 8.9%, from 113 per 100,000 population in 1990 to 103 in 2019.
Globally, the prevalence of T1D has at least tripled in every age group between 65 and 94 years, especially among men, while mortality rates have decreased in all age groups, especially among women and those of under 79 years of age. The most significant decrease in DALYs was also found among those under 79.
However, mortality rates declined 13 times faster in countries with a high sociodemographic index than in countries with a low or medium sociodemographic index (-2.17% per year versus -0.16% per year).
While the highest prevalence of type 1 diabetes remained in high-income areas of North America, Australasia and Western Europe, the highest DALY rates were found in southern sub-Saharan Africa (178 per 100,000 inhabitants), in Oceania (178) and in the Caribbean (177). ).
Elevated fasting plasma glucose (higher than normal blood sugar levels after a period of fasting) was the main risk factor for DALYs among older adults with T1D during the 30-year study period, indicating that control active blood sugar levels remain an important factor. challenge for these patients.
The researchers acknowledge that their estimates were based primarily on modeling and that variations in health information systems and reporting methods in different countries and regions, particularly in low- and middle-income countries and conflict-affected areas, may have influenced the accuracy of their results.
However, for older adults with type 1 diabetes and their families around the world, the decrease in mortality and DALYs associated with this disease is encouraging.
Further high-quality real-world research is needed to validate the findings of this study. The researchers write: “Our study also supports urgent attention to coping strategies for the aging population and older adults with T1D, rational allocation of healthcare resources, and provision of targeted guidelines.”
Substantial increase in type 2 diabetes among young people over the last 30 years
Rates of type 2 diabetes (T2D) in adolescents and young adults globally increased substantially from 1990 to 2019, finds an analysis of the latest data from more than 200 countries and regions published today by the BMJ.
The findings show that countries with a low-to-medium sociodemographic index (a measure of social and economic development) and women under the age of 30 were particularly affected, and a high body mass index was the main attributable risk factor. in all countries.
Researchers say weight control is essential to reduce the burden of early-onset T2D, but countries should establish specific policies to address this problem more effectively.
Type 2 diabetes traditionally develops in middle-aged and older people and carries greater risks of serious complications, including heart disease, vision loss, and death.
Data suggests that early onset T2D (diagnosed before age 40) is becoming increasingly common. But no studies have specifically described the global burden of early-onset T2D, or the variations between sexes and in countries with different levels of socioeconomic development.
Risk factors for early-onset type 2 diabetes in different countries are also unclear.
To address these knowledge gaps, researchers used data from the 2019 Global Burden of Disease Study to estimate new cases (incidence), deaths, and disability-adjusted life years (DALYs), a combined measure of quantity and quality of life, due to type 2 diabetes. in adolescents and young adults (aged 15 to 39 years) from 204 countries and territories between 1990 and 2019.
Grouped by countries with different sociodemographic indices, countries with a medium to low sociodemographic index had the highest age-standardized incidence rate and age-standardized DALY rate in 2019, while countries with a low sociodemographic index had the highest lowest age-standardized incidence but the lowest age-standardized incidence rate, but highest age-standardized mortality rate.
Women generally had higher mortality rates and DALYs than men under 30 years of age, but gender differences were reversed in those over 30 years of age, except in countries with a low sociodemographic index.
The main DALY-attributable risk factor for early-onset type 2 diabetes was high BMI across all regions by sociodemographic index.
The main DALY-attributable risk factor for early-onset type 2 diabetes was high BMI across all regions by sociodemographic index.
The contribution of other risk factors varies from region to region, with higher proportions of ambient particulate air pollution (12% versus 7%) and smoking (13% versus 4%) in countries with a high sociodemographic index and higher proportions of households air pollution from solid fuels (17% versus 0.07%) and low fruit diet (9% versus 6%) in countries with a low sociodemographic index.
The researchers point out some limitations of the study, such as differences in the definition of T2D and a high probability of underdiagnosis in many countries. And although several techniques have been used to reduce biases and inaccuracies in the data, biases cannot be completely ruled out.
They highlight that they have comprehensively assessed global, regional and national temporal trends for early-onset type 2 diabetes and the corresponding contributions of risk factors based on the 2019 Global Burden of Disease Study.
“Our study showed a clear upward trend in the burden of early-onset type 2 diabetes from 1990 to 2019,” they write. “These findings provide a basis for understanding the epidemic nature of early-onset type 2 diabetes and call for urgent action to address the problem from a global perspective.”
Incidence of childhood diabetes increasing globally
Childhood diabetes represents a growing global health challenge, according to a study published online July 3 in JAMA Pediatrics.
Kexin Zhang, of the Affiliated Hospital of Weifang Medical University in China, and colleagues examined trends in weight loss. measured by incidence, mortality and disability-adjusted life years (DALYs) in the global, national, regional and sociodemographic index. (SDI) subgroup levels (1990 to 2019). The analysis included 1.4 million children from birth to 14 years from 204 countries.
The researchers found that cases of childhood diabetes increased by 39.37% from 1990 to 2019. Over the time period, the global incidence rate increased from 9.31 to 11.61 per 100,000 population, while the rate of Mortality associated with diabetes decreased from 0.38 to 0.28 per 100,000 inhabitants. . The highest diabetes-associated infant mortality rate in 2019 was observed in the lowest SDI region.
North Africa and the Middle East saw the greatest increase in incidence (estimated annual percentage change, 2.06). Environmental/occupational risk, suboptimal temperature, high temperature, and low temperature were key global risk factors for diabetes-associated infant mortality.
“Despite global declines in deaths and DALYs, the number of deaths and DALYs remains high among children with diabetes, especially in low-SDI regions,” the authors write. “Diabetes is a serious health problem among children and an accurate estimate of its impact is essential to develop targeted prevention and treatment approaches.”
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