Diabetes Prevalence Expected to Double Globally by 2050

The number of people living with diabetes is expected to more than double globally by 2050, according to research published today in The Lancet.

New estimates predict the number will jump from 529 million people living with diabetes in 2021 to at least 1.3 billion in 2050. Researchers also do not expect any countries to see a drop in age-standardized diabetes rates over the next 3 decades.

“Diabetes was already a substantial concern in 2021 and is set to become an even greater public health issue over the coming three decades, with no effective mitigation strategy currently in place,” the researchers said.

To come to these findings, researchers applied the most updated methodological framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to estimate total, type 1 (T1D), and type 2 (T2D) diabetes prevalence and burden between 1990 and 2021. The findings were published alongside a joint series on the global burden of diabetes by GBD 2021 collaborators.

“This approach allows us to break down these estimates with a high degree of granularity by location, age, and sex, and to present a more holistic picture of the landscape of diabetes—including drivers of the disease and how they have changed over time, as well as forecasting global and location-specific diabetes prevalence through 2050,” the authors said.

The researchers computed estimates for 204 countries and territories, using the Cause of Death Ensemble model and 25,666 location-years of data from vital registration records and verbal autopsy reports to estimate the prevalence of diabetes-related deaths.

According to the research, approximately 529 million individuals (95% CI, 500 million-564 million) were living with diabetes globally in 2021, and the global age-standardized prevalence of diabetes was 6.1% (95% CI, 5.8%-6.5%). The highest age-standardized rates at the super-region level were observed in North Africa and the Middle East, at 9.3% (95% CI, 8.7%-9.9%), and at the regional level, in Oceania, at 12.3% (95% CI, 11.5%-13.0%). At the national level, Qatar had the world’s highest age-specific diabetes prevalence of at 76.1% (95% CI, 73.1%-79.5%) in 2021 among individuals aged between 75 and 79 years.

The burden of diabetes—especially among older adults—is predominantly due to T2D, which accounted for 96.0% of diabetes cases and 95.4% of disability-adjusted life-years (DALYs) in 2021. Researchers found that body mass index (BMI) was contributes significantly to T2D burden, with 52.2% (95% CI, 25.5%-71.8%) of global T2D DALYs attributable to high BMI.

Notably, the contribution of high BMI to T2D DALYs jumped by 24.3% (95% CI, 18.5%-30.4%) globally between 1990 and 2021. Over those 3 decades, the proportion of DALYs due to high BMI increased in all 204 included countries and territories. These increases ranged from just 1.3% (95% CI, –1.5% to 4.1%) in Czechia to 77.2% (95% CI, 52.2-107.9) in Vietnam. The researchers suggested these increases may be linked to global rises in obesity caused by several factors.

The researchers also emphasized that T2D is preventable and even reversible in some cases if it is diagnosed and treated early.

“Preventing and controlling [T2D] remains an ongoing challenge,” they said. “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.”

Despite being preventable and treatable, the new estimates show that more than 1.31 billion (95% CI, 1.22 billion-1.39 billion) people are expected to have diabetes by 2050, more than doubling the 2021 prevalence.

Age-standardized prevalence rates are expected to pass 10% in 2 super-regions: North Africa and the Middle East with 16.8% (95% CI, 16.1%-17.6%) and Latin America and the Caribbean with 11.3% (95% CI, 10.8%-11.9%). Additionally, 89 (43.6%) of the 204 countries and territories analyzed are projected to have an age-standardized rate greater than 10% by 2050.

The Series authors stressed that structural racism and geographic inequity contribute to increasingly high rates of diabetes disease, illness, and mortality.

“The Series finds that people from marginalised communities around the world are less likely to get access to essential medicines like insulin and new treatments, have worse blood sugar control, and have a lower quality of life and reduced life expectancy,” a press release from The Lancet noted. “The COVID-19 pandemic has amplified diabetes inequity globally, with people with diabetes 50% more likely to develop severe infection and twice as likely to die compared to those without diabetes, especially those from ethnic minority groups.”

The GBD 2021 collaborators hope to use the series to highlight real-world interventions that may help reduce inequities in T2D care, improve outcomes among individuals who are part of racially and geographically marginalized groups, and call for more high-quality, real-world research.

“A central focus and understanding of inequity in diabetes is vital to achieve the UN’s Sustainable Development Goal to reduce non-communicable diseases by 30% in less than 7 years and to curtail the increasingly negative effects on the health of marginalised populations and the strength of national economies for decades to come,” Shivani Agarwal, MD, MPH, leader of the Series, associate director of the Fleischer Institute for Diabetes and Metabolism, and assistant professor at the Albert Einstein College of Medicine and Montefiore Health System, said in the press release. “This Series offers an important opportunity for concerted, pragmatic action to transform approaches to diabetes care and outcomes for marginalised populations around the world.”

Reference

GBD 2021 Diabetes Collaborators. 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. Lancet. Published online June 22, 2023. doi:10.1016/PII