The burden of diabetes and hyperglycemia in Brazil-past and present: findings from the Global Burden of Disease Study 2015

Abstract

Background: Diabetes, hyperglycemia, and their complications are a growing problem in Brazil. However, no comprehensive picture of this disease burden has yet been presented to date.

Methods: We used Global Burden of Disease 2015 data to characterize diabetes prevalence, incidence and risk factors from 1990 to 2015 in Brazil. Additionally, we provide mortality, years of life lost prematurely (YLL), years of life lived with disability (YLD) and disability-adjusted life years (DALYs) lost due to diabetes, as well as similar data for chronic kidney disease (CKD) due to diabetes and, as an overall summary measure, for hyperglycemia, the latter expressed as high fasting plasma glucose (HFPG).

Results: From 1990 to 2015 diabetes prevalence rose from around 3.6 to 6.1%, and YLLs, YLDs, and DALYs attributable to diabetes increased steadily. The crude diabetes death rate increased 90% while that of CKD due to diabetes more than doubled. In 2015, HFPG became Brazil's 4th leading cause of disability, responsible for 65% of CKD, for 7.0% of all disability and for the staggering annual loss of 4,049,510 DALYs. Diabetes DALYs increased by 118.6% during the period, increasing 42% due to growth in Brazil´s population, 72.1% due to population ageing, and 4.6% due to the change in the underlying, age-standardized rate of DALY due to diabetes. Main risk factors for diabetes were high body mass index; a series of dietary factors, most notably low intake of whole grains and of nuts and seeds, and high intake of processed meats; low physical activity and tobacco use, in that order.

Conclusions: Our study demonstrates that diabetes, CKD due to diabetes, and hyperglycemia produce a large and increasing burden in Brazil. These findings call for renewed efforts to control the joint epidemics of obesity and diabetes, and to develop strategies to deal with the ever-increasing burden resulting from these diseases.

Keywords: Cost of illness; Diabetes; Hyperglycemia; Morbidity; Mortality.

Fig. 1

Dimensions of assessment of burden of diabetes and high fasting plasma glucose, and burden attributable to its risk factors in the Global Burden of Disease 2015 (GBD 2015 study)

Fig. 2

GBD 2015 estimated crude incidence (left panel) and prevalence (right panel) of diabetes in Brazil, from 1990 to 2015, standardized to the world population. Blue line—females, green line—males, orange line—both sexes

Fig. 3

Age-standardized rates of death attributable to diabetes across countries of Latin America and The Caribbean, 2015

Fig. 4

Risk factors for diabetes, expressed in terms of DALYs attributable to diabetes. 2015 Brazil

Fig. 5

Relative importance of high fasting plasma glucose within the context of all risk factors identified by the GBD 2015. Brazil, 2015. WaSH water, sanitation and hygiene

Fig. 6

Distribution of disease causes of DALYs attributable to high fasting plasma glucose. Brazil, 2015