Changing epidemiology of chronic kidney disease as a result of type 2 diabetes mellitus from 1990 to 2017: Estimates from Global Burden of Disease 2017

Abstract

Aims/introduction: Type 2 diabetes mellitus has been a leading cause of chronic kidney disease (CKD), with a heterogeneous distribution worldwide. Optimal healthcare planning requires an understanding of how the burden of CKD as a result of type 2 diabetes mellitus has changed over time and geographic location, as well as the potential roles of sociodemographic, clinical and behavioral factors in these changes.

Materials and methods: We used the Global Burden of Disease data from 1990 to 2017 at the global, regional and national levels to investigate changes in the incidence, death and disability-adjusted life years of CKD as a result of type 2 diabetes mellitus, incorporating both epidemiological research and risk factor monitoring.

Results: The incident cases of CKD as a result of type 2 diabetes mellitus worldwide in 2017 had increased by 74% compared with 1990; total disability-adjusted life years had increased by 113%, mainly attributable to population expansion and demographic transition. The Sociodemographic Index was significantly and negatively correlated with overall CKD as a result of type 2 diabetes mellitus burden. However, in 82 countries and territories, the burden was not alleviated in parallel with socioeconomic development.

Conclusions: CKD as a result of type 2 diabetes mellitus has been the main contributor to the increasing burden of CKD over the past several decades. We suggest a more pragmatic approach focusing on early diagnosis, primary care and adequate follow up to reduce mortality and the long-term burden in low-to-middle Sociodemographic Index regions. Interventions should address high systolic blood pressure, as well as overweight and obesity problems, especially in high-income regions.

Keywords: Chronic kidney disease; Global Burden of Disease; Type 2 diabetes mellitus.

Figure 1

Estimated annual percentage change (EAPC) in (a) age‐standardized incidence, (b) death and (c) disability‐adjusted life year (DALY) rates between 1990 and 2017.

Figure 2

Age‐standardized disability‐adjusted life year (DALY) rate by sex and age in 2017. SDI, Sociodemographic Index.

Figure 3

The association between (a) age‐standardized incidence, (b) death, (c) disability‐adjusted life year (DALY) rate and Sociodemographic Index. (a) ρ = −0.52, P < 0.001; (b) ρ = −0.27, P < 0.001; (c) ρ = −0.30, P < 0.001; Each circle represents a country; circle size corresponds to population number. The P indices and ρ values were derived from Pearson’s correlation analysis.

Figure 4

Comparing the equivalent ages to global average 50‐year‐olds across countries in 2017. SDI, Sociodemographic Index.

Figure 5

(a) Frontier analysis based on Sociodemographic Index (SDI) and age‐standardized disability‐adjusted life year (DALY) rate from 1990 to 2017. Color scale represents the years from 1990 shown in dark blue to 2017 shown in light blue. The frontier is shown in black color. (b) Frontier analysis based on SDI and age‐standardized chronic kidney disease as a result of type 2 diabetes mellitus DALY rate in 2017. The frontier is shown in black color; countries and territories are represented as dots. The top five countries with the largest effective difference, examples of countries with low effective difference and low SDI (<0.5), and examples of countries (territories) with relatively high effective difference and high SDI (>0.8) are labeled in black. Blue dots indicate countries in the moderate group with compatible declining DALY rate as SDI increased. Green dots indicate countries in the overperforming group. Red dots indicate countries in the underperforming group.

Figure 6

Contributions of risk factors to age‐standardized disability‐adjusted life year (DALY) rate globally and in Sociodemographic Index (SDI) quintiles.