The burden of diabetes and hyperglycemia in Brazil: a global burden of disease study 2017

Abstract

Background: The Global Burden of Diseases (GBD) 2017 database permits an up-to-date evaluation of the frequency and burden of diabetes at the state level in Brazil and by type of diabetes. The objective of this report is to describe, using these updated GBD data, the current and projected future burden of diabetes and hyperglycemia in Brazil, as well as its variation over time and space.

Methods: We derived all estimates using the GBD 2016 and 2017 databases to characterize disease burden related to diabetes and hyperglycemia in Brazil, from 1990 to 2040, using standard GBD methodologies.

Results: The overall estimated prevalence of diabetes in Brazil in 2017 was 4.4% (95%UI 4.0-4.9%), with 4.0% of those with diabetes being identified as having type 1 disease. While the crude prevalence of type 1 disease has remained relatively stable from 1990, type 2 prevalence has increased 30% for males and 26% for females. In 2017, approximately 3.3% of all disability-adjusted life years lost were due to diabetes and 5.9% to hyperglycemia. Diabetes prevalence and mortality were highest in the Northeast region and growing fastest in the North, Northeast, and Center-West regions. Over this period, despite a slight decrease in age-standardized incidence of type 2 diabetes, crude overall burden due to hyperglycemia has increased 19%, with population aging being a main cause for this rise. Cardiovascular diseases, responsible for 38.3% of this burden in 1990, caused only 25.9% of it in 2017, with premature mortality attributed directly to diabetes causing 31.6% of the 2017 burden. Future projections suggest that the diabetes mortality burden will increase 144% by 2040, more than twice the expected increase in crude disease burden overall (54%). By 2040, diabetes is projected to be Brazil's third leading cause of death and hyperglycemia its third leading risk factor, in terms of deaths.

Conclusions: The disease burden in Brazil attributable to diabetes and hyperglycemia, already large, is predicted by GBD estimates to more than double to 2040. Strong actions by the Ministry of Health are necessary to counterbalance the major deleterious effects of population aging.

Keywords: Brazil; Diabetes mellitus; Global Burden of Disease; epidemiology; hyperglycemia.

Fig. 1

Trends in estimated incidence, prevalence, and mortality of type 1 (left) and type 2 (right) diabetes, Brazil, 1990–2017. Diabetes incidence (new cases/100,000 population; top), prevalence (cases/100,000 population; middle), and mortality (diabetes deaths/100,000 population; bottom). Solid lines: crude prevalence; dashed lines: age-standardized prevalence. Red lines: females, blue lines: males

Fig. 2

Estimated age-specific incidence (top) and prevalence (bottom) rates of diabetes, with their 95% uncertainty intervals. Brazil, 2017

Fig. 3

Prevalence and annual change in prevalence of diabetes mellitus in Brazilian states. Left panel: age-standardized prevalence (/100000 population), 2017. Right panel: annual change (%) in this prevalence, 1990–2017. The closer to the red end of the color scale, the greater the prevalence or increase in prevalence; the closer to the dark blue end, the lesser the prevalence or increase in prevalence

Fig. 4

Mortality and annual changes in mortality due to diabetes mellitus in Brazilian states. Left panel: age-standardized mortality (/100000 population), 2017. Right panel: annual change (%) in this rate, 1990–2017. The closer to the red end of the color scale, the greater the mortality or increase in mortality; the closer to the dark blue end, the lesser the mortality or increase in mortality

Fig. 5

Crude burden (DALYs/100000 population) due to hyperglycemia in Brazil, by cause or type of complication, 1990 and 2017. When indicated, the category of burden reports only premature deaths (YLLs) or only disability (YLDs)

Fig. 6

Past trends (1990–2016) and future projections (2017–2040) of overall crude mortality due to diabetes mellitus. Projections are given for reference and better and worse case scenarios