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. 2024 Jun 12:385:e078432.
doi: 10.1136/bmj-2023-078432.

Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study

Kaijie Yang  1 , Xue Yang  1 , Chenye Jin  2 , Shuangning Ding  1 , Tingting Liu  1 , Bing Ma  3 , Hao Sun  3 , Jing Zhang  4 , Yongze Li  5
Affiliations

Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study

Kaijie Yang et al. BMJ. .

Abstract

Objectives: To estimate the burden, trends, and inequalities of type 1 diabetes mellitus (T1DM) among older adults at global, regional, and national level from 1990 to 2019.

Design: Population based study.

Population: Adults aged ≥65 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2019)from 1990 to 2019.

Main outcome measures: Primary outcomes were T1DM related age standardised prevalence, mortality, disability adjusted life years (DALYs), and average annual percentage change.

Results: The global age standardised prevalence of T1DM among adults aged ≥65 years increased from 400 (95% uncertainty interval (UI) 332 to 476) per 100 000 population in 1990 to 514 (417 to 624) per 100 000 population in 2019, with an average annual trend of 0.86% (95% confidence interval (CI) 0.79% to 0.93%); while mortality decreased from 4.74 (95% UI 3.44 to 5.9) per 100 000 population to 3.54 (2.91 to 4.59) per 100 000 population, with an average annual trend of -1.00% (95% CI -1.09% to -0.91%), and age standardised DALYs decreased from 113 (95% UI 89 to 137) per 100 000 population to 103 (85 to 127) per 100 000 population, with an average annual trend of -0.33% (95% CI -0.41% to -0.25%). The most significant decrease in DALYs was observed among those aged <79 years: 65-69 (-0.44% per year (95% CI -0.53% to -0.34%)), 70-74 (-0.34% per year (-0.41% to -0.27%)), and 75-79 years (-0.42% per year (-0.58% to -0.26%)). Mortality fell 13 times faster in countries with a high sociodemographic index versus countries with a low-middle sociodemographic index (-2.17% per year (95% CI -2.31% to -2.02%) v -0.16% per year (-0.45% to 0.12%)). While the highest prevalence remained in high income North America, Australasia, and western Europe, the highest DALY rates were found in southern sub-Saharan Africa, Oceania, and the Caribbean. A high fasting plasma glucose level remained the highest risk factor for DALYs among older adults during 1990-2019.

Conclusions: The life expectancy of older people with T1DM has increased since the 1990s along with a considerable decrease in associated mortality and DALYs. T1DM related mortality and DALYs were lower in women aged ≥65 years, those living in regions with a high sociodemographic index, and those aged <79 years. Management of high fasting plasma glucose remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the National Natural Science Foundation of China and the China Postdoctoral Science Foundation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Equations used to calculate age standardised rate and average annual percentage change (AAPC)
Fig 2
Fig 2
Map showing average annual percentage change in global prevalence of type 1 diabetes mellitus among people aged ≥65 years, 1990-2019
Fig 3
Fig 3
Map showing average annual percentage change in global mortality among people with type 1 diabetes mellitus aged ≥65 years, 1990-2019
Fig 4
Fig 4
Map showing average annual percentage change in global DALYs among people with type 1 diabetes mellitus aged ≥65 years, 1990-2019
See this image and copyright information in PMC

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