Time trends and advances in the management of global, regional, and national diabetes in adolescents and young adults aged 10-24 years, 1990-2021: analysis for the global burden of disease study 2021

Abstract

Background: Estimation of global diabetes burden in adolescents and young adults (10-24 years) from 1990 to 2021.

Methods: Data were extracted from the 2021 Global Burden of Disease Study. Joinpoint regression analysis was employed to examine trends over the past 30 years, frontier analysis identified regions with potential for improvement, and the slope index of inequality and the relative concentration index were used to assess health inequalities.

Results: From 1990 to 2021, the age-standardized prevalence rates (ASPR) and age-standardized disability-adjusted life years rates (ASDR) of diabetes in adolescents and young adults increased globally, while age-standardized death rates (ASMR) remained stable. Oceania bore the highest burden regionally, East Asia experienced the fastest rise in ASPR and ASDR, and High-income Asia Pacific saw the most significant decrease in ASMR. Among 204 countries, Marshall Island and Hait reported the highest ASPR, ASDR, and ASMR in 2021. Health inequality analysis confirmed that the burden was concentrated in countries with lower Socio-Demographic Index (SDI). Frontier analysis showed that ASMR and ASDR were negatively correlated with SDI, with Yemen and Honduras, which have lower socio-demographic indices, exhibiting more smaller overall differences from frontier boundaries.

Conclusions: The analysis revealed a sharp increase in the global ASPR and ASDR of diabetes in adolescents and young adults. Additionally, the disease burden is typically concentrated in countries with lower SDI, highlighting an urgent need for governments to develop flexible health policies to mitigate the escalating threat of diabetes in this demographic.

Keywords: Adolescents and young adults; Diabetes; Epidemiology; Global burden of disease 2021; Joinpoint regression analysis.

Fig. 1

Joinpoint regression analysis of age-standardized prevalence rate of diabetes in adolescents and young adults at the global and five SDI regions from 1990 to 2021. P-value *P < 0.05

Fig. 2

Maps showing (A) age-standardized prevalence rate, (B) age-standardized death rate and (C) age-standardized disability-adjusted life years rate of diabetes among adolescents and young adults, in 204 countries and territories, between 1990 and 2021

Fig. 3

World map of AAPCs in (A) age-standardized prevalence rate, (B) age-standardized death rate and (C) age-standardized disability-adjusted life years rate of diabetes among adolescents and young adults from 1990 to 2021. AAPC, average annual percentage change

Fig. 4

1990 and 2021, health inequality regression curves (A) and concentration curves (B) for age-standardized death rate of diabetes among adolescents and young adults. Health inequality regression curves (C) and concentration curves (D) for age-standardized disability-adjusted life years rate of diabetes among adolescents and young adults

Fig. 5

Frontier analysis involving SDI and burden of diabetes among adolescents and young adults in 2021. A and C, Frontier analysis with ASMR. B and D, Frontier analysis with ASDR. The frontier is marked using a solid black color, and countries and territories are presented as dots. The leading 15 countries with the most EF (the highest ASMR of diabetes among adolescents and young adults gap from frontier) are marked in black. Examples of frontier countries with low SDI (< 0.5) and reduced EF are marked in blue, and those with high SDI (> 0.85) and relatively elevated EF for their development are marked in red. The red dots represent a reduction in the burden of diabetes among adolescents and young adults between 1990 and 2021. Blue dots represent a rise in the burden of diabetes among adolescents and young adults during the same duration of time. ASMR; age-standardized death rate; ASDR, age-standardized disability-adjusted life years rate; EF, effective difference; and SDI, sociodemographic index