Prevalence and trends in the burden of diabetes, by country income levels, 1990-2021: a descriptive cross-sectional study

Abstract

Diabetes is one of the leading causes of death and disability worldwide and affects people regardless of country, age group or gender. The chronic nature of diabetes and related complications make it a costly disease. The aim of this study is to descriptively examine the trend of diabetes prevalence and burden of disease differences in countries among international income groups from 1990 to 2021. It also aims to determine the trends in the increase in diabetes in countries according to income group classification. Between 1990 and 2021, data on diabetes prevalence and mortality, years of life lost due to premature death due to diabetes and years of disability were extracted from the Global Burden of Disease platform database. Countries were classified according to the economic income groups determined by the World Bank, and the top 6 countries in each income group with the highest prevalence of diabetes in 2021, including Turkey, were included in the current study. Descriptive analyses, frequency, percentage, ratio values and 95% confidence intervals were calculated for 24 countries in total. In 2021, the highest diabetes prevalence rate per 100000 population among high-income countries is South Korea (10346,1; CI: 9782,9-10807,5), while among middle-high-income countries, after Mexico, the highest is Turkey (6626,9; CI: 6104,8-7227,0). Between 1990 and 2021, the mortality rate per 100000 population due to diabetes decreased significantly among high-income countries, while it increased significantly in middle- and low-income countries. As the prevalence of diabetes is increasing worldwide, it remains an important public health problem for all countries. There is an urgent need for policies to be formulated by administrators in the prevention and treatment of diabetes.

Keywords

• Diabetes
• burden of diabetes
• diabetes-related death
• country income level
• prevalence

1990-2021 yıllarında ülke gelir düzeylerine göre diyabet yükünün yaygınlığı ve eğilimleri: tanımlayıcı kesitsel bir çalışma

Abstract

Diyabet, dünya çapında önde gelen ölüm ve sakatlık nedenlerinden biridir ve ülke, yaş grubu veya cinsiyetten bağımsız olarak insanları etkilemektedir. Diyabetin kronik yapısı ve ilgili komplikasyonları onu maliyetli bir hastalık haline getirmektedir. Bu çalışmanın amacı, uluslararası gelir gruplarında yer alan ülkelerdeki diyabet prevalansı ve hastalık yükü farklılıklarının 1990 yılından 2021 yılına kadar olan süreçteki trendini tanımlayıcı olarak incelemektir. Ayrıca gelir grubu sınıflandırmasına göre, ülkelerin diyabet artış eğilimlerinin nasıl olduğunu ortaya koymaktır. 1990 ve 2021 yıllarına yönelik diyabete ilişkin prevalans ve mortalite ile diyabet hastalığına bağlı erken ölüm nedeniyle kaybedilen yaşam yılları ve engellilikle geçirilen yıllara ait veriler Küresel Hastalık Yükü platformu veritabanından çekilmiştir. Ülkeler Dünya Bankası tarafından belirlenen ekonomik gelir gruplarına göre sınıflandırılmış olup, her bir gelir grubunda 2021 yılında en çok diyabet prevalansına sahip Türkiye’nin de arasında bulunduğu ilk 6 ülke mevcut çalışma kapsamına alınmıştır. Toplamda 24 ülke için tanımlayıcı analizler, frekans, yüzde, oran değerleri ile her biri için %95 güven aralığı hesaplanmıştır. 2021 yılında, 100000 nüfus başına diyabet prevalans oranı yüksek gelirli ülkeler arasında en yüksek Güney Kore (10346,1; GA: 9782,9–10807,5) iken, orta-yüksek gelirli ülkeler arasında Meksika’dan sonra en yüksek Türkiye’dir (6626,9; GA: 6104,8–7227,0). 1990-2021 yılları arasında, diyabet nedeniyle 100000 nüfus başına ölüm oranı yüksek gelirli ülkeler arasında ciddi bir azalış gösterirken, orta ve düşük gelirli ülkelerde belirgin artış göstermiştir. Diyabet prevalansı dünya geneli bir artış gösterdiğinden, bütün ülkeler için önemli bir halk sağlığı sorunu olmaya devam etmektedir. Yöneticiler tarafından diyabetin önlenmesi ve tedavisinde acilen politikaların oluşturulması gerekmektedir.

Keywords

• Diyabet
• diyabet yükü
• diyabete bağlı ölüm
• ülke gelir düzeyi
• prevalans

Supporting Institution

Yoktur.

Ethical Statement

Mevcut çalışmada kullanılan veri seti herkes tarafından kolaylıkla erişilebilir kamuya açık verilerin kullanılması ve verilerin tamamen anonim olması nedeniyle Helsinki Tıbbi Araştırmalar İçin Etik İlkeler Deklarasyonu kapsamında herhangi bir etik kurul onayına ihtiyaç duyulmamıştır.

References

1. 1. Chan, J.C.N., Lim, L.L., Wareham, N.J., Shaw, J.E., Orchard, T.J., Zhang, P, The Lancet Commission on diabetes: using data to transform diabetes care and patient lives, Lancet, 2020, 396(10267):2019–82.
2. 2. Vos, T., Lim, S.S., Abbafati, C., Abbas, K.M., Abbasi, M., Abbasifard, M., Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, Lancet, 2020, 396(10258):1204–22.
3. 3. Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B.B., IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045, Diabetes Res Clin Pract, 2022 Jan;183:109119.
4. 4. Richards, S.E., Wijeweera, C., Wijeweera, A., Lifestyle and socioeconomic determinants of diabetes: Evidence from country-level data, PLoS One, 2022 Jul 28;17(7):e0270476.
5. 5. Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, Diabetes Res Clin Pract, 2019 Nov;157:107843.
6. 6. Liu, J., Bai, R., Chai, Z., Cooper, M.E., Zimmet, P.Z., Zhang, L., Low- and middle-income countries demonstrate rapid growth of type 2 diabetes: an analysis based on Global Burden of Disease 1990–2019 data, Diabetologia, 2022, 19;65(8):1339–52.
7. 7. Squires, E., Duber, H., Campbell, M., Cao, J., Chapin, A., Horst, C., Health Care Spending on Diabetes in the U.S., 1996–2013, Diabetes Care, 2018, 1;41(7):1423–31.
8. 8. United Nations (UN), Sustainable Development Report 2023, https://dashboards.sdgindex.org (Erişim Tarihi: 13.012024).

9. 9. Suwannaphant, K., Association between Socioeconomic Status and Diabetes Mellitus: The National Socioeconomics Survey, 2010 and 2012. J Clin Diagnostıc Res, 2017.
10. 10. Narayan, K.M.V., Zhang, P., Kanaya, A.M., Williams, D.E., Engelgau, M.M., Imperatore, G., Diabetes: The Pandemic and Potential Solutions. In: Jamison D.,T., Breman J.,G., Measham A.,R., (eds) Disease Control Priorities in Developing Countries, 2nd edn., The International Bank for Reconstruction and Development/The World Bank: New York, NY: Oxford University Press; 2006.
11. 11. Bhutta, Z.A., Salam, R.A., Gomber, A., Lewis-Watts, L., Narang, T., Mbanya, J.C., A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries. Lancet, 2021, 398(10313):1837–50.
12. 12. Flood, D., Seiglie, J.A., Dunn, M., Tschida, S., Theilmann, M., Marcus, M.E., The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults, Lancet Heal Longev, 2021, 2(6):e340–51.
13. 13. Scott, A., Chambers, D., Goyder, E., O’Cathain, A., Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review, PLoS One, 2017, 10;12(5):e0177210.
14. 14. Shaw, J.E., Sicree, R.A., Zimmet, P.Z., Global estimates of the prevalence of diabetes for 2010 and 2030, Diabetes Res Clin Pract, 2010, 87(1):4–14.
15. 15. Hill-Briggs, F., Adler, N.E., Berkowitz, S.A., Chin, M.H., Gary-Webb, T.L., Navas-Acien, A., Social Determinants of Health and Diabetes: A Scientific Review, Diabetes Care, 2021, 1;44(1):258–79.
16. 16. Afroz, A., Alramadan, M.J., Hossain, M.N., Romero, L., Alam, K., Magliano, D.J., Cost-of-illness of type 2 diabetes mellitus in low and lower-middle income countries: a systematic review, BMC Health Serv Res, 2018, 17;18(1):972.
17. 17. Global Burden of Disease Study 2021, Global Health Data Exchange, 2023, https://ghdx.healthdata.org (Erişim Tarihi: 10.11.2023).
18. 18. Ong, K.L., Stafford, L.K., McLaughlin, S.A., Boyko, E.J., Vollset, S.E., Smith, A.E., Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021, Lance, 2023, 402(10397):203–34.
19. 19. Ahmad, E., Lim, S., Lamptey, R., Webb, D.R., Davies, M.J., Type 2 diabetes, Lancet, 2022, 400(10365):1803–20. 20. Xu, G., Liu, B., Sun, Y., Du, Y., Snetselaar, L.G., Hu, F.B., Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study, BMJ, 2018, 4;k1497.
20. 21. WHO. Geneva: World Health Organization. 2013 [cited 2023 Nov 17]. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Available from: https://www.who.int/publications/i/item/9789241506236
21. 22. Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025, Sci Rep, 2020, 8;10(1):14790.
22. 23. Tandon, N., Anjana, R.M., Mohan, V., Kaur, T., Afshin, A., Ong, K., The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990–2016, Lancet Glob Heal, 2018, 6(12):e1352–62.
23. 24. Liu, M., Liu, S.W., Wang, L.J., Bai, Y.M., Zeng, X.Y., Guo, H.B., Burden of diabetes, hyperglycaemia in China from to 2016: Findings from the 1990 to 2016, global burden of disease study, Diabetes Metab, 2019, 45(3):286–93.
24. 25. Roze, S., de Portu, S., Smith-Palmer, J., Delbaere, A., Valentine, W., Ridderstråle, M., Cost-effectiveness of sensor-augmented pump therapy versus standard insulin pump therapy in patients with type 1 diabetes in Denmark, Diabetes Res Clin Pract, 2017, 128:6–14.
25. 26. International Diabetes Federation, IDF Diabetes Atlas 2021, https://diabetesatlas.org/atlas/tenth-edition (Erişim Tarihi: 11.11.2023).
26. 27. Wang, Y., Zhao, L., Gao, L., Pan, A., Xue, H., Health policy and public health implications of obesity in China, Lancet Diabetes Endocrinol, 2021, Jul;9(7):446–61.
27. 28. Mutyambizi, C., Booysen, F., Stokes, A., Pavlova, M., Groot, W., Lifestyle and socio-economic inequalities in diabetes prevalence in South Africa: A decomposition analysis, PLoS One, 2019, 30;14(1):e0211208.
28. 29. Chakhtoura, M., Mantzoros, C.S., Advances in physiology, design and development of novel medications changing the landscape of obesity pharmacotherapy, Metabolism, 2023, 142:155531.
29. 30. Wang, L., Zhou, B., Zhao, Z., Yang, L., Zhang, M., Jiang, Y., Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004–18, Lancet, 2021, 398(10294):53–63.
30. 31. WHO, Assessing national capacity for the prevention and control of noncommunicable diseases: report of the 2019 global survey, 2020 https://www.who.int/publications/i/item/9789240002319 (Erişim Tarihi: 13.11.2023).
31. 32. WHO, First-ever global coverage targets for diabetes adopted at the 75th World Health Assembly, 2022, https://www.who.int/news-room/feature-stories/detail/first-ever-global-coverage-targets-for-diabetes-adopted-at-the-75-th-world-health-assembly (Erişim Tarihi: 13.08.2023).
32. 33. Mukonda, E., Lesosky, M. A., Comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries, J Glob Health, 2021, 4;11:04055.
33. 34. Manne-Goehler, J., Geldsetzer, P., Agoudavi, K., Andall-Brereton, G., Aryal, K.K., Bicaba, B.W., Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys, PLOS Med, 2019, 16(3):e1002751.