Diabetes Projected to Affect 1.3 Billion People by 2050

SAN DIEGO -- The total number of people living with diabetes worldwide is expected to more than double over the next 30 years, reported researchers of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.

Based on data from 204 countries and territories, approximately 529 million were estimated to be living with diabetes across the world in 2021, a number projected to grow to over 1.31 billion by 2050, according to Kanyin Liane Ong, PhD, of the University of Washington in Seattle, and colleagues of the GBD 2021 Diabetes Collaborators.

Over that stretch of time, the age-standardized global diabetes prevalence is expected to increase from 6.1% to 9.8%, showed data presented here at the annual American Diabetes Association (ADA) Scientific Sessions and simultaneously published in The Lancet.

Type 2 diabetes comprised 96% of the total diabetes diagnoses in 2021. It also accounted for 95.4% of the diabetes disability-adjusted life-years (DALYs), the sum of years of life lost due to premature death plus the years lived with disability.

"Diabetes was already a substantial concern in 2021 and is set to become an even greater public health issue over the coming three decades, with no effective mitigation strategy currently in place. We need to urgently identify solutions that will limit population increases in risk factors for diabetes, otherwise the advance of the disease is likely to continue unabated," Ong and colleagues wrote.

"At the same time, we must enhance and expand access to better diabetes care to limit the complications associated with the disease," the investigators added.

About half of the type 2 diabetes DALYs may be attributable to obesity, they reported, as the estimated contribution of high BMI to type 2 diabetes DALYs worldwide rose by 24.3% from 1990 to 2021.

The investigators cited structural inequalities, such as access to healthy food options, as well as shifts toward an industrialized diet among low- to middle-income populations as part of the cause for higher BMI.

Social determinants of health may also play a role in the rising diabetes prevalence worldwide despite well-established strategies to reduce the disease burden (e.g., increasing access to insulin, enhancing health system infrastructure).

In their GBD report, Ong and colleagues noted that "the burden of diabetes-related deaths and disability, as well as their drivers, varies widely."

As of 2021, the super-region with the highest age-standardized prevalence of diabetes was north Africa and the Middle East, at 9.3%, while the region with the highest age-standardized rate was Oceana, at 12.3%. Qatar had the highest country-level age-specific prevalence, at 76.1% in people ages 75 to 79 years.

The authors also indicated that diabetes will be prevalent in over 10% of people in 2050 in the super-regions of Latin America and the Caribbean (11.3%) and north Africa and the Middle East (16.8%).

During a presentation at ADA on structural racism, geographic inequity, and diabetes, Louise Maple-Brown, PhD, of Charles Darwin University in Australia, discussed the impact of five social determinants of health on disparities in diabetes: economic development, sociocultural norms, public awareness and policy, access to high-quality care, and innovations in diabetes management.

"Minoritized communities [are] starting at a more disadvantaged position and face more adverse diabetes outcomes than their non-minoritized counterparts due to structural inequity," she said. "So finally we have here, the compound effect of structural inequity and social determinants of health across multiple generations, fueling a cascade of ever-widening global inequity in diabetes."

For their 2021 report, the GBD investigators had drawn upon data from multiple sources, including systematic reviews and records shared by country collaborators and the World Health Organization. Prior studies where participants self-reported their diabetes status were excluded.

Ong's group cautioned that due to the timing of the study, they were unable to factor the impact of the COVID-19 pandemic into their analysis. Other study limitations include variances in documenting underlying causes of death, exclusion of gestational diabetes, and missing blood collection data.

Even so, an accompanying editorial authored by The Lancet stressed the urgency of the problem of diabetes growing among the global population.

"Diabetes will be a defining disease of this century," they wrote. "How the health community deals with diabetes in the next two decades will shape population health and life expectancy for the next 80 years. The world has failed to understand the social nature of diabetes and underestimated the true scale and threat the disease poses."