Study predicts the global burden of type 1 diabetes is expected to double by 2040

Study predicts the global burden of type 1 diabetes is expected to double by 2040

An estimated 8.4 million people worldwide were living with type 1 diabetes (T1D) in 2021, according to results of a new modeling study published in The Lancet Diabetes & Endocrinology. It is estimated that this number will increase to 13.5 to 17.4 million people with type 1 diabetes by 2040.

"With the prevalence of people with T1D predicted to rise to up to 17.5 million cases across all countries in 2040, our results are a warning of significant negative impacts on societies and health systems. There is an opportunity to save millions of lives in the world. We will raise the standard of care for type 1 diabetes (including ensuring universal access to insulin and others) in the coming decades essential goods) and raise awareness of the signs and symptoms of type 1 diabetes to enable a 100% diagnosis rate in all countries. Our model, which will be “open sourced, will make data on the burden of T1D widely available and serve as a platform for stakeholders to make improvements in T1D care and outcomes,” says Prof. Graham Ogle, one of the study authors, Sydney Medical School, University of Sydney, Australia.

Data on T1D prevalence and mortality are rarely available in most countries – missing data tend to relate to LMICs and adult populations, with most previous studies calculating T1D incidence based on European and North American data. The 2017 Lancet Diabetes & Endocrinology Commission on Diabetes in Sub-Saharan Africa, the WHO and the WHA have all identified an urgent need for global data on T1D. The aim of this new study is to address these calls by providing model estimates that are highly comparable to observed data and for the first time estimate missing prevalence, thereby providing a more meaningful basis for changes in T1D care and policy. The results will be made publicly available in an open source database as part of the T1D Index Project and are intended to help health planners, professionals and advocates improve care and health outcomes.

Researchers modeled T1D prevalence data in children, adolescents and adults in 97 countries, as well as incidence over time data from 65 countries and mortality data from 37 countries to predict T1D incidence, prevalence and mortality in 2021 for 201 countries, with projections of future prevalence through 2040. The estimates were made using real prevalence data tested for accuracy from 15 countries.

In 2021, the model estimated that 8.4 million people were living with T1D worldwide. Of these individuals, 18% were under 20 years old, 64% were between 20 and 59 years old, and 19% were over 60 years old. Although T1D has historically been a childhood-onset disease, these results show that more adults than children are diagnosed each year (316,000 versus 194,000 incidents worldwide in 2021), with the median age of diagnosis being 32 years.

"These results have important implications for diagnosis, care models and peer support programs. Such programs are designed and implemented almost exclusively for children and adolescents with type 1 diabetes in the countries where they exist. Furthermore, our results highlight the urgent need." for improved surveillance and data collection on the incidence, prevalence and mortality of T1D in adult populations – an area where data is particularly scarce,” says Prof. Dianna Magliano, one of the study authors, Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia.

The ten countries with the highest estimated T1D prevalence are the United States, India, Brazil, China, Germany, the United Kingdom, Russia, Canada, Saudi Arabia and Spain, accounting for 5.08 million (60%) of global T1D cases. Model estimates also suggest that 21% of individuals with T1D live in LICs and LMICs.

Model estimates suggest that there will be 175,000 deaths worldwide due to T1D in 2021. Of these, 35,000 or 20% were attributed to undiagnosis, including 14,500 in sub-Saharan Africa and 8,700 in South Asia. Researchers estimate that an additional 3.1 million people would still be alive in 2021 if they had not died prematurely due to suboptimal treatment for T1D, and another 700,000 people would still be alive if they had not died prematurely due to non-diagnosis.

"Our results suggest that the overall footprint of T1D is much larger than previous estimates suggested when taking into account the lack of prevalence due to excess mortality. This is particularly true in low- and middle-income countries - for example in sub-Saharan Africa." which accounts for 357,000 T1D cases, or 4% of the global prevalence, but 23% (40,000) of deaths lost annually - underscoring the urgent need to raise awareness of the signs and symptoms of T1D in LMICs," says Prof. Kim Donaghue, one of the study authors, Sydney Medical School, University of Sydney, Australia.

The model predicted T1D prevalence in 2040 is 13.5 to 17.5 million people, with the largest relative increase expected in LICs and LMICs. Conservative estimates suggest that the relative increase in the number of people living with T1D by 2040 will be 66% compared to 2020.

We hope that these country-level modeling results will be used by policymakers, researchers and health experts alike to develop initiatives that improve surveillance of T1D worldwide and promote universal health insurance programs so that T1D care is available and affordable for all to address the significant global burden of this disease."

Mr Tom Robinson, study author, Juvenile Diabetes Research Foundation, Australia

The authors acknowledge some limitations of this study, including the lack of data to input into the model. For adult populations, in LMICs and before 1975, data are more limited. Information obtained based on extrapolations from neighboring countries may be less accurate depending on genetic and environmental factors. In addition, estimated death rates due to undiagnosis are based on doctor's impressions and are likely to be higher or lower than the actual situation. Little information is available about mortality rates in diagnosed cases before 1980.

In a linked comment, Hui Shao from the University of Florida, USA (who was not involved in the study) wrote: “The increasing global burden of type 1 diabetes.” […] calls for global action to alleviate insulin access and affordability problems. Possible solutions are diverse and often depend on the country's political and economic environment. In short, countries must strengthen insulin price regulation and reimbursement policies while building subsidy programs to ensure access to insulin and meet the growing demand for insulin.”

Source:

The lancet

Reference:

Gregory, GA, et al. (2022) Global incidence, prevalence and mortality of type 1 diabetes in 2021 with forecast to 2040: a modeling study. The lancet. doi.org/10.1016/S2213-8587(22)00218-2.