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Health Transformation — Journal
September 20, 2022
This is a republication of the paper below, with the title above.
Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study
The Lancet — Diabetes and Endocrinology
Gabriel A Gregory, MD *, Thomas I G Robinson, LLB *, Sarah E Linklater, PhD, Fei Wang, PhD, Prof Stephen Colagiuri, MD; Prof Carine de Beaufort, PhD; Prof Kim C Donaghue, PhD
September 13, 2022
SUMMARY
Background
- Accurate data on type 1 diabetes prevalence, incidence, associated mortality and life expectancy are crucial to inform public health policy, but these data are scarce.
- We therefore developed a model based on available data to estimate these values for 201 countries for the year 2021 and estimate the projected prevalent cases in 2040.
Methods:
- We fitted a discrete-time illness-death model (Markov model) to data on type 1 diabetes incidence and type 1 diabetes-associated mortality to produce type 1 diabetes prevalence, incidence, associated mortality and life expectancy in all countries.
- Type 1 diabetes incidence and mortality data were available from 97 and 37 countries respectively.
- Diagnosis rates were estimated using data from an expert survey.
- Mortality was modelled using random-forest regression of published type 1 diabetes mortality data, and life expectancy was calculated accordingly using life tables.
- Estimates were validated against observed prevalence data for 15 countries.
- We also estimated missing prevalence (the number of additional people who would be alive with type 1 diabetes if their mortality matched general population rates).
Findings:
The situation in 2021:
- In 2021, there were about 8·4 (95% uncertainty interval 8·1–8·8) million individuals worldwide with type 1 diabetes:
– of these 1·5 million (18%) were younger than 20 years,
– 5·4 million (64%) were aged 20–59 years, and
– 1·6 million (19%) were aged 60 years or older.
- In that year there were 0·5 million new cases diagnosed (median age of onset 39 years), …
- … about 35 000 non-diagnosed individuals died within 12 months of symptomatic onset.
- One fifth (1·8 million) of individuals with type 1 diabetes were in low-income and lower-middle-income countries.
- Remaining life expectancy of a 10-year-old diagnosed with type 1 diabetes in 2021 ranged from a mean of 13 years in low-income countries to 65 years in high-income countries.
- Missing prevalent cases in 2021 were estimated at 3·7 million.
Forecasts for 2040
- In 2040, we predict an increase in prevalent cases to 13·5–17·4 million (60–107% higher than in 2021) …
- … with the largest relative increase versus 2021 in low-income and lower-middle-income countries.
Interpretation
The burden of type 1 diabetes in 2021 is vast and is expected to increase rapidly, especially in resource-limited countries.
Most incident and prevalent cases are adults.
The substantial missing prevalence highlights the premature mortality of type 1 diabetes and an opportunity to save and extend lives of people with type 1 diabetes.
Our new model, which will be made publicly available as the Type 1 Diabetes Index model, will be an important tool to support health delivery, advocacy, and funding decisions for type 1 diabetes.
The burden of type 1 diabetes in 2021 is vast and is expected to increase rapidly, especially in resource-limited countries. Most incident and prevalent cases are adults.
The substantial missing prevalence highlights the premature mortality of type 1 diabetes and an opportunity to save and extend lives of people with type 1 diabetes.
Funding
JDRF International.
References:
See original publication
Originally published at https://www.thelancet.com.
