Global,Regional,and National Burden Of Diabetes,1990-2017

BackgroundDiabetes mellitus is one of the top 10 causes of death and the second biggest negative total effect on reducing global health adjusted life expectancy worldwide Diabetes is characterized by high morbidity and high prevalence of complications which contribute greatly to disability and death.It was estimated that one in eleven adults have diabetes and there was one death every eight seconds.Diabetes and its complications impact harshly on the individuals and their families,and the society.This study aimed to estimate the global burden of diabetes by type,year,regions,and socioeconomic status in 195 countries and territories from 1990 to 2017,further analyze the associations between the socioeconomic status and diabetic burden,and explore the trend of risks factors of diabetes.Our findings may facilitate strategic interventions and resources allocations.MethodsWe used data from the Global Burden of Disease Study 2017 to estimate the burden of diabetes in 195 countries and territories,as measured by incidence,prevalence,mortality,disability-adjusted life-years(DALYs).Secondary analyses were performed by year,age,sex and region.The 2017 Socio-demographic Index(SDI)was used as an indicator of national socioeconomic status covering educational attainment,lagged distributed income,and total fertility rate.Nonlinear regression analysis were applied to explore the association between age-standardized incidence,prevalence,mortality,DALYs rates and SDI.We evaluated age-standardized rates of mortality and DALYs associated with metabolic,environmental and occupational,and behavioral factors.ResultsIn 2017,global incidence,prevalence,death,and DALYs associated with diabetes were 22.9 million,476.0 million,1.37 million,and 67.9 million,with a projection to 26.6 million,570.9 million,1.59 million,and 79.3 million in 2025,respectively.The trend of global type 2 diabetes burden was similar to that of total diabetes,while global age-standardized rate of mortality and DALYs for type 1 diabetes declined.Males had a disproportionately higher burden than females except for number of deaths.Both the trend and magnitude of diabetes related diseases burden varied substantially across regions and countries.The low-middle,middle,and high-middle SDI regions were associated with higher burden,while high SDI regions had lower burden.Globally,metabolic risks(high body mass index),dietary factor(diet low in whole grain,nuts and seeds,and fruits),and behavioral factors(smoking and low physical activity)contributed the most attributable death and DALYs.ConclusionThe global burden of diabetes has increased significantly since 1990 and is likely to continue increasing considerably.The trend and magnitude of diabetes related diseases burden varied substantially across regions and countries.Socioeconomic development played a critical roles in diabetic burden.Most diabetic burden was attributable to modifiable risk factors.These estimations could be useful in policy-making,priority setting,and resource allocation in diabetes prevention and treatment.