Diabetes is a chronic disease that affects more than 540 million people worldwide and is one of the leading causes of death and disability worldwide. In China, there are more than 114 million adults with diabetes, accounting for about a quarter of the world's diabetes patients. With the change of living and eating habits, diabetes has become the third major factor affecting human health after cardiovascular and cerebrovascular diseases and malignant tumors, bringing a heavy physical and mental burden to individuals and families.

On June 22, 2023, a research paper entitled "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" was published in the authoritative journal The Lancet. Based on the latest evidence and analytical framework from the Global Burden of Disease, Injury, and Risk Factors Study (GBD), researchers at the Institute for Evaluation (IHME) produced site-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, and estimated the proportion of type 1 and type 2 diabetes in 2021, the proportion of type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence to 2050.

1. Introduction of Diabetes

Diabetes is a serious chronic disease characterized by elevated blood sugar concentrations associated with the effects of abnormal beta cell biology on insulin action. Diabetes occurs when the pancreas does not produce enough insulin or the body does not use the insulin it does produce efficiently. Diabetes is the eighth leading cause of death and disability worldwide and a leading cause of ischaemic heart disease, blindness, kidney failure, stroke and lower limb amputation.

The most common forms of diabetes are type 1 diabetes and type 2 diabetes. Type 1 diabetes (once known as insulin-dependent diabetes or juvenile onset diabetes) is characterized by insufficient insulin production and the need for daily insulin intakes, and it is unclear what causes it. More than 95 percent of people with diabetes have type 2 diabetes (formerly known as non-insulin-dependent diabetes or adult-onset diabetes), which is characterized by the body's abnormal use of insulin that affects the body's use of glucose for energy, mainly due to obesity, physical inactivity and genetics.

2. Diabetes Prevalence Assessment

In 2021, there will be approximately 529 million diabetic patients of all ages in the world, and the global age-standardized prevalence rate is about 6.1%. Researchers estimate that there will be approximately 485 million diabetic patients aged 20-79, of which 43 countries and regions have an age-standardized diabetes prevalence rate of more than 10%.

From the perspective of different genders, in 140 (68.6%) countries, the incidence of diabetes in men is higher than that in women, with the incidence rate of 6.5% in men and 5.8% in women.

From the perspective of different ages, the total prevalence of diabetes in the age group under 20 years old is less than 1%; the total prevalence of diabetes is particularly obvious in people aged 65 and over, with an incidence of more than 20%; the global prevalence of diabetes peaks at 24.4% between the ages of 75 and 79.

Globally, the DALYs (disability-adjusted life years) caused by diabetes are 79.2 million. In China, the DALYs of diabetes in 2021 are 11.7 million, and the change rate of DALYs from 1990 to 2021 is 172.9%.

From the perspective of disease type, in all 204 countries and regions, type 2 diabetes cases accounted for more than 80% of all diabetes cases, and in 183 countries and regions with more than 89.7%, the prevalence of type 2 diabetes accounted for 96%.

From the perspective of risk factors, 76.5% of DALYs (disability-adjusted life years) caused by type 2 diabetes can be attributed to risk factors. Obesity (high BMI) is the main risk factor, accounting for 52.2% of type 2 diabetes DALYs, followed by diet (25.7%), environmental or occupational risks (19.6%), smoking (12.1%), lack of exercise (7.4%), and alcohol consumption (1.8%). From 1990 to 2021, the proportion of DALYs caused by high BMI increased in every country and region in the world, from 42.2% in 1990 to 52.2% in 2021.

The changes in the prevalence of diabetes from 1990 to 2021, and the forecast of the prevalence to 2050 are as follows.

Between 1990 and 2021, the global age-standardized diabetes prevalence increased by 90.5%, from 3.2% to 6.1%. In 97 of the 100 countries (47.5%) the age-standardized prevalence of diabetes increased by more than 204%.

From 2021 to 2050, the global age-standardized total prevalence of diabetes is expected to increase by 59.7%, from 6.1% to 9.8%, and 1.31 billion people will have diabetes by 2050, with an annualized rate of change of 3.31%. Of this increase, 49.6 percent was driven by obesity trends and the remaining 50.4 percent was driven by demographic changes.

The increase in the overall prevalence of diabetes is expected to be primarily driven by the increase in type 2 diabetes. The global age-standardized prevalence of type 2 diabetes is projected to increase by 61.2%, from 5.9% in 2021 to 9.5% in 2050, affecting more than 1.27 billion people. The global age-standardized prevalence of type 1 diabetes is projected to increase by 23.9%, from 0.2% in 2021 to 0.3% in 2050.

3. Diabetes Treatment And Prevention

Type 1 diabetes is treated with insulin injections. The majority of diabetic patients are obesity-induced patients, that is, type 2 diabetes patients. Type 2 diabetes mainly uses hypoglycemic drugs to control blood sugar, and often requires life-long medication, such as metformin, sulfonylureas, or sodium-glucose cotransporter type 2 (SGLT-2) inhibitors, etc. If the islet function is reduced or insulin secretion is too low, insulin injection therapy also needs to be considered. Non-drug-assisted treatment of type 2 diabetes is mainly diet control and exercise. Most type 2 diabetes is caused by obesity. Obese people have abnormal fat distribution and excessive accumulation, which will lead to insulin resistance and overload the pancreas. Weight loss can be used to regulate lipid metabolism, thereby affecting glucose metabolism, and repairing lipid metabolism to achieve the goal of balancing glucose metabolism.

For ordinary people, if you want to prevent diabetes, you must first monitor your blood sugar and have regular physical examinations; in addition, you must maintain a healthy diet, reduce your sugar intake, and eat more low-glycemic foods (mainly coarse grains and other foods), work and rest, and do some aerobic exercise appropriately; of course, the most important thing is to maintain a healthy weight, and eliminating obesity is the most effective measure to treat and prevent diabetes.

4.Conclusion

The continuous and rising prevalence of diabetes has brought great public health challenges to the world. Governments and public health departments around the world are increasingly concerned about the soaring prevalence of diabetes and its impact on healthcare systems and society.

At current rates of prevalence, more than 1.31 billion people are projected to be living with diabetes by 2050, the majority of them with type 2 diabetes. Addressing the escalating challenges of diabetes prevention and the barriers to managing diabetes and its complications will become an essential part of healthcare delivery globally. There is an urgent need to address the unfavorable trends in the prevalence of type 2 diabetes risk factors, especially obesity. If new and more effective countermeasures are not taken, diabetes will continue to have increasingly serious negative impacts on the quality of life of individuals, population health and social productive activities in the coming decades.

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