In a study recently published in the BMJ, researchers assessed regional, national and global inequalities, trends and burden of early-onset type 1 diabetes (insulin-dependent diabetes mellitus) (T1DM) among older adults from 1990 to 2019.
study: Global burden of type 1 diabetes among adults aged 65 years and older from 1990 to 2019: a population-based studyImage credit: DGLimages/Shutterstock.com
background
Previous studies have linked type 1 diabetes to a reduced life expectancy, but diabetes treatment and management of complications improved dramatically during the 1990s, and recent studies have reported an increase in the number of older adults with type 1 diabetes.
Most countries lack detailed statistics on the prevalence of early-onset diabetes and specialized clinical care guidelines for older adults. Understanding the changes in mortality and disability-adjusted life years (DALYs) in older adults (≥65 years) with insulin-dependent diabetes is crucial for their management.
About the Research
In this study, researchers looked at the prevalence, mortality, and DALYs (per 100,000 people) of early-onset diabetes among adults aged 65 years and older at the global, national, and regional levels from 1990 to 2019.
The survey included older adults from 21 regions in 204 countries and territories. [2019 Global Burden of Disease (GBD) Study] From 1990 to 2019. Primary outcome measures were type 1 diabetes-related age-standardized prevalence, number of deaths, DALYs, and mean annual rate of change.
The researchers used microsimulation to calculate the final number of years of disability after accounting for comorbidities.
They determined years of life lost by projecting the number of early-onset diabetes-related deaths multiplied by the life expectancy at time of death. They calculated DALYs by adding years lived with disability and years lost.
The researchers identified type 1 diabetes as a doctor-diagnosed condition in diabetes registries and hospital records.
The researchers stratified their findings by sociodemographic index scores, biological sex, and age of the population. Additionally, they assessed factors that may affect DALYs among older adults with type 1 diabetes.
The researchers determined developmental status based on sociodemographic index scores and divided participants into age groups (years): 65-69, 70-74, 75-79, 80-84, 85-89, 90-94, and 95+ years.
They used Bayesian meta-regression and space-time Gaussian regression for analysis and descriptive statistics to characterize the burden of early-onset diabetes.
result
The global prevalence of early-onset diabetes among people aged 65 years and older increased by 180% between 1990 and 2019, from 1.3 million to 3.7 million, including from 0.6 million to 1.7 million in men and from 0.7 million to 2 million in women.
The global age-standardized prevalence of type 1 diabetes in this age group increased by 28% during the period, from 400 to 514, with an average annual rate of change of 0.9%. Deaths decreased from 4.7 to 3.5, with an average annual rate of decline trend of 1.0%, and age-standardized disability-adjusted life-years decreased from 113 to 103 per 100,000 (average annual trend -0.3%).
The researchers noted that the most statistically significant annual declines in disability-adjusted life years were in people under 79 years of age, followed by those aged 65-69 (0.4%), 70-74 (0.3%), and 75-79 (0.4%). The decline in disability-adjusted life years was more statistically significant in women aged 65 and over, with an average annual trend of -0.6%.
In 1990, among individuals aged 65 years and older, women had more disability-adjusted life years due to type 1 diabetes than men (118 vs. 106). However, in 2019, women aged 65 years and older had fewer disability-adjusted life years than men (100 vs. 106).
Mortality rates in developed countries decreased 13-fold compared with developing countries (-2.2% vs. -0.2%). Prevalence was higher in Australasia, Western Europe and North America, but disability-adjusted life-years were highest in sub-Saharan southern Africa, the Caribbean and Oceania.
From 1990 to 2019, elevated fasting plasma glucose was the strongest DALY risk factor in older adults.
From 1990 to 2019, the global age-standardized prevalence of type 1 diabetes in individuals aged 65 years or older increased in both men and women. Prevalence increased more rapidly in men than in women (mean percentage change 1.0% vs. 0.7%).
Age-standardized mortality rates from type 1 diabetes decreased in men and women aged 65 years and older, although the decrease was smaller in men (mean annual percentage change -0.6% vs -1.3%).
Conclusion
Overall, the findings reveal that life expectancy of older adults with type 1 diabetes increased during the 1990s, with a significant decrease in associated mortality and disability-adjusted life years.
Type 1 diabetes-related mortality and disability-adjusted life years were lower in women aged 65 years or older, in people living in developed regions, and in people aged 79 years or younger.
Elevated fasting plasma glucose levels are a concern for older adults with early-onset diabetes and require special strategies.
