More people with type 1 diabetes are living longer, but global inequalities still exist

An analysis of data from more than 200 countries and regions published in The BMJ found that the number of people aged 65 years and over with type 1 diabetes increased from 1.3 million in 1990 to 3.7 million in 2019, while the death rate decreased by 25%, from 4.7 per 100,000 population in 1990 to 3.5 in 2019. p>

Overall, the results show that more people with type 1 diabetes are living longer. However, mortality rates fell 13 times faster in high-income countries compared with low- and middle-income countries, suggesting that there are significant global inequalities in diabetes care.

Type 1 diabetes has traditionally been considered a disease that can severely shorten life expectancy, but recent studies report an increasing number of older adults with type 1 diabetes, likely due to improved treatment and care.

However, accurate data on the burden of type 1 diabetes is still lacking in most countries and regions of the world.

To address this problem, researchers in China used data from the 2019 Global Disease Burden and Risk Factors study to estimate prevalence (the number of people with the condition), mortality, and healthy life years lost (DALYs), a combined measure of quantity and quality of life. - due to type 1 diabetes in people aged 65 years and older in 204 countries and regions from 1990 to 2019.

Data was analyzed at the global, regional and national levels by age, gender and the Sociodemographic Index (SDI), a measure of social and economic development.

The team found that globally, the age-standardized prevalence of type 1 diabetes among older people increased by 28%, from 400 per 100,000 population in 1990 to 514 in 2019, while mortality fell by 25%, from 4.74 per 100,000 population in 1990 to 3.54 in 2019.

Age-standardized DALYs due to type 1 diabetes also decreased over the same period, but to a lesser extent, by 8.9%, from 113 per 100,000 population in 1990 to 103 in 2019.

Globally, the prevalence of type 1 diabetes has increased at least threefold in every age group from 65 to 94 years, especially among men, while mortality rates have decreased in all age groups, especially among women and those under 79 years of age. The largest decline in DALYs was also observed among those under 79 years of age.

However, mortality rates fell 13 times faster in countries with a high sociodemographic development index compared to countries with a low or average sociodemographic development index (-2.17% per year versus -0.16% per year).

Although the highest prevalence of type 1 diabetes remained in high-income North America, Australia and Western Europe, the highest rates of DALYs were found in southern sub-Saharan Africa (178 per 100,000 population), Oceania (178) and the Caribbean islands ( 177).

High fasting plasma glucose (higher blood sugar after a period of fasting) was the main risk factor for DALYs among older people with type 1 diabetes over the 30-year study period, suggesting that active control of levels Blood glucose remains a problem for these patients.

The researchers acknowledge that their estimates relied heavily on modeling, and that variations in health systems and reporting practices across countries and regions, particularly in low- and middle-income countries and in conflict-affected areas, may have influenced the accuracy of their results.

However, for older people with type 1 diabetes and their families around the world, the reduction in deaths and DALYs associated with the disease is encouraging.

Further qualitative research in the real world is required to validate the results of this study. The researchers write: "Our study also advocates for urgent attention to coping strategies for aging populations and older adults with type 1 diabetes, rational healthcare allocation, and targeted recommendations."