Global Mortality and Disability from Type 1 Diabetes Have Decreased

The life expectancy of older people with type 1 diabetes has increased, suggesting that significant improvements have occurred in the care of people with this disease, according to new prevalence study recently published in BMJ.

Type 1 diabetes is an autoimmune disease that affects about 2 million Americans, according to the Centers for Disease Control and Prevention. In type 1 diabetes, the pancreas does not make insulin. Type 1 diabetes can shorten life, at least one study has found.

Researchers from the First Hospital of China Medical University in Shenyang, China, wanted to assess the global prevalence of type 1 diabetes, as well as global mortality, disability adjusted life years and average annual percentage change. They used the Global Burden of Disease and Risk Factors Study 2019, which was developed by the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME). The Global Burden of Disease is an effort to quantify health loss across outcomes, risk factors and countries.

Researchers in the BMJ study assessed data from 1990 to 2019. They extracted information on type 1 diabetes in people aged ≥65 years; location, age, and sex specific prevalence; mortality; numbers and rates for disability adjusted life years; and disability adjusted life years attributable to each risk factors.

Disability adjusted life years (DALY) represents the loss of the equivalent of one year of full health. According to the World Health Organization, mortality does not give a complete picture of the burden of disease by individuals. DALY is a measurement of disease’s burden on health and disability.

Researchers in the BMJ study found that the global prevalence of type 1 diabetes among older people aged ≥65 years increased by 180% between 1990 and 2019, from 1.3 million to 3.7 million. Among standardized age groups, the prevalence increased 28% from 400 per 100,000 population in 1990 to 514 per 100,000 population in 2019. The proportion of older people with type 1 diabetes is trending upward from 12% in 1990 to 17% in 2019.

At the same time, mortality decreased from 4.74 per 100,000 population to 3.54 per 100,000 population. Mortality fell 13 times faster in countries with a high sociodemographic index versus countries with a low-middle sociodemographic index.

Additionally, they found that age standardized DALYs decreased from 113 per 100,000 population to 103 per 100,000 population, with the greatest impact among people aged 65 to 69 years of age.

“The results suggest that T1DM [type 1 diabetes] is no longer a contributory factor in decreased life expectancy owing to improvements in medical care over the three decades,” the researchers wrote.

But they said optimal blood glucose control remains challenging among older people. “Our study extended the current understanding of the increasing global burden of T1DM by focusing on trends in older people (≥65 years) with T1DM,” researchers wrote. Our study also advocates for urgent attention to coping strategies for aging populations and older people with T1DM, rational allocation of health resources, and the provision of targeted guidelines.”

Among the limitations, study researchers said, was that data was extrapolated from countries with existing epidemiological data and there were variations in health information systems and reporting mechanisms across countries and regions. This, they said, could