Type 1 diabetes burden shifts: Higher prevalence but lower death rates in elderly

In a recent study published in BMJ, researchers evaluated the regional, national, and global inequalities, trends, and burden of juvenile-onset, type 1, or insulin-dependent diabetes mellitus (T1DM) among elders between 1990 and 2019.

Study: Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study. Image Credit: DGLimages/Shutterstock.comStudy: Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study. Image Credit: DGLimages/Shutterstock.com

Background

Previous research links type 1 diabetes to a shorter life expectancy. However, diabetes treatment and complication management have improved dramatically during the 1990s, with recent studies reporting an increase in the number of older individuals with type 1 diabetes.

Most countries lack detailed statistics on the prevalence of juvenile-onset diabetes and specialized clinical care guidelines for elders. Understanding changes in death rates and disability-adjusted life years (DALYs) for older adults (65 years and above) with insulin-dependent diabetes is crucial for their management.

About the study

In the present study, researchers investigated juvenile-onset diabetes prevalence, mortality rates, and DALYs, expressed as per 100,000 individuals, among adults aged 65 years and older at global, national, and regional levels from 1990 to 2019.

The study included older adults from 21 areas across 204 nations and territories [2019 Global Burden of Disease (GBD) Study] between 1990 and 2019. The primary outcome measures were type 1 diabetes-associated age-standardized prevalence rates, deaths, DALYs, and the mean annual percent change.

After controlling for comorbidity, the researchers utilized microsimulation to calculate the final number of years with impairment.

They determined life years lost by projecting the number of juvenile-onset diabetes-related deaths multiplied by the average life span at the time of death. They calculated DALYs by adding the number of years survived with disabilities to the number of years lost.

The researchers identified type 1 diabetes as a doctor-diagnosed illness in diabetic registries or hospital-based records.

They stratified their findings by social demographic index scores and the biological sex and age of the population. In addition, they assessed factors that may influence DALYs among older individuals with type 1 diabetes.

The researchers determined the development status based on the sociodemographic index scores. They divided the participants into age groups (years) of 65 to 69, 70 to 74, 75 to 79, 80 to 84, 85 to 89, 90 to 94, and ≥95.

They used Bayesian meta-regressions and spatiotemporal Gaussian regressions for analysis and descriptive statistics to characterize the juvenile-onset diabetes burden.

Results

Global juvenile-onset diabetes prevalence among individuals aged 65 years and older increased by 180% between 1990 and 2019, from 1.30 million to 3.70 million, from 0.60 million to 1.70 million for men, and from 0.70 million to 2.0 million for women.

The worldwide age-standardized prevalence rates of type 1 diabetes in this age group increased by 28%, from 400 to 514 during the period, with a mean change of 0.9% per year. Deaths reduced from 4.7 to 3.5, a mean declining trend of 1.0% per year, and age-standardized disability-adjusted life years reduced from 113 to 103 per 100,000 individuals (mean annual trend, −0.3%).

The team noted the most statistically significant annual reductions in disability-adjusted life years among individuals under 79 years of age: 65 to 69 years (0.4%), 70 to 74 years (0.3%), and 75 to 79 years (0.4%). Disability-adjusted life year reductions were more statistically significant among females aged ≥65 years, with a mean annual trend of −0.6%.

In 1990, among individuals aged ≥65 years, females had higher disability-adjusted life years from type 1 diabetes than males (118 vs. 106). In 2019, however, females aged ≥65 years had fewer disability-adjusted life years than males (100 vs. 106).

Mortality was reduced 13 times more among developed nations than among developing countries (−2.2% vs. −0.2%). While prevalence rates were high in Australasia, West Europe, and North America, disability-adjusted life-year rates were the highest for the southern parts of sub-Saharan parts of Africa, the Caribbean, and Oceania.

Elevated fasting blood glucose levels were the strongest DALY risk factor among older adults between 1990 and 2019.

From 1990 to 2019, the age-standardized global prevalence of type 1 diabetes among individuals aged ≥65 years increased for males and females. The increase in prevalence was more rapid among males than females (mean percent change of 1.0% vs. 0.7%).

Age-standardized mortality rates from type 1 diabetes were reduced for males and females aged ≥65 years, although the reductions were smaller among males (mean annual percent change of −0.6% vs. −1.3%).

Conclusion

Overall, the study's findings revealed that the lifespan of older individuals with type 1 diabetes has grown during the 1990s, with significant decreases in related fatalities and disability-adjusted life years.

Type 1 diabetes-related fatalities and disability-adjusted life years were lower among females aged 65 and older, those residing in developed regions, and those below 79 years of age.

Elevated fasting blood glucose control concerns older adults with juvenile-onset diabetes, necessitating specific strategies.

Journal reference:
Pooja Toshniwal Paharia

Written by

Pooja Toshniwal Paharia

Pooja Toshniwal Paharia is an oral and maxillofacial physician and radiologist based in Pune, India. Her academic background is in Oral Medicine and Radiology. She has extensive experience in research and evidence-based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

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