New global data show a dramatic surge in childhood and adolescent diabetes, especially type 2, yet improved care is helping reduce mortality worldwide.
Study: Analysis of the global burden of diabetes and attributable risk factor in children and adolescents across 204 countries and regions from 1990 to 2021. Image credit: mother_ana/Shutterstock.com
A recent study in Frontiers in Endocrinology examined trends in diabetes among children and adolescents in 204 countries and regions. The incidence of diabetes has sharply increased in children and adolescents, but diabetes-related mortality has declined over time.
The growing threat of diabetes
Diabetes is a severe chronic condition typically resulting from insulin deficiency. As of 2019, it affected 460 million people worldwide and was the eighth leading cause of death and disability. Forecasts indicate that the number of individuals with diabetes may increase to an alarming 783 million by 2045. This shows the substantial burden that diabetes can impose on the healthcare system.
Diabetes is predominantly classified as type 1 (T1D) and type 2 diabetes (T2D). Recent evidence points to a rising incidence of diabetes among younger individuals. Despite the progress made in prevention strategies, they have not been able to prevent the trend of early onset of diabetes and the rising incidence. To aid in better disease management in the younger population, it is crucial to understand the global epidemiological trends of diabetes in children and adolescents (age less than 20 years).
About the study
This study extracted data from the Global Burden of Disease (GBD) database for 204 countries and regions from 1990 to 2021 to examine trends in diabetes among children and adolescents. It also considers diabetes-related mortality and examines the associated risk factors. The GBD 2021 provides extensive mortality, incidence, and Disability-Adjusted Life Years (DALYs) data.
The Socio-Demographic Index (SDI) is a composite metric of a country’s developmental status and is significantly associated with health outcomes. Using its values between 0 (least developed) and 1 (most developed), the countries were categorized into low SDI, low-middle SDI, middle SDI, high-middle SDI, and high SDI regions. The patients were also divided into subgroups by age, namely, 15-19 years, 10 – 14 years, 5 – 9 years, 2 – 4 years, and under 1 year.
Sixty-six specific attributable risk factors were identified, including lead exposure, high consumption of red meat, particulate pollution, extreme temperatures, active and passive smoking, high sodium intake, and others. However, data were available only on three risk factors: elevated fasting blood glucose and high and low temperatures.
Study findings
Globally, diabetes incidence among children and adolescents has increased by approximately 94% from 25.77 per 100,000 in 1990 to 49.99 per 100,000 in 2021. The incidence of T2D has surpassed that of T1D, and T2D now contributes more to the rising disease burden; despite this, T1D still accounts for a higher mortality rate. Before 2020, the incidence rates were higher in females than in males. Across all five SDI categories, rates increased, with the lowest burden in low SDI regions and the highest in high-middle SDI regions.
Concerning geographical regions, the highest incidence rates were seen in Oceania. The most notable increases were in East Asian Regions, North Africa, and the Middle East. India and China report the highest numbers of diabetes cases at the national level. Pakistan also showed a significant increase in cases between 1990 and 2021.
The diabetes-related death rate among children and adolescents declined from 0.39 per 100,000 in 1990 to 0.31 per 100,000 in 2021. T1D-related deaths were significantly higher than T2D, and the death rates were comparable between males and females. However, whilst T1D mortality declined, the T2D mortality rate rose slightly from 0.06 to 0.08 per 100,000.
High SDI regions recorded the lowest death rates at the SDI level, while low SDI regions carried the highest. Oceania had the highest regional death rate overall, whereas East Asia saw a significant decline. India reported the highest number of deaths, while China showed a marked decrease during the study period.
The overall DALY rate among children and adolescents declined during the study period, from 39.45 per 100,000 in 1990 to 37.83 per 100,000 in 2021. The DALY rate for T2D increased, while that for T1D decreased. Despite this, T1D DALY rates remain higher overall than those of T2D.
The reduction significantly influenced the overall decline in the diabetes DALY rate for females. For males, the DALY rate remained stable. An increase in the diabetes DALY rate was noted only in the high SDI region. In contrast, the low SDI region showed the most pronounced decline in DALY rates. Oceania showed the highest DALY rate, while India not only exhibited the highest total diabetes DALYs but also an increasing trend. Conversely, China’s total diabetes DALYs decreased between 1990 and 2021.
The highest diabetes incidence was noted in the 15–19-year-old age group, both across the five SDI regions and globally. In some subgroup analyses, however, the 10-14-year-old age group also showed particularly high incidence rates. For patients under 1 year of age, the mortality and DALY rates for T1D were significantly higher than those of other age groups.
Among the risk factors, the main determinant of diabetes-related mortality and DALYs in children and adolescents is elevated fasting blood glucose. The study also projected, using ARIMA models, that the global incidence of diabetes in children and adolescents will continue to rise over the next 15 years, while mortality is expected to keep declining.
Conclusions
The results show that diabetes-related mortality in children and adolescents has declined over time. However, the marked increase in incidence is alarming and seriously threatens global child and adolescent health.
A key limitation of the current study is data quality, as several countries may have a significantly high number of undiagnosed diabetes cases and may also lack data on risk factors. Furthermore, epidemiological methods could not be used to study the data because the data provided by GBD are aggregate.
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