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Cited by 1,149Diabetes Management and ResearchDiabetes and associated disordersDiabetes, Cardiovascular Risks, and Lipoproteins

Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study

Gregory, Gabriel A, Robinson, Thomas I G, Linklater, Sarah E, Wang, Fei, Colagiuri, Stephen, de Beaufort, Carine, Donaghue, Kim C, Harding, Jessica L +17 more·2022·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(22)00218-2
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Abstract

Background Accurate data on type 1 diabetes prevalence, incidence, associated mortality and life expectancy are crucial to inform public health policy, but these data are scarce. We therefore developed a model based on available data to estimate these values for 201 countries for the year 2021 and estimate the projected prevalent cases in 2040.Methods We fitted a discrete-time illness-death model (Markov model) to data on type 1 diabetes incidence and type 1 diabetes-associated mortality to produce type 1 diabetes prevalence, incidence, associated mortality and life expectancy in all countries. Type 1 diabetes incidence and mortality data were available from 97 and 37 countries respectively. Diagnosis rates were estimated using data from an expert survey. Mortality was modelled using random-forest regression of published type 1 diabetes mortality data, and life expectancy was calculated accordingly using life tables. Estimates were validated against observed prevalence data for 15 countries. We also estimated missing prevalence (the number of additional people who would be alive with type 1 diabetes if their mortality matched general population rates).Findings In 2021, there were about 8·4 (95% uncertainty interval 8·1-8·8) million individuals worldwide with type 1 diabetes: of these 1·5 million (18%) were younger than 20 years, 5·4 million (64%) were aged 20-59 years, and 1·6 million (19%) were aged 60 years or older. In that year there were 0·5 million new cases diagnosed (median age of onset 39 years), about 35 000 non-diagnosed individuals died within 12 months of symptomatic onset. One fifth (1·8 million) of individuals with type 1 diabetes were in low-income and lower-middle-income countries. Remaining life expectancy of a 10-year-old diagnosed with type 1 diabetes in 2021 ranged from a mean of 13 years in low-income countries to 65 years in high-income countries. Missing prevalent cases in 2021 were estimated at 3·7 million. In 2040, we predict an increase in prevalent cases to 13·5-17·4 million (60-107% higher than in 2021) with the largest relative increase versus 2021 in low-income and lower-middle-income countries.Interpretation The burden of type 1 diabetes in 2021 is vast and is expected to increase rapidly, especially in resource-limited countries. Most incident and prevalent cases are adults. The substantial missing prevalence highlights the premature mortality of type 1 diabetes and an opportunity to save and extend lives of people with type 1 diabetes. Our new model, which will be made publicly available as the Type 1 Diabetes Index model, will be an important tool to support health delivery, advocacy, and funding decisions for type 1 diabetes.Funding JDRF International.

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Authors
Gregory, G. A., Robinson, T. I. G., Linklater, S. E., Wang, F., Colagiuri, S., de Beaufort, C., Donaghue, K. C., Harding, J. L., Wander, P. L., Zhang, X., Li, X., Karuranga, S., Chen, H., Sun, H., Xie, Y., Oram, R., Magliano, D. J., Zhou, Z., Jenkins, A. J., Ma, R. C., Magliano, D. J., Maniam, J., Orchard, T. J., Rai, P., & Ogle, G. D.
Affiliations
  • The University of Sydney (AU)
  • Juvenile Diabetes Research Foundation (AU)
  • Baker Heart and Diabetes Institute (AU)
  • University of Pittsburgh (US)
Corresponding author
Karuranga, Suvi
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2022-10
Volume
10
Issue
10
Pages
741-760
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(22)00218-2
OpenAlex
W4296162804
Cited by
1,149
References
36
Citations by year
2026: 232 · 2025: 358 · 2024: 342 · 2023: 202 · 2022: 15
FWCI
170.51
Type
journal article
Language
en
Update notices
erratum (2022-11-01)
Open access
closed
Licence
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Abbott Diabetes Care
  • University of Sydney Sydney Medical School
  • Leona M. and Harry B. Helmsley Charitable Trust
  • Juvenile Diabetes Research Foundation United States of America
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 1 diabetes, diabetes prevalence, diabetes incidence, diabetes mortality, life expectancy, disease burden, global health burden, low-income countries, undiagnosed cases, illness-death model, Markov model, random forest regression, age of onset, underdiagnosis, public health policy, health equity
MeSH terms
Adult, Child, Diabetes Mellitus, Type 1, Humans, Life Expectancy, Global Health, Incidence, Prevalence

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