Author: Laura Cowen
medwireNews: Diabetes burden is large, heterogenous, and has increased across all six regions of the Americas since 1990, mostly as a result of type 2 diabetes, show data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.
“Unless strong actions are taken, this burden is likely to increase further in the foreseeable future, given the ever-growing prevalence of diabetes,” write Ewerton Cousin (University of Seattle, Washington, USA) and co-authors in The Lancet Diabetes & Endocrinology.
They add: “Although better access to high-quality health care is much needed in the region, vigorous implementation of public health policies aimed at primary prevention of type 2 diabetes is of [the] essence.”
The analysis included data for adults aged 20 years or older in 39 countries and territories across the six GBD regions for the Americas, namely high-income North America, the Caribbean, and central, Andean, tropical, and southern Latin America.
Cousin and team report that, in 2019, there were an estimated 409,000 adult deaths from diabetes, which represented 5.9% of all deaths during that year.
For type 1 diabetes, the age-standardized death rate of 3.3 per 100,000 in 2019 marked a 13.5% increase on the rate of 2.9 per 100,000 in 1990. By comparison the global death rate due to type 1 diabetes fell by 9.3%, from 3.2 to 2.9 per 100,000, during the same period.
The change in death rate over time varied substantially across the regions, with a 45.3% increase observed in central Latin America (4.0 to 5.8 per 100,000) and a 27.8% decrease (3.9 to 2.8 per 100,000) in tropical Latin America. In high-income North America, the type 1 diabetes death rate increased by 11.6% (2.0 to 2.2 per 100,000) between 1990 and 2019.
The researchers observed a similar pattern for disability-adjusted life years (DALYs), which were calculated as the sum of years of life lost and years lived with disability.
For type 2 diabetes, the age-standardized death rate across the Americas increased by 19.0% during the observation period, from 39.3 to 46.8 per 100,000. The global death rate as a result of type 2 diabetes also increased, but at the slower rate of 13.5%, from 32.9 to 37.4 per 100,000.
Again, there was large variation across the regions, with the greatest increase, of 30.9% (41.0 to 53.6 per 100,000), occurring in Andean Latin America. The greatest decrease occurred in tropical Latin America, where type 2 diabetes death rates fell by 10.1%, from 57.6 per 100,000 in 1990 to 51.8 per 100,000 in 2019.
The pattern for DALY rate associated with type 2 diabetes was slightly different to that of the death rate, and also that of type 1 diabetes. In this case, all but one region (tropical Latin America) saw an increase in the DALY rate, with the greatest changes occurring in Andean Latin America (35.3%) and high-income North America (33.7%).
Cousin et al also looked at factors that were associated with diabetes burden overall as determined by DALYs. They found that diabetes prevalence was strongly associated with disease burden and that individual countries with both the highest prevalence and burden were generally located in the Caribbean and central Latin America.
However, regions with lower prevalence overall, such as the southern and Andean Latin America regions, also had the greatest increase in prevalence over time, which the researchers say suggests “that the diabetes burden in the Americas is now expanding.”
Sociodemographic and Healthcare Access and Quality Indices were also associated with diabetes burden.
This finding “raises concern, as the less socioeconomically developed countries expected to experience the largest increases in burden from diabetes and its complications will be those least prepared to deal with the consequences, given their limited ability to increase spending on health, and their health systems, which are ill prepared to manage diabetes and its complications,” the investigators remark.
They conclude: “Thus, curtailing the diabetes epidemic, a major challenge for the Americas, will require greater use of population-based strategies, given their wide reach and low costs.”
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Lancet Diabetes Endocrinol 2022; doi:10.1016/S2213-8587(22)00186-3
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