A recent study published by The BMJ has revealed a significant increase in the prevalence of type 1 diabetes among the elderly, accompanied by a notable reduction in mortality rates, particularly in high-income regions. Despite these advancements, disparities in diabetes care persist across the globe, emphasizing the need for further research and improved management strategies.
As life expectancy for individuals with type 1 diabetes continues to rise, a striking contrast in the quality and accessibility of care remains evident between different regions.
According to the study, the number of people aged 65 and older living with type 1 diabetes surged from 1.3 million in 1990 to 3.7 million in 2019. Over the same period, death rates associated with the condition decreased by 25%, dropping from 4.7 deaths per 100,000 people in 1990 to 3.5 per 100,000 in 2019. This analysis, which encompasses data from more than 200 countries and regions, underscores a global trend of increasing longevity among those with type 1 diabetes.
However, the findings also revealed that death rates fell at a much faster rate in high-income countries compared to those in low and middle-income countries. Mortality rates dropped 13 times more rapidly in wealthier nations, a statistic that underscores the persistent inequalities in diabetes care worldwide.
Shifts in Longevity and Prevalence
Traditionally considered a condition that significantly reduces life expectancy, type 1 diabetes has seen a growing number of elderly individuals managing the disease thanks to improved treatment options and care. Yet, the true burden of type 1 diabetes remains underreported in many countries.
To fill this gap, researchers from China utilized data from the Global Burden of Disease and Risk Factors Study 2019 to estimate the prevalence, deaths, and disability-adjusted life years (DALYs) related to type 1 diabetes among people aged 65 and older. Their findings spanned 204 countries and regions between 1990 and 2019, offering insights at global, regional, and national levels based on age, gender, and socioeconomic factors.
The study found that the global age-standardized prevalence rate of type 1 diabetes in the elderly increased by 28%, rising from 400 cases per 100,000 people in 1990 to 514 per 100,000 in 2019. Simultaneously, deaths decreased by 25%, and DALYs—a combined measure of life quality and quantity—fell by nearly 9%, from 113 per 100,000 people in 1990 to 103 per 100,000 in 2019.
The data indicated a dramatic increase in the prevalence of type 1 diabetes across all age groups between 65 and 94, with men showing a higher prevalence, while death rates declined across all demographics, particularly among women and those younger than 79.
Global Disparities and Regional Findings
Despite these positive trends, the study exposed stark regional variations. Mortality rates fell more rapidly in high-income regions, with declines averaging 2.17% per year, compared to a meager 0.16% per year decrease in low and middle-income countries. This discrepancy highlights the critical role that socioeconomic factors play in access to quality healthcare.
The highest prevalence of type 1 diabetes was observed in high-income areas such as North America, Australasia, and Western Europe, while the highest DALY rates were concentrated in regions like Southern sub-Saharan Africa, Oceania, and the Caribbean.
Elevated fasting plasma glucose levels emerged as the leading risk factor contributing to DALYs among elderly individuals with type 1 diabetes. This finding suggests that maintaining controlled blood sugar levels remains a significant challenge, even in older populations.
Research Limitations and Call for Action
The researchers acknowledge that their findings are based largely on modeling, which may introduce inaccuracies due to differences in health information systems and reporting methods across various regions. These limitations are especially pronounced in low and middle-income countries and conflict-affected areas.
Nevertheless, the study’s findings offer a hopeful outlook for older individuals with type 1 diabetes. Declining mortality and DALYs associated with the disease reflect advancements in care, particularly in high-income regions. The researchers call for further high-quality, real-world research to validate their results and advocate for strategies that address the needs of aging populations with type 1 diabetes.
“Our study highlights the urgent need for tailored healthcare strategies for the elderly with type 1 diabetes, better allocation of healthcare resources, and targeted guidelines for managing the condition in aging populations,” the researchers concluded.
The study, titled “Global Burden of Type 1 Diabetes in Adults Aged 65 Years and Older, 1990-2019: Population-Based Study,” was conducted by researchers including Kaijie Yang and Xue Yang and published in The BMJ on June 12, 2024.
Funding for the research was provided by the National Natural Science Foundation of China and the China Postdoctoral Science Foundation.
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