Objectives To estimate the burden, trends, and inequalities of type 1 diabetes mellitus (T1DM) among older adults at global, regional, and national level from 1990 to 2019. Design Population based study. Population Adults aged ≥65 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2019) from 1990 to 2019. Main outcome measures Primary outcomes were T1DM related age standardised prevalence, mortality, disability adjusted life years (DALYs), and average annual percentage change. Results The global age standardised prevalence of T1DM among adults aged ≥65 years increased from 400 (95% uncertainty interval (UI) 332 to 476) per 100 000 population in 1990 to 514 (417 to 624) per 100 000 population in 2019, with an average annual trend of 0.86% (95% confidence interval (CI) 0.79% to 0.93%); while mortality decreased from 4.74 (95% UI 3.44 to 5.9) per 100 000 population to 3.54 (2.91 to 4.59) per 100 000 population, with an average annual trend of −1.00% (95% CI −1.09% to −0.91%), and age standardised DALYs decreased from 113 (95% UI 89 to 137) per 100 000 population to 103 (85 to 127) per 100 000 population, with an average annual trend of −0.33% (95% CI −0.41% to −0.25%). The most significant decrease in DALYs was observed among those aged <79 years: 65-69 (−0.44% per year (95% CI −0.53% to −0.34%)), 70-74 (−0.34% per year (−0.41% to −0.27%)), and 75-79 years (−0.42% per year (−0.58% to −0.26%)). Mortality fell 13 times faster in countries with a high sociodemographic index versus countries with a low-middle sociodemographic index (−2.17% per year (95% CI −2.31% to −2.02%) v −0.16% per year (−0.45% to 0.12%)). While the highest prevalence remained in high income North America, Australasia, and western Europe, the highest DALY rates were found in southern sub-Saharan Africa, Oceania, and the Caribbean. A high fasting plasma glucose level remained the highest risk factor for DALYs among older adults during 1990-2019. Conclusions The life expectancy of older people with T1DM has increased since the 1990s along with a considerable decrease in associated mortality and DALYs. T1DM related mortality and DALYs were lower in women aged ≥65 years, those living in regions with a high sociodemographic index, and those aged <79 years. Management of high fasting plasma glucose remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed. The data used for analyses are publicly available at . All data will be made available on request to the corresponding author. Proposals will be reviewed and approved by the sponsor, investigator, and collaborators based on scientific merit. After approval of a proposal, data will be shared through a secure online platform after the signing of a data access agreement.

中文翻译：

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1990-2019 年 65 岁及以上成年人的全球 1 型糖尿病负担：基于人群的研究


目标 评估 1990 年至 2019 年全球、区域和国家层面老年人 1 型糖尿病 (T1DM) 的负担、趋势和不平等。设计基于人群的研究。人口 1990 年至 2019 年，来自 21 个地区和 204 个国家和地区的 65 岁以上成年人口（2019 年全球疾病负担和风险因素研究）。 主要结局指标 主要结局指标是 T1DM 相关年龄标准化患病率、死亡率、伤残调整生命年 (DALY) ），以及平均年百分比变化。结果 全球 65 岁以上成年人中 T1DM 患病率从 1990 年每 10 万人 400 例（95% 不确定区间 (UI) 332 至 476 例）增加到 2019 年每 10 万人 514 例（417 例至 624 例），年均趋势为 0.86%（95% 置信区间 (CI) 0.79% 至 0.93%）；死亡率从每10万人4.74（95% UI 3.44至5.9）下降至每10万人3.54（2.91至4.59），年平均趋势为-1.00%（95% CI -1.09%至-0.91%） ，年龄标准化DALY从每10万人113（95% UI 89至137）下降至每10万人103（85至127），年平均趋势为-0.33%（95% CI -0.41%至- 0.25%）。在年龄 <79 id=18> 的人群中观察到 DALY 下降最显着。所有数据将根据相应作者的要求提供。提案将由申办者、研究者和合作者根据科学价值进行审查和批准。提案获得批准后，数据将在签署数据访问协议后通过安全的在线平台共享。