Background

Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories.

Methods

We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA_1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA_1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment.

Findings

In 2022, an estimated 828 million (95% credible interval [CrI] 757–908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554–713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401–496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait).

Interpretation

In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

Funding

UK Medical Research Council, UK Research and Innovation (Research England), and US Centers for Disease Control and Prevention.

中文翻译：

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1990 年至 2022 年全球糖尿病患病率和治疗趋势：对 1108 项具有人口代表性的研究（涉及 1.41 亿参与者）的汇总分析

 背景

糖尿病可以在初级卫生保健机构检测到，有效的治疗可降低并发症的风险。关于糖尿病治疗的覆盖率及其变化的数据不足。我们估计了 200 个国家和地区从 1990 年到 2022 年糖尿病患病率和治疗的趋势。

 方法

我们使用了来自 1108 项具有人群代表性的研究的数据，涉及 1.41 亿名 18 岁及以上的参与者，测量了空腹血糖和糖化血红蛋白 （HbA_1c），以及糖尿病治疗信息。我们将糖尿病定义为空腹血糖 （FPG） 为 7·0 mmol/L 或更高，HbA_1c 为 6·5% 或更高，或服用糖尿病药物。我们将糖尿病治疗定义为服用糖尿病药物治疗的糖尿病患者的比例。我们在贝叶斯分层 meta 回归模型中分析数据，以估计糖尿病患病率和治疗。

 发现

2022 年，估计有 8.28 亿（95% 可信区间 [CrI] 757-908）成年人（18 岁及以上的人）患有糖尿病，比 1990 年增加了 6.3 亿（554-713）。从 1990 年到 2022 年，131 个国家/地区的女性和 155 个国家/地区的男性糖尿病年龄标准化患病率增加，后验概率超过 0·80。增幅最大的是东南亚（如马来西亚）、南亚（如巴基斯坦）、中东和北非（如埃及）以及拉丁美洲和加勒比地区（如牙买加、特立尼达和多巴哥以及哥斯达黎加）的低收入和中等收入国家。在西欧和中欧的一些国家、撒哈拉以南非洲、东亚和太平洋、加拿大和一些太平洋岛国，年龄标准化患病率既没有增加也没有减少，后验概率超过 0·80，这些国家的患病率在 1990 年就已经很高;它在日本、西班牙和法国的女性以及瑙鲁的男性中以超过 0·80 的后验概率下降。2022 年全球男女患病率最低的是西欧和东非，日本和加拿大的女性患病率最低，2022 年全球患病率最高的是波利尼西亚和密克罗尼西亚国家、加勒比地区和中东和北非的一些国家，以及巴基斯坦和马来西亚。2022 年，4.45 亿（95% CrI 401-496）30 岁或以上的糖尿病成年人没有接受治疗（59% 的 30 岁或以上的糖尿病成年人），是 1990 年的 3·5 倍。从 1990 年到 2022 年，118 个国家/地区的女性和 98 个国家/地区的男性糖尿病治疗覆盖率增加，后验概率超过 0·80。 治疗覆盖率改善最大的是中欧和西欧以及拉丁美洲（墨西哥、哥伦比亚、智利和哥斯达黎加）、加拿大、韩国、俄罗斯、塞舌尔和约旦的一些国家。撒哈拉以南非洲的大多数国家的治疗覆盖率没有增加;加勒比地区;太平洋岛国;以及南亚、东南亚和中亚。2022 年，撒哈拉以南非洲和南亚国家的年龄标准化治疗覆盖率最低，一些非洲国家的治疗覆盖率不到 10%。在韩国、许多高收入西方国家以及中欧和东欧的一些国家（如波兰、捷克和俄罗斯）、拉丁美洲（如哥斯达黎加、智利和墨西哥）以及中东和北非（如约旦、卡塔尔和科威特），治疗覆盖率为 55% 或更高。

 解释

在大多数国家，尤其是低收入和中等收入国家，糖尿病治疗根本没有增加，或者与患病率的增加相比没有增加足够。糖尿病和未经治疗的糖尿病负担越来越多地由低收入和中等收入国家承担。在扩大医疗保险和初级卫生保健的同时，应辅以重新调整糖尿病规划，并为卫生服务提供资源，以加强糖尿病的早期发现和有效治疗。

 资金

英国医学研究委员会、英国研究与创新 （Research England） 和美国疾病控制和预防中心。