Skip to main content
SpringerLink
Log in

Type-2 Diabetes Mellitus (T2DM): Spatial-temporal Patterns of Incidence, Mortality and Attributable Risk Factors from 1990 to 2019 among 21 World Regions

Endocrine Aims and scope Submit manuscript

Cite this article

Abstract

Purpose

Type-2 diabetes Mellitus (T2DM) is one of the leading causes of death and disability worldwide. This study examines temporal patterns of the global, regional, and national burden of T2DM in the last three decades.

Data and methods

The estimates of age, sex and location-wise incident cases, deaths, prevalent cases, and disability-adjusted-life-years (DALYs) and risk factors for 21 regions and 204 countries are retrieved from the Global Burden of Disease 2019 study from 1990 to 2019. Socio-demographic index (SDI) is used as the indicator of the development status of countries, and quadratic regression is employed to examine the relationship between country-level age-standardized rates and SDI.

Results

Globally, incident cases of T2DM more than doubled from 8.4 million[95% uncertainty interval, 7.8–9.1 million] in 1990 to 21.7 million[20.0–23.5 million] in 2019, and deaths more than doubled from 606,407[573,069–637,508] to 1.5 million[1.4–1.6 million] between 1990 and 2019. Global T2DM prevalence increased from 148.4 million[135.5–162.6 million] in 1990 to 437.9 million[402.0–477.0 million] in 2019. In 2019, global age-standardized prevalence rate stood at 5282.8/100,000[4853.6–5752.1], varying from 2174.5/100,000[1924.3–2470.5] in Mongolia to 19876.8/100,000[18211.1–21795.3] in American Samoa. SDI exhibited inverted-U shaped relationship with country-level age-standardised rates. Globally, high body-mass-index (51.9%), ambient particulate matter pollution (13.6%), smoking (9.9%) and secondhand smoke (8.7%) were the major contributing risk factors towards T2DM DALYs in 2019.

Conclusion

With ubiquitously rising prevalent cases globally, particularly in low and middle-income countries and regions, T2DM requires immediate attention and targeted policy response worldwide centered on lifestyle interventions (e.g., physical activity, smoking, diet, and obesity), air pollution control and cost-effective timely treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

All data is procured from GBD Results Tool http://ghdx.healthdata.org/gbd-results-tool.

References

  1. IDF Atlas Ninth Edition (2019). Available at https://www.diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf. Accessed 13.3.2021

  2. G.M. Reaven, Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 37, 1595–1607 (1988)

    Article  CAS  PubMed  Google Scholar 

  3. C. Weyer, C. Bogardus, D.M. Mott, R.E. Pratley, The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J. Clin. Invest 104, 787–794 (1999)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. The Emerging Risk Factors Collaboration, Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375, 2215–22 (2010)

    Article  PubMed Central  Google Scholar 

  5. Y. Zheng, S.H. Ley, F.B. Hu, Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat. Rev. Endocrinol. 14(2), 88 (2018)

    Article  PubMed  Google Scholar 

  6. C. Bommer, E. Heesemann, V. Sagalova, J. Manne-Goehler, R. Atun, T. Bärnighausen et al. The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study. Lancet Diabetes Endocrinol. 5(6), 423–30 (2017)

    Article  PubMed  Google Scholar 

  7. WHO. Global action plan for the prevention and control of noncommunicable diseases 2013–20 (2013). Available at https://www.who.int/publications/i/item/9789241506236. Accessed April 16, 2022

  8. T. Vos, S.S. Lim, C. Abbafati et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 396, 1204–22 (2020)

    Article  Google Scholar 

  9. H. Wang, K.M. Abbas, M. Abbasifard et al. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the global burden of disease study 2019. Lancet 396, 1160–203 (2020)

    Article  Google Scholar 

  10. C.J. Murray, Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull. World health Org. 72(3), 429–445 (1994)

    CAS  PubMed  PubMed Central  Google Scholar 

  11. B. Zhou, Y. Lu, K. Hajifathalian et al. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4· 4 million participants. Lancet 387(10027), 1513–30 (2016)

    Article  Google Scholar 

  12. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle: Institute for Health Metrics and Evaluation (IHME). Source: Institute for Health Metrics Evaluation. Used with permission. All rights reserved. Available from http://ghdx.healthdata.org/gbd-results-tool. Accessed: Jan–Feb 2021

  13. K.J. Foreman, R. Lozano, A.D. Lopez, C.J. Murray, Modeling causes of death: an integrated approach using CODEm. Popul Health Metr. 10(1), 1 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  14. C.J. Murray, A.Y. Aravkin, P. Zheng et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396(10258), 1223–49 (2020)

    Article  Google Scholar 

  15. A. Nordström, J. Hadrévi, T. Olsson, P.W. Franks, P. Nordström, Higher prevalence of type 2 diabetes in men than in women is associated with differences in visceral fat mass. J. Clin. Endocrinol. Metab. 101(10 Oct), 3740–6 (2016)

    Article  PubMed  Google Scholar 

  16. J. Logue, J.J. Walker, H.M. Colhoun, G.P. Leese, R.S. Lindsay, J.A. McKnight, A.D. Morris, D.W. Pearson, J.R. Petrie, S. Philip, S.H. Wild, Do men develop type 2 diabetes at lower body mass indices than women? Diabetologia 54(12), 3003–6 (2011)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. F.E. von Eyben, E. Mouritsen, J. Holm et al. Intra-abdominal obesity and metabolic risk factors: a study of young adults. Int J. Obes. Relat. Metab. Disord. 27, 941–949 (2003)

    Article  Google Scholar 

  18. A. Chandra, I.J. Neeland, J.D. Berry et al. The relationship of body mass and fat distribution with incident hypertension: observations from the Dallas Heart Study. J. Am. Coll. Cardiol. 64, 997–1002 (2014)

    Article  PubMed  Google Scholar 

  19. P. Wiklund, F. Toss, L. Weinehall et al. Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women. J. Clin. Endocrinol. Metab. 93, 4360–4366 (2008)

    Article  CAS  PubMed  Google Scholar 

  20. B. Tramunt, S. Smati, N. Grandgeorge, F. Lenfant, J.F. Arnal, A. Montagner, P. Gourdy, Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia 63(3 Mar), 453–61 (2020)

    Article  PubMed  Google Scholar 

  21. F. Mauvais-Jarvis, Sex differences in metabolic homeostasis, diabetes, and obesity. Biol. Sex. Differ. 6, 14 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  22. J.C. Chen et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA 301, 2129–2140 (2009)

    Article  Google Scholar 

  23. S.H. Ley, O. Hamdy, V. Mohan, F.B. Hu, Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 383(9933), 1999–2007 (2014)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. A. Majeed, A.A. El-Sayed, T. Khoja, R. Alshamsan, C. Millett, S. Rawaf, Diabetes in the Middle-East and North Africa: an update. Diabetes Res Clin. Pr. 103(2), 218–22 (2014)

    Article  Google Scholar 

  25. Y. Li, Y. He, L. Qi, V.W. Jaddoe, E.J. Feskens, X. Yang et al. Exposure to the Chinese famine in early life and the risk of hyperglycemia and type 2 diabetes in adulthood. Diabetes 59(10), 2400–6 (2010)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. L. Chen, D.J. Magliano, P.Z. Zimmet, The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat. Rev. Endocrinol. 8(4), 228–36 (2012)

    Article  CAS  Google Scholar 

  27. D. Dabelea, E.J. Mayer-Davis, S. Saydah, G. Imperatore, B. Linder, J. Divers et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA 311(17), 1778–86 (2014)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. T. Reinehr, Type 2 diabetes mellitus in children and adolescents. World J. diabetes 4(6), 270 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  29. J. Holmes, E. Gear, J. Bottomley, S. Gillam, M. Murphy, R. Williams, Do people with type 2 diabetes and their carers lose income? (T2ARDIS-4). Health Policy 64(3), 291–6 (2003)

    Article  PubMed  Google Scholar 

  30. X. Liu, C. Zhu, Will knowing diabetes affect labor income? Evidence from a natural experiment. Econ. Lett. 124, 74–8 (2014)

    Article  Google Scholar 

  31. T. Seuring, O. Archangelidi, M. Suhrcke, The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics 33, 811–31 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  32. R.J. Rubin, W.M. Altman, D.N. Mendelson, Health care expenditures for people with diabetes mellitus, 1992. J. Clin. Endocrinol. Metab. 78(4), 809A-F (1994)

    Article  Google Scholar 

  33. F.B. Hu et al. Diet, Lifestyle, and the risk of type 2 diebetes mellitus in women. N. Eng. J. Med 345, 790–97 (2001)

    Article  CAS  Google Scholar 

  34. E.S. Schellenberg, D.M. Dryden, B. Vandermeer, C. Ha, C. Korownyk, Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis. Ann. Intern Med 159(8), 543–51 (2013)

    Article  PubMed  Google Scholar 

  35. C. Merlotti, A. Morabito, A.E. Pontiroli, Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies. Diabetes Obes. Metab. 16, 719–27 (2014)

    Article  CAS  PubMed  Google Scholar 

  36. Diabetes Prevention Program Research Group, Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol. 3, 866–75 (2015)

    Article  PubMed Central  Google Scholar 

  37. Global Health Observatory data repository. Prevalence of overweight among adults, BMI ≥ 25, age-standardized. Available at http://apps.who.int/gho/data/view.main.CTRY2430A?lang=en. Accessed 26 Feb 2020

  38. T. Kelly, W. Yang, C.S. Chen, K. Reynolds, J. He, Global burden of obesity in 2005 and projections to 2030. Int J. Obes. 32(9), 1431–7 (2008)

    Article  CAS  Google Scholar 

  39. E.V. Balti, J.B. Echouffo-Tcheugui, Y.Y. Yako, A.P. Kengne, Air pollution and risk of type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Res Clin. Pr. 106(2), 161–72 (2014)

    Article  CAS  Google Scholar 

  40. G. Weinmayr, F. Hennig, K. Fuks, M. Nonnemacher, H. Jakobs, S. Möhlenkamp, R. Erbel, K.H. Jöckel, B. Hoffmann, S. Moebus, Long-term exposure to fine particulate matter and incidence of type 2 diabetes mellitus in a cohort study: effects of total and traffic-specific air pollution. Environ. Health 14(1), 1–8 (2015)

    Article  CAS  Google Scholar 

  41. C. Liu, C. Yang, Y. Zhao, Z. Ma, J. Bi, Y. Liu, X. Meng, Y. Wang, J. Cai, H. Kan, R. Chen, Associations between long-term exposure to ambient particulate air pollution and type 2 diabetes prevalence, blood glucose and glycosylated hemoglobin levels in China. Environ. Int. 92, 416–21 (2016)

    Article  PubMed  Google Scholar 

  42. S. Zhang, S. Mwiberi, R. Pickford, S. Breitner, C. Huth, W. Koenig, W. Rathmann, C. Herder, M. Roden, J. Cyrys, A. Peters, Longitudinal associations between ambient air pollution and insulin sensitivity: results from the KORA cohort study. Lancet Planet. Health 5(1), e39–49 (2021)

    Article  PubMed  Google Scholar 

  43. T. Liu, X. Chen, Y. Xu, W. Wu, W. Tang, Z. Chen, G. Ji, J. Peng, Q. Jiang, J. Xiao, X. Li, Gut microbiota partially mediates the effects of fine particulate matter on type 2 diabetes: evidence from a population-based epidemiological study. Environ. Int. 130, 104882 (2019)

    Article  CAS  PubMed  Google Scholar 

  44. T.L. Alderete, R. Habre, C.M. Toledo-Corral, K. Berhane, Z. Chen, F.W. Lurmann, M.J. Weigensberg, M.I. Goran, F.D. Gilliland, Longitudinal associations between ambient air pollution with insulin sensitivity, β-cell function, and adiposity in Los Angeles Latino children. Diabetes 66(7), 1789–96 (2017)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. C. Willi, P. Bodenmann, W.A. Ghali, P.D. Faris, J. Cornuz, Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. Jama 298(22), 2654–64 (2007)

    Article  CAS  PubMed  Google Scholar 

  46. L. Zhang, G.C. Curhan, F.B. Hu, E.B. Rimm, J.P. Forman, Association between passive and active smoking and incident type 2 diabetes in women. Diabetes care 34(4), 892–7 (2011)

    Article  PubMed  PubMed Central  Google Scholar 

  47. A. Pan, Y. Wang, M. Talaei, F.B. Hu, T. Wu, Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 3(12), 958–67 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  48. T.K. Houston, S.D. Person, M.J. Pletcher, K. Liu, C. Iribarren, C.I. Kiefe, Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study. Bmj 332(7549), 1064–9 (2006)

    Article  PubMed  PubMed Central  Google Scholar 

  49. B. Zhu, X. Wu, X. Wang, Q. Zheng, G. Sun, The association between passive smoking and type 2 diabetes: a meta-analysis. Asia Pac. J. Public Health 26(3), 226–37 (2014)

    Article  PubMed  Google Scholar 

  50. X. Wei, E. Meng, S. Yu, A meta-analysis of passive smoking and risk of developing Type 2 Diabetes Mellitus. Diabetes Res Clin. Pr. 107(1), 9–14 (2015)

    Article  Google Scholar 

  51. S. Oba, A. Goto, T. Mizoue, M. Inoue, N. Sawada, M. Noda, S. Tsugane, Passive smoking and type 2 diabetes among never‐smoking women: The Japan Public Health Center‐based Prospective Study. J. Diabetes Investig. 11(5), 1352–8 (2020)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Y. Hayashino, S. Fukuhara, T. Okamura, H. Yamato, H. Tanaka, T. Tanaka, T. Kadowaki, H. Ueshima, A prospective study of passive smoking and risk of diabetes in a cohort of workers: the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study. Diabetes care 31(4), 732–4 (2008)

    Article  PubMed  Google Scholar 

  53. S.G. Wannamethee, C.A. Camargo, J.E. Manson, W.C. Willett, E.B. Rimm, Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger women. Arch. Intern. Med. 163(11 Jun), 1329–36 (2003)

    Article  PubMed  Google Scholar 

  54. S. Carlsson, N. Hammar, V. Grill, Alcohol consumption and type 2 diabetes. Diabetologia 48(6 Jun), 1051–4 (2005)

    Article  CAS  PubMed  Google Scholar 

  55. D.O. Baliunas, B.J. Taylor, H. Irving, M. Roerecke, J. Patra, S. Mohapatra, J. Rehm, Alcohol as a risk factor for type 2 diabetes: a systematic review and meta-analysis. Diabetes care 32(11), 2123–32 (2009)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. A. Pietraszek, S. Gregersen, K. Hermansen, Alcohol and type 2 diabetes. A review. Nutr., Metab. Cardiovascular Dis. 20(5 Jun), 366–75 (2010)

    Article  CAS  Google Scholar 

  57. X.H. Li, F.F. Yu, Y.H. Zhou, J. He, Association between alcohol consumption and the risk of incident type 2 diabetes: a systematic review and dose-response meta-analysis. Am. J. Clin. Nutr. 103(3 Mar), 818–29 (2016)

    Article  CAS  PubMed  Google Scholar 

  58. P. Zimmet, K.G. Alberti, D.J. Magliano, P.H. Bennett, Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nat. Rev. Endocrinol. 12(10), 616 (2016)

    Article  PubMed  Google Scholar 

  59. Z.J. Andersen, O. Raaschou-Nielsen, M. Ketzel, S.S. Jensen, M. Hvidberg, S. Loft, A. Tjønneland, K. Overvad, M. Sørensen, Diabetes incidence and long-term exposure to air pollution: a cohort study. Diabetes care 35(1), 92–8 (2012)

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Institute of Health Metrics and Evaluation for providing GBD 2019 estimates in the public domain.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. University School of Management and Entrepreneurship, Delhi Technological University, Delhi, India

    Mehak Nanda, Rajesh Sharma & Aashima Aashima

  2. Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China

    Sumaira Mubarik

  3. Empire Innovation Associate Professor, Department of Environmental Health Sciences, School of Public Health | University at Albany, State University of New York, Albany, USA

    Kai Zhang

Authors
  1. Mehak Nanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajesh Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sumaira Mubarik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aashima Aashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kai Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rajesh Sharma.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Consent for publication

The authors of the study have consent and responsibility for submission to the journal.

Ethical approval and consent to participate

The research was conducted using data available in the public domain and did not include any human participants or animals. Therefore, no ethical approvals were required.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nanda, M., Sharma, R., Mubarik, S. et al. Type-2 Diabetes Mellitus (T2DM): Spatial-temporal Patterns of Incidence, Mortality and Attributable Risk Factors from 1990 to 2019 among 21 World Regions. Endocrine 77, 444–454 (2022). https://doi.org/10.1007/s12020-022-03125-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-022-03125-5

Keywords

search

Navigation