The global prevalence of type 1 diabetes (T1D) in people 65 years of age and older increased between 1990 and 2019, while mortality rates associated with the disease decreased substantially during the same period, according to research published in BMJ.1
Current clinical guidelines lack targeted recommendations for the management of T1D in older adults. However, these recommendations are urgently needed as the global population ages and as improved diabetes care and management of complications have extended the life expectancy of those with the condition.
Key Takeaways
- The number of people over 65 with T1D has nearly tripled in the last 3 decades, highlighting a growing public health concern as the global population ages.
- While overall mortality rates for T1D have decreased substantially, the benefits are not shared equally across gender, region, or age group.
- Current clinical guidelines lack specific recommendations for managing T1D in older adults. The rise in T1D prevalence and the potential of diabetes technology to improve outcomes emphasize the need for updated guidelines and educational materials for clinicians and caregivers.
To fill this gap in clinical literature and raise the standard of care for the patient population, investigators assessed T1D-associated prevalence, mortality, and disability adjusted life years (DALYs) in adults aged 65 years and older at global, regional, and national levels between 1990 and 2009.
Using the Global Burden of Disease and Risk Factors Study 2019, investigators assessed data from adults aged 65 years and older with T1D across 21 regions and 24 countries and territories during the 30-year study period. Information on location, age, and sex specific prevalence; mortality; numbers and rates for DALYs; and DALYs attributable to each risk factor were gleaned for the patient population.
Sociodemographic indexes were calculated for each region from 0.005 to 1, with 1 indicating the highest education level, highest per capita income, and lowest fertility rate.
The number of people over 65 years of age with T1D nearly tripled between 1990 and 2019, increasing from 1.3 to 3.7 million. The age standardized prevalence rate of T1D increased from 400 per 100,000 population in 1990 to 514 per 100,000 population in 2019, translating to a year-over-year change of 0.86%.
Concomitantly, the age standardized mortality of T1D decreased substantially from 4.7 per 100,000 population in 1990 to 3.5 per 100,000 population in 2019, with an average annual trend of −1.00%. Age standardized DALYs also decreased from 113 per 100,000 population to 103 per 100,000 population, with an average annual trend of −0.33%.
Investigators noted that while the overall global mortality and DALYs of T1D decreased, the benefit was not equally distributed. Women, people living in countries with a higher sociodemographic index, and those under 79 years of age all experienced a greater decrease in mortality and DALYs than men, people living in countries with a low-middle sociodemographic index—where mortality decreased 13 times slower than in countries with a high sociodemographic index—and those over 79 years of age.
