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Time trends and advances in the management of global, regional, and national diabetes in adolescents and young adults aged 10–24 years, 1990–2021: analysis for the global burden of disease study 2021

Diabetology & Metabolic Syndrome volume 16, Article number: 252 (2024) Cite this article

Abstract

Background

Estimation of global diabetes burden in adolescents and young adults (10–24 years) from 1990 to 2021.

Methods

Data were extracted from the 2021 Global Burden of Disease Study. Joinpoint regression analysis was employed to examine trends over the past 30 years, frontier analysis identified regions with potential for improvement, and the slope index of inequality and the relative concentration index were used to assess health inequalities.

Results

From 1990 to 2021, the age-standardized prevalence rates (ASPR) and age-standardized disability-adjusted life years rates (ASDR) of diabetes in adolescents and young adults increased globally, while age-standardized death rates (ASMR) remained stable. Oceania bore the highest burden regionally, East Asia experienced the fastest rise in ASPR and ASDR, and High-income Asia Pacific saw the most significant decrease in ASMR. Among 204 countries, Marshall Island and Hait reported the highest ASPR, ASDR, and ASMR in 2021. Health inequality analysis confirmed that the burden was concentrated in countries with lower Socio-Demographic Index (SDI). Frontier analysis showed that ASMR and ASDR were negatively correlated with SDI, with Yemen and Honduras, which have lower socio-demographic indices, exhibiting more smaller overall differences from frontier boundaries.

Conclusions

The analysis revealed a sharp increase in the global ASPR and ASDR of diabetes in adolescents and young adults. Additionally, the disease burden is typically concentrated in countries with lower SDI, highlighting an urgent need for governments to develop flexible health policies to mitigate the escalating threat of diabetes in this demographic.

Introduction

Diabetes is a metabolic disease marked by elevated blood sugar levels, involving intricate mechanisms, numerous risk factors, extended disease duration, and chronic persistence. Its incidence and mortality rates are continuously increasing, positioning it as one of the world’s major chronic non-communicable diseases and a significant threat to human health [1, 2]. In 2021, an estimated 537 million adults had diabetes, with projections suggesting this number will rise to 783 million by 2045 [3]. Although diabetes is prevalent among adults, it is increasingly affecting adolescents [4]. Early onset of diabetes results in prolonged exposure to high blood sugar, precipitating early development of microvascular and macrovascular complications, thereby increasing its destructive potential [5, 6]. This issue has evolved into an international health concern for children and adolescents, imposing a significant burden on individuals, families, and society, and posing a substantial global health challenge [7]. Therefore, it is crucial to elucidate the epidemiology of diabetes among adolescents and young adults comprehensively. However, the epidemiology of diabetes in this demographic has been investigated in very limited geographic regions, mostly within specific countries using national health system data, lacking age-standardized processes to track and compare the longitudinal burden of diabetes among adolescents and young adults globally [8, 9]. This limitation hinders further cross-regional and cross-national comparisons. Undoubtedly, providing global estimates of age-standardized rates (ASR) of diabetes among adolescents and young adults over the past decades could fill gaps in disease statistics, enhancing the understanding of the evolution of diabetes in this demographic both globally and in specific geographical locations. This information can inform policy decisions and resource prioritization for this critical yet inadequately addressed public health condition.

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 is a critical resource in epidemiological research. Its estimates facilitate the identification of health disparities within and between populations and enable the assessment of temporal changes in these disparities, thus quantifying health improvements [10]. Consequently, the GBD 2021 is instrumental in monitoring and evaluating national and local health interventions. It provides a foundational basis for the development of relevant strategies, practices, and policies aimed at enhancing public health [11].

In this study, we extracted data from the GBD Study 2021 and calculated age-standardized prevalence rates (ASPR), age-standardized death rates (ASMR), and age-standardized disability-adjusted life years rates (ASDR) of diabetes among adolescents and young adults from 1990 to 2021, further analyzing their temporal trends and progress in health management, at global, regional, and national levels over the past thirty years.

Method

Study Population

Adolescence is a life stage between childhood and adulthood, including growth and the transformation of major social roles. Sawyer defines adolescents and young adults as those between 10 and 24 years old [12].

Definition of disability-adjusted life years

Disability-adjusted life years (DALYs) are defined as the sum of years lost due to premature death (YLLs) and years lived with disability (YLDs) (details in Supplementary Methods).

Definition of diabetes

Diabetes is defined by a fasting plasma glucose (FPG) concentration of 7 mmol/L (126 mg/dL) or higher, or by the use of insulin or diabetes medication [1]. This definition incorporates data from population-representative sources that provide individual-level data or report the prevalence or incidence of diabetes. Identification of diabetes is based on glucose thresholds of FPG, glycated hemoglobin (HbA1c), oral glucose tolerance test (OGTT), or postprandial glucose (PPG). The definition includes Type 1 and Type 2 diabetes, as well as other forms such as gestational diabetes and monogenic diabetes [1].

Data sources

The methodological details of the GBD Study 2021 have been previously published [10]. These studies comprehensively detail health burdens associated with 371 diseases and injuries and 88 risk factors across 204 countries and territories [11]. We retrieved estimates of prevalence, death, and DALYs for diabetes, along with their 95% uncertainty intervals (UI), for three age groups (10–14, 15–19, 20–24 years) from 1990 to 2021 using the Global Health Data Exchange (GHDx) query tool (https://vizhub.healthdata.org/gbd-results/). These uncertainty intervals are based on the 25th and 975th ranked values of 1000 independent estimates according to GBD algorithms.

Statistical analysis

To estimate ASPR, ASMR, and ASDR of diabetes among adolescents and young adults, direct age standardization was employed. This method assumes that the distribution of rates is a weighted sum of independent Poisson random variables, and all rates are expressed per 100,000 population [13]. Joinpoint regression analysis was used to assess trends in ASPR, ASMR, and ASDR. This analysis method identifies points where significant changes in trends occur, segmenting the overall trend accordingly. Each segment’s epidemiological trend is evaluated by calculating the annual percentage change (APC) and 95% confidence interval (CI). The average annual percentage change (AAPC) was also calculated for an overall assessment, encompassing the entire study period from 1990 to 2021. An increasing trend is inferred if the lower limit of the 95% CI of the APC or AAPC estimates exceeds zero. Conversely, a decreasing trend is indicated if the upper limit of the 95% CI is below zero. Otherwise, the trend is considered stable over time [14, 15]. In addition, frontier analysis explores the relationship between the burden of diabetes in adolescents and economic prosperity and determines the lowest ASPR, ASMR, and ASDR. Using the inequality slope index (SII) and relative concentration index, the inequality of the distribution of diabetes burden in adolescents is quantified (details in Supplementary Methods).

The environment for joinpoint regression analysis was configured using the “configr” package in R version 4.3.0. The “ggplot2” package was used for data visualization, and the “epitools” package was employed for calculating age-standardized rates. All analyses were conducted using R software (v.4.3.0) (http://www.r-project.org).

Results

Diabetes in adolescents and young adults: global trends

In 1990, the global ASPR of diabetes in adolescents and young adults was 501.47 cases per 100,000 population (95% UI: 392.6 to 625.83). By 2021, the ASPR had risen to 944.8 cases per 100,000 population (95% UI: 767.52 to 1146.73), indicating an increase of 443.33 cases per 100,000 over the period (AAPC = 2.1%, 95% CI: 1.94–2.25%; P < 0.001) (Table 1; Fig. 1). Additionally, the ASMR was 0.56 cases per 100,000 population (95% UI: 0.5 to 0.63) in 1990 and 0.55 cases per 100,000 population (95% UI: 0.48 to 0.61) in 2021. This represents a stable trend from 1990 to 2021 (AAPC = 0.06%, 95% CI: -0.21–0.09%; P > 0.05) (Table 1, Supplementary Fig. S1). Moreover, the ASDR was 65.63 per 100,000 population (95% UI: 554.11 to 81.5) in 1990, which rose to 87.89 per 100,000 population (95% UI: 68.31 to 113.61) in 2021, representing an increase of 22.26 per 100,000 (AAPC = 0.96%, 95%CI: 0.86–1.06%; P < 0.001) (Table 1, Supplementary Fig. S2).

Table 1 ASPR, ASMR and ASDR of diabetes mellitus in adolescents and young adults in 1990 and 2021, and change from 1990 to 2021 at the global and regional level. Abbreviations: ASPR, age-standardized prevalence rate; ASMR, age-standardized death rate; ASDR, age-standardized disability-adjusted life years rates; SDI, sociodemographic index; UI, uncertainty interval; AAPC, average annual percent change; CI, confidence interval
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Fig. 1
figure 1

Joinpoint regression analysis of age-standardized prevalence rate of diabetes in adolescents and young adults at the global and five SDI regions from 1990 to 2021. P-value *P < 0.05

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Diabetes in adolescents and young adults: geographic regional trends

Research conducted in 2021 across various global regions found that the ASPR of diabetes among adolescents and young adults was highest in the high SDI region, with 997.1 cases per 100,000 people (95% UI: 822.5 to 1181.84) (Table 1). Geographically, Oceania exhibited the highest ASPR at 2009.22 cases per 100,000 people (95% UI: 1667.9 to 2416.19), followed by East Asia with 1590.84 cases per 100,000 people (95% UI: 1276.69 to 1956.24). In contrast, certain regions in Europe and Latin America had significantly lower ASPR, including Central Europe with 219.26 cases per 100,000 people (95% UI: 169.61 to 282.91), Eastern Europe with 283.87 cases per 100,000 people (95% UI: 219.64 to 360.09), Southern Latin America with 400.6 cases per 100,000 people (95% UI: 316.06 to 501.25), and Andean Latin America with 460.97 cases per 100,000 people (95% UI: 366.31 to 563.88) (Table 1). From 1990 to 2021, the ASPR trend showed a consistent increase across all SDI regions. The highest increase was observed in the High SDI region (AAPC = 2.75%, 95% CI: 2.69–2.8%; P < 0.001), while the smallest change occurred in the Low-middle SDI region (AAPC = 1.88%, 95% CI: 1.87–1.9%; P < 0.001) (Table 1; Fig. 1). Geographically, all regions exhibited an upward trend over the 30 years. Notable increases were seen in East Asia (AAPC = 3.27%, 95% CI: 2.97–3.57%; P < 0.001), reaching 1590.84 cases per 100,000 people in 2021 (95% UI: 1276.69 to 1956.24); High-income Asia Pacific (AAPC = 3.05%, 95% CI: 2.99–3.11%; P < 0.001), reaching 1186.44 cases per 100,000 people in 2021 (95% UI: 939.59 to 1444.95); and North Africa and the Middle East (AAPC = 2.89%, 95% CI: 2.83–2.95%; P < 0.001), reaching 1000.8 cases per 100,000 people in 2021 (95% UI: 793.73 to 1228.99) (Table 1).

In 2021, the ASMR for diabetes among adolescents and young adults was highest in the Low SDI region, at 0.96 per 100,000 people (95% UI: 0.79 to 1.14), and lowest in the High SDI region, at 0.21 per 100,000 people (95% UI: 0.20 to 0.22) (Table 1). Over the past 30 years, the ASMR has consistently declined across all SDI regions, with the most significant decrease observed in the High-middle SDI region (AAPC=-1.38%, 95% CI: -1.75% to -1%; P < 0.001), where it dropped by 0.12 per 100,000 people (Table 1, Supplementary Fig. S1). Geographically, Oceania had the highest ASMR at 1.75 per 100,000 people (95% UI: 1.23 to 2.41), followed by the Caribbean at 1.34 per 100,000 people (95% UI: 0.97 to 1.82) (Table 1). Notably, between 1990 and 2021, the High-income Asia Pacific region exhibited the most significant reduction in ASMR (AAPC=-4.26%, 95% CI: -4.75% to -3.78%; P < 0.001), decreasing to 0.08 per 100,000 people (95% UI: 0.07 to 0.09) (Table 1). Conversely, Southern Sub-Saharan Africa experienced the most significant increase in ASMR (AAPC = 0.6%, 95% CI: 0.2–0.99%; P < 0.001), rising to 0.85 per 100,000 people (95% UI: 0.69 to 1.01) (Table 1).

Globally, the ASDR of diabetes among adolescents and young adults mirrors the rising trend observed in the ASPR. This increase is evident across all SDI regions, with the most significant increase observed in the high SDI region (AAPC = 1.5%, 95% CI: 1.42–1.57%; P < 0.001), where it raised by 23.98 per 100,000 people (Table 1, Supplementary Fig. S2). In 2021, the ASDR peaked in the low SDI region at 115.26 per 100,000 people (95% UI: 92.53 to 142.68) and was lowest in the high SDI region at 65.25 per 100,000 (95% UI: 46.57 to 90.42) (Table 1). East Asia experienced the most significant increase, with an AAPC of 1.95% (95% CI: 1.73–2.16%; P < 0.001), reaching 91.44 per 100,000 people in 2021 (95% UI: 58.62 to 133.32) (Table 1). High-income North America also exhibited a notable rise, with an AAPC of 1.7% (95% CI: 1.39–2.02%; P < 0.001) and an ASDR of 70.84 per 100,000 people (95% UI: 53.95 to 93.56) (Table 1). Oceania reported the highest ASDR at 228.12 per 100,000 people (95% UI: 167.35 to 307.01), followed by the Caribbean at 158.37 per 100,000 (95% UI: 122.68 to 204.02), and Central Sub-Saharan Africa at 137.4 per 100,000 people (95% UI: 102.45 to 178.58) (Table 1).

Diabetes in adolescents and young adults: National trends

In 2021, the ASPR of diabetes among adolescents and young adults was highest in the Marshall Islands (4,398.38 per 100,000 people; 95% UI: 3,582.93 to 5,364.68), American Samoa (3,849.92 per 100,000 people; 95% UI: 3,039.52 to 4,761.88), Niue (3,410.72 per 100,000 people; 95% UI: 2,761.81 to 4,249.41), Cook Islands (3,387 per 100,000 people; 95% UI: 2,724.36 to 4,136.72), and Tokelau (3,110.97 per 100,000 people; 95% UI: 2,486.65 to 3,862.48) (Supplementary Table 1, Fig. 2(A)). Conversely, the lowest ASPR was found in Romania (154.4 per 100,000 people; 95% UI: 119.68 to 197.94), Albania (183 per 100,000 people; 95% UI: 139.36 to 238.53), Slovenia (186.65 per 100,000 people; 95% UI: 141.98 to 243.41), and Slovakia (189.43 per 100,000 people; 95% UI: 139.8 to 253.89) (Supplementary Table 1, Fig. 2(A)). Between 1990 and 2021, significant changes in ASPR were observed, with the Republic of Korea (AAPC = 3.84%, 95% CI: 3.52–4.16%; P < 0.001) and the United Kingdom (AAPC = 3.71%, 95% CI: 3.52–3.9%; P < 0.001) showing the largest relative increases (Supplementary Table 1, Fig. 3(A)).

Fig. 2
figure 2

Maps showing (A) age-standardized prevalence rate, (B) age-standardized death rate and (C) age-standardized disability-adjusted life years rate of diabetes among adolescents and young adults, in 204 countries and territories, between 1990 and 2021

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Fig. 3
figure 3

World map of AAPCs in (A) age-standardized prevalence rate, (B) age-standardized death rate and (C) age-standardized disability-adjusted life years rate of diabetes among adolescents and young adults from 1990 to 2021. AAPC, average annual percentage change

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The national distribution of ASMR is detailed in Fig. 2(B) and Supplementary Table S2. For ASMR, the highest rates in 2021 were recorded in Haiti (2.56 per 100,000 people; 95% UI: 1.55 to 3.95), Fiji (2.39 per 100,000 people; 95% UI: 1.67 to 3.36), and Kiribati (2.33 per 100,000 people; 95% UI: 1.53 to 3.53) (Supplementary Table S2, Fig. 2(B)). In contrast, the lowest ASMR was seen in Ireland (0.03 per 100,000 people; 95% UI: 0.03 to 0.04) and Iceland (0.04 per 100,000 people; 95% UI: 0.03 to 0.05) (Supplementary Table S2, Fig. 2(B)). From 1990 to 2021, notable decreases in ASMR were observed in the Republic of Korea (AAPC = -4.95%, 95% CI: -5.46% to -4.43%; P < 0.001), Luxembourg (AAPC = -4.44%, 95% CI: -5.48% to -3.38%; P < 0.001), and Spain (AAPC = -4.09%, 95% CI: -4.64% to -3.55%; P < 0.001) (Supplementary Table S2, Fig. 3(B)).

In 2021, the highest ASDR were observed in the Marshall Islands (375.38 per 100,000 people; 95% UI: 263.13 to 522.93), Niue (336.38 per 100,000 people; 95% UI: 241.67 to 461.23), Tokelau (317.27 per 100,000 people; 95% UI: 219.2 to 436.9), Kiribati (277.61 per 100,000 people; 95% UI: 204.48 to 371.4), and American Samoa (277.47 per 100,000 people; 95% UI: 193.25 to 383.09) (Supplementary Table S3, Fig. 2(C)). Conversely, the lowest rates were in Albania (13.42 per 100,000 people; 95% UI: 9.23 to 19.57), Romania (14.78 per 100,000 people; 95% UI: 11.15 to 19.98), Slovenia (17.22 per 100,000 people; 95% UI: 12.89 to 23.56), and Slovakia (18.56 per 100,000 people; 95% UI: 13.55 to 25.19) (Supplementary Table S3, Fig. 2(C)). From 1990 to 2021, the most significant increases were noted in Niue (AAPC = 3.28%, 95% CI: 3.17–3.39%; P < 0.001), Tokelau (AAPC = 2.75%, 95% CI: 2.51–2.99%; P < 0.001), and Turkmenistan (AAPC = 2.68%, 95% CI: 2.03–3.34%; P < 0.001). In contrast, Ethiopia (AAPC = -1.93%, 95% CI: -2.01% to -1.85%; P < 0.001) and Rwanda (AAPC = -1.71%, 95% CI: -1.93% to -1.48%; P < 0.001) showed the most significant decreases (Supplementary Table S3, Fig. 3(C)).

Moreover, over the past thirty years, the changes in ASPR, ASMR, and ASDR have varied across different countries/regions and periods (Supplementary Tables S4–S9).

Burden of diabetes in adolescents and young adults by SDI

Supplementary Figs. S3 and S4 illustrate the relationship between ASMR, and ASDR with the SDI across 204 countries and regions in 2021. A downward trend in ASMR and ASDR is observed at the national level as SDI increases. Countries such as Haiti, Kiribati, the Marshall Islands, Fiji, Niue, Tokelau, and Trinidad and Tobago exhibit ASMR and ASDR rates significantly higher than expected based on their SDI.

Cross-country inequality analysis

To further examine the relationship between the burden of diabetes in adolescents and young adults and socioeconomic levels, we conducted an SDI-related health inequality analysis. Both absolute and relative inequalities associated with SDI were identified. Countries with lower SDI experienced a disproportionately high burden of ASMR and ASDR. For ASMR, the slope index showed differences between countries from − 0.82 (95% CI: -0.96 to -0.68) in 1990 to -0.98 (95% CI: -1.13 to -0.84) in 2021 (Fig. 4(A)); the relative concentration index changed from − 0.21 (95% CI: -0.26 to -0.17) in 1990 to -0.29 (95% CI: -0.32 to -0.25) in 2021 (Fig. 4(B)). For ASDR, the slope index showed differences from − 63.59 (95% CI: -76.98 to -50.2) in 1990 to -80.77 (95% CI: -97.75 to -63.79) in 2021 (Fig. 4(C)); the relative concentration index was − 0.14 (95% CI: -0.17 to -0.12) in 1990 and − 0.12 (95% CI: -0.14 to -0.1) in 2021 (Fig. 4(D)). Over time, from 1990 to 2021, health inequality related to ASMR and ASDR of diabetes in adolescents and young adults associated with SDI still exists (Fig. 4).

Fig. 4
figure 4

1990 and 2021, health inequality regression curves (A) and concentration curves (B) for age-standardized death rate of diabetes among adolescents and young adults. Health inequality regression curves (C) and concentration curves (D) for age-standardized disability-adjusted life years rate of diabetes among adolescents and young adults

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Frontier analysis

Frontier analysis of adolescent diabetes ASMR reveals an inverse relationship between the SDI and ASMR (Supplementary Table S10, Fig. 5(A, C)). As SDI increases, the effective difference (EF) decreases, and variance reduces. Overall, once SDI exceeds 0.75, the frontier trend of adolescent diabetes ASMR stabilizes. The top 10 countries with the smallest EF from the frontier are Albania, Greece, Honduras, Iceland, Ireland, Italy, Belgium, Luxembourg, Spain, and Yemen (range, 0-0.01). Conversely, the top 10 countries with the highest EF are Haiti, Fiji, Niue, Kiribati, Tokelau, Trinidad and Tobago, Marshall Islands, Mauritius, Palau, and Guyana (range, 1.54–2.29). Notably, countries like Albania (SDI: 0.707), Greece (SDI: 0.792), Honduras (SDI: 0.513), Iceland (SDI: 0.876), and Ireland (SDI: 0.874) showed the smallest overall differences from the frontier in ASMR (Supplementary Table S10). These results indicate that the burden is more disproportionately borne by the countries least capable of managing it, but there are opportunities to reduce the burden of adolescent diabetes across all levels of development.

Fig. 5
figure 5

Frontier analysis involving SDI and burden of diabetes among adolescents and young adults in 2021. A and C, Frontier analysis with ASMR. B and D, Frontier analysis with ASDR. The frontier is marked using a solid black color, and countries and territories are presented as dots. The leading 15 countries with the most EF (the highest ASMR of diabetes among adolescents and young adults gap from frontier) are marked in black. Examples of frontier countries with low SDI (< 0.5) and reduced EF are marked in blue, and those with high SDI (> 0.85) and relatively elevated EF for their development are marked in red. The red dots represent a reduction in the burden of diabetes among adolescents and young adults between 1990 and 2021. Blue dots represent a rise in the burden of diabetes among adolescents and young adults during the same duration of time. ASMR; age-standardized death rate; ASDR, age-standardized disability-adjusted life years rate; EF, effective difference; and SDI, sociodemographic index

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Frontier analysis of adolescent diabetes ASDR indicates that as SDI rises, EF for specific SDIs also decreases, and variance reduces (Supplementary Table 10, Fig. 5(B, D)). After SDI exceeds 0.7 in 2021, the frontier trend of ASDR stabilizes. The top 10 countries/regions with the highest EF from the frontier (EF range: 216.56-356.11) are the Marshall Islands, Niue, Tokelau, American Samoa, Fiji, Palau, Kiribati, Nauru, Cook Islands, and Haiti. These countries/regions have significantly higher ASDR for adolescent diabetes compared to other countries with similar socio-demographic conditions. The top 10 countries/regions with the lowest EF from the frontier are Albania, Romania, Slovenia, Slovakia, Poland, Croatia, Hungary, Czechia, Serbia, and Greenland (Supplementary Table S11).

Discussion

This study examines the global burden of diabetes among adolescents and young adults, analyzes temporal trends, and highlights regional and national disparities. A key strength of this research is the accurate estimation of age-standardized diabetes indicators among adolescents, which accounts for variations in age structure and eliminates age-related confounding effects across different geographic regions. These findings facilitate effective comparisons and provide a foundation for further scientific research.

Several important points emerge from this analysis. First, the age-standardized prevalence rates and age-standardized disability‐adjusted life‐years rate of diabetes among adolescents and young adults are rising across various Socio-Demographic Index regions. Second, although the global trend in potential age-standardized deaths rates is not pronounced, a decline is observed across the five SDI regions. Third, despite significant heterogeneity in epidemiological trends across countries and regions, the burden of adolescent diabetes is disproportionately higher in poorer and less developed economies, exacerbating health inequalities. Fourth, frontier analysis reveals that even among underdeveloped economies, some countries perform better than others at the same SDI level in managing adolescent diabetes ASMR and ASDR. These countries can serve as models, inspiring policymakers and clinicians to develop effective prevention and management strategies to reduce the burden of adolescent diabetes.

Although ASMR has improved in most regions, the ASPR has doubled over the past thirty years. This rise in ASPR indicates that diabetes poses a significant global health threat to adolescents and presents an increasing challenge to public health and healthcare systems worldwide. Despite advancements in medical public health over the past three decades, such as the establishment of universal diabetes screening programs and improved early diagnosis rates, diabetes prevalence remains high across regions. This paradox can partly be explained by these improvements, as enhanced screening and early detection contribute to the identification of more cases. However, the burden of diabetes may still be underestimated [16]. For example, a cohort study conducted in China in 2013 revealed that over 60% of diabetes patients were unaware of their diagnosis [17]. Similarly, a study conducted in India from 2019 to 2021 indicated that one-fourth of diabetes patients aged 15–49 were undiagnosed, and nearly half of those over 18 were unaware of their elevated fasting blood glucose levels [18]. Rapid economic development in various regions has significantly altered adolescents’ dietary patterns and lifestyles. Existing healthcare services are inadequate to support and promote healthy lifestyles, provide early screening, and sustain continuous monitoring and intervention. This has created an imbalance between economic development and disease burden [19]. For instance, in India and China, rapid economic development and globalization have made low-cost, high-calorie, overly processed foods more accessible and affordable, replacing traditional low-fat, high-fiber diets with those high in calories, saturated fats, sugars, and salt [20, 21]. Additionally, industrialization and urbanization have changed work patterns, increasing sedentary behavior and reducing overall physical activity. Environmental pollution resulting from industrialization has also increased the risk of diabetes [22, 23].

Our analysis reveals that global health inequalities in ASMR and ASDR for diabetes among young people may be influenced by socioeconomic factors, disease awareness, and disparities in healthcare access. In some low-income countries and regions, type 1 diabetes is a leading cause of death, primarily due to poor blood glucose control. The scarcity of essential treatment drugs, particularly insulin, and inadequate monitoring technologies in these areas contribute to high mortality rates and a significant disease burden [24]. According to the International Diabetes Federation (IDF) report, in high-income countries, 75% of basal insulin is supplied to children by the government, compared to 50% in middle-income countries and none in low-income countries. Strengthening the supply of basic insulin and medications for diabetes in economically underdeveloped regions could prevent such deaths [24].

Despite the higher ASDR of diabetes in underdeveloped regions, our findings indicate that the increase in ASDR over the past 30 years has primarily occurred in developed regions, especially in high-SDI areas. From 1990 to 2021, the global adolescent diabetes ASDR increased by 33.9%, with the most significant rises in East Asia and high-income North America. Meanwhile, Oceania, which has the highest ASDR, also has the lowest drug coverage rate globally. To address the surge in ASDR, countries need to establish universal healthcare systems that include insulin, glucose-lowering drugs, and essential health education.

In frontier analysis, attention should be directed not only towards low-SDI frontier countries such as Yemen and Honduras, which have demonstrated excellent performance despite limited resources. In Yemen, significant advancements in public health information systems and data collection [25], increased accessibility to health services [26], improved health intervention coverage, and financial risk protection have markedly enhanced the prevention and management of diabetes in adolescents and young adults [27]. Similarly, in Honduras, regional cooperation and medical assistance, capacity building for local health workers, continuous patient care within local systems, and advancements in primary healthcare services in rural and community settings have driven substantial progress in local healthcare [28,29,30,31]. Their practices and models can serve as valuable references for other resource-limited and heavily burdened countries. Additionally, high-SDI frontier countries such as Palau and Trinidad and Tobago, which perform poorly despite higher SDI, warrant attention, as this indicates that other factors have outweighed the benefits of development on health. Future research must further explore the driving factors of leading countries and the barriers faced by lagging countries.

Strengths and limitations

A major strength of this study is the precise estimation of age-standardized indicators for diabetes in adolescents and young adults, compensating for the heterogeneity of age structure and eliminating the confounding effect of age across different geographic areas. This finding facilitates effective comparisons and lays the foundation for further scientific research.

Several limitations should be noted. First, due to the poor health record systems in underdeveloped countries, the burden of diabetes in adolescents and young adults in the GBD study might be underestimated. Second, due to the time lag in the information report of the national authorities in the GBD study, it is unable to capture the latest changes in diabetes in adolescents and young adults. Although GBD modeling techniques aim to standardize data, the extracted data may heavily rely on model-based estimates, which could impact accuracy. Finally, different subtypes of diabetes in adolescents and young adults need to be explored in future studies.

Conclusion

This study provides accurate age-standardized estimates of the disease burden of adolescents and young adults with diabetes, enabling effective comparisons between different regions. Significant differences in the time trends of adolescent diabetes globally, nationally, and regionally from 1990 to 2021 are highlighted, alongside the cross-national inequalities in disease burden. Our findings reveal that the impact of diabetes on adolescents remains substantial, with a greater burden on poorer and less developed economies. These insights underscore the need for targeted monitoring and health management, particularly in economically underdeveloped regions. Governments should formulate flexible health policies and allocate medical resources judiciously to mitigate this growing global threat.

Data availability

Data are available (https://vizhub.healthdata.org/gbd-results/).

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Acknowledgements

The authors are grateful to all members who participated in the 2021 GBD study.

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Authors and Affiliations

  1. Department of Endocrinology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China

    Yan Liu, Shenhang Yao, Xiangxiang Shan & Wu Dai

  2. Department of Science and Education, The Second People’s Hospital of Hefei, Hefei Hospital, Affiliated to Anhui Medical University, Hefei, Anhui, China

    Yuting Luo & Lulu Yang

  3. Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital, Affiliated to Anhui Medical University, Hefei, Anhui, China

    Ben Hu

  4. The Fifth Clinical Medical School of Anhui Medical University, Hefei, Anhui, China

    Shenhang Yao, Wu Dai & Ben Hu

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All authors made substantial contributions to the original draft, software, resources, methodology, and investigation, took part in editing and validation, and agreed to submit to the current journal.

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Liu, Y., Yao, S., Shan, X. et al. Time trends and advances in the management of global, regional, and national diabetes in adolescents and young adults aged 10–24 years, 1990–2021: analysis for the global burden of disease study 2021. Diabetol Metab Syndr 16, 252 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13098-024-01491-w

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Keywords

Diabetology & Metabolic Syndrome

ISSN: 1758-5996

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