Signs of slowing diabetes incidence in higher-income countries
medwireNews: The incidence of diabetes in high- and middle-income countries may at last be stabilizing, or even in decline, say researchers.
As reported in The Lancet Diabetes & Endocrinology, Dianna Magliano (Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia) and colleagues obtained 24 datasets from 21 high- or middle-income countries. These included Canada, the USA, Russia, Australia, Israel, several East Asian countries, and a number of European countries. The data included 22 million new cases of diagnosed diabetes from 5 billion person–years of follow-up, and came from administrative sources (50%), registries (25%), health insurance data (21%), and a survey (4%).
The researchers looked at diabetes incidence between 1995 and 2018; a few data sources covered the majority of this time period, but most just a period within it. They found a notable change in incidence at around the year 2010, with 19 of the 23 sources with data after 2009 showing stable or declining diabetes rates from this time, with the annual estimated changes in incidence ranging from –1.1% to –10.8%.
By contrast, the team found persistently rising rates in Lithuania and Singapore, a small rise in one of the two Israeli data sources following recent declines, and a rise in one of the three US data sources, after a dip in around 2005.
Given that “[c]hanges in diabetes screening and diagnostic tests seemed unlikely to account for all of the decrease in the incidence of diagnosed diabetes,” the researchers suggest that national prevention efforts could play a part.
However, Mohammed Ali (Emory University, Atlanta, Georgia, USA) and co-authors of a linked commentary write that “it would be a big leap of faith to attribute changes in incidence at the population level, even if real, to diabetes prevention efforts, without more rigorous examination of causality.”
They stress that the high proportion of administrative data in the study “might exclude lower socioeconomic and uninsured or underinsured populations.”
This means that, rather than revealing an overall stabilization of diabetes rates, the present study may instead reflect declining incidence only among wealthier groups in these countries, while rates in poorer segments of society continue to rise.
“As an illustration of this, the countries experiencing economic and demographic transitions with representative data that included all segments of their populations such as Latvia, Lithuania, Russia, Singapore, and Ukraine all experienced upward or flat incidence trends,” say Ali and co-authors.
They also highlight the issue of undiagnosed diabetes, thought to account for nearly four in 10 of all diabetes case, and recent data showing persistently rising rates of diabetes in middle- and low-income countries.
The commentators therefore conclude that the present findings “might signal stark and troubling disparities across countries whereby high-income countries are experiencing declines while diabetes burdens (including incidence) are intensifying in low-income and middle-income countries.”
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