An elderly person with Type 1 diabetes, standing in a medical setting with charts showing rising prevalence of diabetes, surrounded by futuristic medical devices and care equipment, highlighting disparities in healthcare access across different regions of the world.
Type 1 diabetes (T1DM) is no longer just a concern for children and young adults. A study published in The BMJ shines a light on the growing global burden of T1DM among those aged 65 and older. Between 1990 and 2019, the prevalence of T1DM among older adults increased significantly, alongside advancements in medical care that have helped to reduce mortality.
“We observed a global increase in prevalence from 400 per 100,000 people in 1990 to 514 per 100,000 in 2019,” explains Kaijie Yang, one of the researchers. This increase reflects improvements in life expectancy among those with T1DM, allowing more individuals to live into their senior years with the condition.
Mortality and Disability Adjusted Life Years Trends
Despite the rise in prevalence, mortality related to T1DM has seen a marked decline. The global age-standardized mortality rate dropped from 4.74 per 100,000 in 1990 to 3.54 per 100,000 in 2019. “This is a promising trend,” says Chenye Jin. “Our data shows a 25% reduction in age-standardized mortality, which indicates that more patients are managing their condition better, living longer lives.”
While mortality has decreased, managing the complications that come with living longer with T1DM remains a challenge. The study reports a slight reduction in disability-adjusted life years (DALYs) during the same period. “Though the reduction in DALYs is modest at 0.33%, it’s critical to note that older adults face unique challenges in managing the disease,” says Yongze Li. “This is especially true for those in countries with lower socioeconomic development.”
Disparities by Region and Socioeconomic Status
The study revealed significant disparities in outcomes based on socioeconomic status. While mortality dropped more than twice as fast in countries with high socioeconomic indices compared to those with lower ones, the burden remains disproportionately high in underdeveloped regions.
Regions such as southern sub-Saharan Africa, Oceania, and the Caribbean report the highest DALY rates among older adults. “For example, the mortality rate in countries with a high sociodemographic index decreased by 2.17% per year, compared to just 0.16% in countries with lower indexes,” notes Shuangning Ding. This disparity calls for targeted public health interventions to address the unique challenges faced by older adults in low-resource settings.
The Challenge of Managing High Glucose Levels
One of the study’s key findings is the ongoing struggle to manage high fasting plasma glucose levels, a significant risk factor for T1DM. “Even though medical advancements have led to better outcomes overall, hyperglycemia remains a pervasive problem,” explains Xue Yang. “Older adults, in particular, face challenges in maintaining optimal blood sugar control, and this issue must be addressed more aggressively.”
The study emphasizes the need for updated clinical guidelines that cater specifically to the older population. As the global population continues to age, the number of older adults living with T1DM will only increase, underscoring the need for targeted healthcare strategies to improve outcomes.
Citation:
Yang K, Yang X, Jin C, Ding S, Liu T, Ma B, Sun H, Zhang J, Li Y. Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study. BMJ. 2024;385. doi:10.1136/bmj-2023-078432.
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