Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019

Young-onset type 2 diabetes-Epidemiology, pathophysiology, and management

The prevalence and incidence of young-onset type 2 diabetes is increasing globally, especially in low- and middle-income countries, and predominantly affects non-White ethnic and racial populations. Young-onset type 2 is heterogeneous in terms of the genetic and environmental contributions to its underlying pathophysiology, which poses challenges for glycemic management. Young at-risk individuals remain underrepresented in clinical trials, including diabetes prevention studies, and there is still an insufficient evidence base to inform practice for this age group. Improvements in diabetes care delivery have not reached young people who will progress to have disabling complications at an age when they are most productive. This review summarizes recent studies on the epidemiology of young-onset type 2 diabetes and its complications. We discuss the genetic and environmental risk factors that act in concert to promote glycemic dysregulation and early onset of type 2 diabetes. We provide perspectives on diabetes prevention and management, and propose strategies to address the unique medical and psychosocial issues associated with young-onset type 2 diabetes. The Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes Randomized Controlled Trial (PRISM-RCT) is the first large-scale clinical trial designed to evaluate the effect of a structured care model that integrates biogenetic markers with communication and information technology on attaining strict metabolic targets and improving clinical outcomes in individuals with young-onset type 2 diabetes. The results of this study will inform the scientific community about the impact of multifactorial intervention and precision care in young patients, for whom the legacy effect is particularly significant.

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

The Future Diabetes Mortality: Challenges in Meeting the 2030 Sustainable Development Goal of Reducing Premature Mortality from Diabetes

Objective: This study seeks to forecast the global burden of diabetes-related mortality by type, age group, WHO region, and income classification through 2030, and to assess progress toward Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality (among people age 30-70 years) from noncommunicable diseases (including diabetes) by one-third. Methods: We analyzed diabetes mortality data from the Institute for Health Metrics and Evaluation, Global Burden of Disease 2019, covering 30 years (1990-2019). Using this historical dataset, we generated 11-year prospective forecasts (2020-2030) globally and stratified by diabetes type (type 1, type 2), age groups, WHO regions, and World Bank income classifications. We employed multiple time series and epidemic modeling approaches to enhance predictive accuracy, including ARIMA, GAM, GLM, Facebook's Prophet, n-sub-epidemic, and spatial wave models. We compared model outputs to identify consistent patterns and trends. Results: Our forecasts indicate a substantial increase in global diabetes-related mortality, with type 2 diabetes driving the majority of deaths. By 2030, annual diabetes mortality is projected to reach 1.63 million deaths (95% PI: 1.48-1.91 million), reflecting a 10% increase compared to 2019. Particularly concerning is the projected rise in mortality among adults aged 15-49 and 50-69 years, especially in Southeast Asia and low- and middle-income countries. Mortality in upper-middle-income countries is also expected to increase significantly, exceeding a 50% rise compared to 2019. Conclusions: Diabetes-related deaths are rising globally, particularly in younger and middle-aged adults in resource-limited settings. These trends jeopardize the achievement of SDG 3.4. Urgent action is needed to strengthen prevention, early detection, and management strategies, especially in Southeast Asia and low-income regions. Our findings provide data-driven insights to inform global policy and target public health interventions.

The relationship between diabetes distress and eHealth literacy among patients under 60 years of age with diabetes: a multicenter cross-sectional survey

BACKGROUND

Given the increasing prevalence of digital health management, eHealth literacy plays a crucial role in the self-management of diabetes. eHealth literacy refers to an individual's ability to use electronic devices and online resources to manage health issues. In diabetes self-care, the way patients effectively access and apply health information directly impacts disease management outcomes. However, limited research has examined eHealth literacy among diabetes patients, and there is insufficient evidence to show its specific impact on diabetes distress. Therefore, this study aims to assess the eHealth literacy of diabetes patients and explore its relationship with diabetes distress.

METHODS

This cross-sectional study was conducted from November 2022 to July 2023 and involved 260 diabetes patients from three tertiary hospitals in Nantong, China. The participants were selected using convenience sampling, and all participants were adults aged 60 years or younger who were capable of communicating in Chinese. Individuals with severe mental illness, hearing or visual impairments, or physical conditions that hindered their participation were excluded. The eHealth Literacy Scale (eHEALS) was used to assess the participants' eHealth literacy. Additionally, data were collected on social support, anxiety, depression, and diabetes distress (DDS). Structural equation modeling (SEM) was used to analyze the data and explore the pathways through which eHealth literacy influences diabetes distress.

RESULTS

eHealth literacy was significantly negatively correlated with anxiety, depression, and diabetes distress (r = - 0.408, p < 0.01; r = - 0.294, p < 0.01; and r = - 0.398, p < 0.01, respectively). Additionally, eHealth literacy was significantly positively correlated with social support (r = 0.346, p < 0.01). The results of the mediation analysis revealed that social support and psychological factors (anxiety and depression) played mediating roles in the relationship between eHealth literacy and diabetes distress.

CONCLUSIONS

This study shows that eHealth literacy significantly influences the perception of distress among patients with diabetes, with social support and psychological status playing important mediating roles. Enhancing eHealth literacy, especially patients' ability to access and apply health information, may help reduce diabetes distress. Future research should explore more representative samples and long-term study designs to validate these findings and evaluate the effectiveness of various interventions.

Effects of preconception nutrition interventions on pregnancy and birth outcomes in South Asia: a systematic review

Undernutrition amongst reproductive age women, low birth weight, small for gestational age and preterm birth present significant health burdens in South Asia which interventions in pregnancy alone have not resolved. Effectiveness of preconception nutrition interventions is not well-documented. This systematic review summarises evidence on the effect of preconception nutrition interventions on pregnancy and birth outcomes in South Asia. We found highly heterogeneous evidence across four micronutrient supplementation, two food supplementation, and three complex interventions trials. Preconception micronutrient supplementation alone did not affect birth size, but food supplementation was effective with and without multiple micronutrients, especially when initiated at least 90 days before conception. Combined health, nutrition, psychosocial care, and WaSH interventions addressing determinants at multiple levels were most effective. However intensive delivery by project employees poses problems for scale-up. More robust South Asian preconception intervention trials to identify scalable interventions that are effective in real-world delivery settings are needed.

Funding

UNICEF Regional Office for South Asia contract number 43384734.

Global Burden of Lip and Oral Cavity Cancer From 1990 to 2021 and Projection to 2040: Findings From the 2021 Global Burden of Disease Study

BACKGROUND

The aim of this study was to estimate the global burden of lip and oral cavity cancer (LOC) and its trends in different genders, age groups, regions, and countries globally.

METHODS

Data were sourced from the Global Burden of Disease 2021 study.

RESULTS

During the 32-year period, a 92.92% and 113.94% increase was estimated in the absolute counts of LOC deaths and disability-adjusted life years (DALYs), respectively. Throughout the 32-year period, males exhibited higher age-standardized rates (ASRs) of incidence (ASIRs), prevalence (ASPRs), mortality (ASMRs), and DALYs (ASDRs) related to LOC. The age group of 60-64 years consistently recorded the highest numbers of new and prevalent cases across the years 1990, 2019, and 2021. In 2019 and 2021, the highest ASMR and ASDR were observed in individuals aged 95 years and older. Regions with low-middle and low socio-demographic index (SDI) consistently showed higher ASMRs and ASDRs associated with LOC from 1990 to 2021. Eastern Europe, South, North, and Southeast Asia exhibited a concentration of countries with higher ASIRs, ASPRs, ASMRs, and ASDRs in 2021. South Asia maintained high levels of ASIRs, ASPRs, ASMRs, and ASDRs in 2021. In 2021, Palau recorded the highest ASIR, ASPR, ASMR, and ASDR, followed by Pakistan. Projections indicate that ASIR, ASPR, ASMR, and ASDR are expected to increase by 7.40%, 10.10%, 2.85%, and 4.60%, respectively, from 2021 to 2040.

CONCLUSION

LOC remains a critical public health concern that requires immediate attention, particularly among certain demographics such as males, aged 60-64 or 95 and older, as well as in low- and middle-SDI regions, particularly Eastern Europe, South Asia (notably Pakistan), North Asia, and Southeast Asia.

Elevated plasma concentrations of lipoprotein (a) are associated with cardiovascular diseases in patients with early-onset type 2 diabetes mellitus

Objective

To ascertain whether vascular complications and high lipoprotein (a) [Lp(a)] concentrations are related in individuals with early-onset type 2 diabetes mellitus (T2DM).

Methods

This observational cross-sectional study included 591 individuals with early-onset T2DM who were divided into four groups based on Lp(a) values which was measured using immunoturbidimetry and presented as mg/dL: high, >50; intermediate, 30≤Lp(a)<50; low, 10≤Lp(a)<30; and very low, <10. The relationship between the risk of vascular complications and Lp(a) level was examined using a logistic regression model.

Results

The median age of onset for individuals with early-onset T2DM (n=591) was 37 years, duration of diabetes was 12 years, and glycated hemoglobin (HbA1c) level was 8.8%. The median Lp(a) was 10.40 (4.80-21.80) mg/dL, and Lp(a) concentration did not correlate with age, sex, or glycemic control (P>0.05). Individuals in the low Lp(a) (OR=2.12, 95% CI 1.17-3.84, P<0.05), intermediate Lp(a) (OR=2.76, 95% CI 1.10-6.98, P<0.05) and high Lp(a) (OR=4.79, 95% CI 2.03-11.31, P<0.01) groups had an increased risk of coronary heart disease (CHD) compared with those in the very low Lp(a) group after adjustment. Nevertheless, among individuals with early-onset T2DM, there was no correlation between Lp(a) concentration and the risk of cerebrovascular disease (CVL) and microvascular complications (P>0.05).

Conclusions

In patients with early-onset T2DM, Lp(a) concentration was independently associated with CHD. Lp(a) testing is essential to determine who has a latent high risk of CHD among patients with early-onset T2DM.

Global burden of type 2 diabetes attributable to secondhand smoke: a comprehensive analysis from the GBD 2021 study

Introduction

Secondhand smoke (SHS) exposure represents an underappreciated global health risk for type 2 diabetes mellitus (T2DM), with complex epidemiological implications.

Methods

Leveraging the comprehensive Global Burden of Disease (GBD) 2021 dataset, we systematically evaluated the worldwide burden of type 2 diabetes mellitus attributable to secondhand smoke (T2DM-SHS) across 204 countries. The analysis encompassed both death and disability-adjusted life years (DALYs) across various genders, age groups, and 204 nations over the period from 1990 to 2021. We examined trends and socioeconomic impacts by analyzing age-standardized DALYs rates and estimated annual percentage changes, stratified by socio-demographic Index (SDI) quintiles.

Results

The following changes occurred between 1990 and 2021: while age-standardized mortality rates decreased by 8.903% (95% UI: -16.824% to -1.399%), DALYs increased by 17.049% (95% UI: 9.065% to 25.557%). Age-stratified analysis revealed peak death in the 70-74 years group, with females experiencing highest DALYs in the 75-79 years group and males in the 90-94 years group. An inverted U-shaped relationship between SDI and disease burden emerged, with peak rates at moderate SDI levels.

Discussion

Despite lowest burdens in high-income countries, disease dynamics were most complex in middle-range SDI countries, indicating that economic development does not linearly correlate with health outcomes. This comprehensive analysis unveils the multifaceted global landscape of T2DM-SHS, exposing critical disparities across gender, age, and socioeconomic contexts. The findings urgently call for targeted, context-specific public health interventions, particularly in low- and middle-income countries, to mitigate the escalating T2DM-SHS burden.

Metabolic modelling reveals increased autonomy and antagonism in type 2 diabetic gut microbiota

Type 2 diabetes (T2D) presents a global health concern, with evidence highlighting the role of the human gut microbiome in metabolic diseases. This study employs metabolic modelling to elucidate changes in host-microbiome interactions in T2D. Glucose levels, diet, 16S sequences and metadata were collected for 1866 individuals. In addition, microbial community models, and ecological interactions were simulated for the gut microbiomes. Our findings revealed a significant decrease in metabolic fluxes provided by the host's diet to the microbiome in T2D patients, accompanied by increased within-community exchanges. Moreover, the diabetic microbiomes shift towards increased exploitative ecological interactions at the expense of collaborative interactions. The reduced microbiome-to-host butyrate flux, along with decreased fluxes of amino acids (including tryptophan), nucleotides, and B vitamins from the host's diet, further highlight the dysregulation in microbial-host interactions in diabetes. In addition, microbiomes of T2D patients exhibit enrichment in energy metabolism, indicative of increased metabolic activity and antagonism. This study sheds light on the increased microbiome autonomy and antagonism accompanying diabetes, and provides candidate metabolic targets for intervention studies and experimental validation.

Global trends in prevalence, disability adjusted life years, and risk factors for early onset dementia from 1990 to 2021

This study aims to analyze temporal trends in the prevalence and disability-adjusted life year (DALY) burden of early-onset dementia (EOD) globally from 1990 to 2021 and assess the attributable burdens of modifiable risk factors. Data from the Global Burden of Disease Study (GBD) 2021 were used. EOD was defined as dementia in individuals aged 40-64. The analysis included case numbers, age-standardized prevalence rates (ASPRs), and DALY rates (ASDRs) with 95% confidence intervals (CIs), stratified by global, regional, and national levels, sociodemographic index (SDI), and sex. Joinpoint regression analysis evaluated the average annual percent change (AAPC). Population attributable fractions (PAFs) estimated the proportion of DALYs attributable to risk factors. The global number of EOD cases and DALYs nearly doubled from 1990 to 2021, reaching 7.758 million cases (95% CI 5.827-10.081) and 3.774 million DALYs (95% CI 1.696-8.881) in 2021. ASPR and ASDR increased slightly to 355.9 (95% CI 267.2-462.8) and 173.3 (95% CI 77.9-407.7) per 100,000 in 2021. In 2021, the highest ASPR was in high-middle SDI countries at 387.6 per 100,000 (95% CI 291.1-506.8), while the highest ASDR was in middle SDI at 182.9 per 100,000 (95% CI 82.2-431). The fastest ASDR increase was in low and low-middle SDI countries from 2010 to 2021, with AAPCs of 0.42% (95% CI 0.34-0.50) and 0.36% (95% CI 0.33-0.39), respectively. A significant negative correlation was found between SDI and ASDR. During the COVID-19 pandemic (2019-2021), ASPR and ASDR in high-SDI countries declined, while other SDI regions saw an accelerated increase. In 2021, high fasting plasma glucose (FPG) was the most significant attributable risk factor for EOD-related DALYs globally, with PAFs for high body mass index and high FPG increasing in nearly all regions since 1990, while the PAF for smoking decreased. In 2021, EOD burden was highest in high-middle and middle SDI countries, particularly rising during the COVID-19 pandemic. The growing influence of metabolic risk factors underscores the need for targeted public health policies and resource allocation to mitigate the EOD burden.

Cost-effectiveness analysis of nephroprotection programs for patients with type 2 diabetes mellitus in insurers in Colombia

BACKGROUND

This research aimed to determine the cost-effectiveness of nephroprotection programs compared to no intervention in adults with type 2 diabetes mellitus (T2DM) in the Colombian national health system.

METHODS

A Markov analysis with 3 disease states (controlled, uncontrolled and death) was modeled using a 1-year cycle and a 10-year time horizon based on T2DM and chronic kidney disease (CKD) data in Colombia from 2020 to 2023 from the perspective of the health insurance system. Effectiveness was considered as the control of CKD progression, with a decrease of estimated glomerular filtration rate (eGFR using CKD-EPI) of less than 5 ml/min/1.73 m2, and glycated hemoglobin (HBA1c) of less than or equal to 7%. Costs are expressed in 2023 $USD. Univariate and multivariate probabilistic sensitivity analyses were conducted using 1,000 Monte Carlo simulations.

RESULTS

Compared to no intervention, nephroprotection programs were found to be cost-effective, with a dominant incremental cost-effectiveness ratio (ICER). Furthermore, the sensitivity analysis results showed that having a nephroprotection program is a cost-effective strategy in 89.2% and dominant in 56.7% of the simulations.

CONCLUSIONS

Nephroprotection programs result in better T2DM control and slower CKD progression, while also being lower in costs incurred during the year.

Paeoniflorin: a review of its pharmacology, pharmacokinetics and toxicity in diabetes

The escalating global prevalence of diabetes underscores the urgency of addressing its treatment and associated complications. Paeoniflorin, a monoterpenoid glycoside compound, has garnered substantial attention in recent years owing to its potential therapeutic efficacy in diabetes management. Thus, this study aims to systematically overview the pharmacological effects, pharmacokinetics and toxicity of paeoniflorin in diabetes. Plenty of evidences have verified that paeoniflorin improves diabetes and its complication through reducing blood sugar, enhancing insulin sensitivity, regulating gut microbiota and autophagy, restoration of mitochondrial function, regulation of lipid metabolism, anti-inflammation, anti-oxidative stress, inhibition of apoptosis, immune regulation and so on. Paeoniflorin possess the characteristics of rapid absorption, wide distribution, rapid metabolism and renal excretion. Meanwhile, toxicity studies have suggested that paeoniflorin has low acute toxicity, minimal subacute and chronic toxicity, and no genotoxic or mutational toxic effects. In conclusion, this paper systematically elucidates the potential therapeutic application and safety profile of paeoniflorin in diabetes management.

Global burden and trends of oral disorders among adolescent and young adult (10-24 years old) from 1990 to 2021

OBJECTIVE

To determine the patterns and trends in the global, regional, and national burden of oral disorders among adolescents and young adults (AYA) from 1990 to 2021.

METHODS

This is an epidemiological observational study that analyzed annual prevalence and disability-adjusted life years (DALYs) for oral disorders-including dental caries, periodontal disease, edentulism, and other oral conditions-among adolescents and young adults (ages 10-24) from 1990 to 2021. Data were sourced from the Global Burden of Disease Study (GBD) 2021. To assess temporal trends, the estimated annual percentage changes (EAPC) in age-standardized prevalence and DALY rates were calculated at global, regional, and national levels. The GBD 2021 also provides sociodemographic index (SDI) data across 204 countries and territories. Pearson correlation analyses were conducted to explore the relationships between age-standardized prevalence and DALY rates with the SDI and their respective EAPCs.

RESULTS

Globally, the prevalent cases of oral disorders increased by 17.1%, from 549.2 million in 1990 to 643.3 million in 2021, and DALYs rose by 22.2%, from 1.4 million in 1990 to 1.7 million in 2021. The overall age-standardized prevalence rate (EAPC = - 0.07 [95% CI, - 0.12 to - 0.03]) decreased, while the age-standardized DALY rate (EAPC = 0.06 [0.02 to 0.11]) increased over the same period. While the burden of dental caries declined, the burden of periodontitis and edentulism significantly increased. A negative correlation was observed between age-standardized prevalence and DALY rates and SDI, while a positive correlation was found between the EAPC of age-standardized DALY rates and SDI.

CONCLUSIONS

The prevalence and DALYs of oral disorders among AYA have risen over the past three decades, particularly due to the growing burden of periodontitis and edentulism. Notably, the most significant increases have been observed in Southern Latin America and South Asia. While the global decline in dental caries has led to a reduction in ASPR, the escalating burden of periodontal disease and edentulism remains a critical concern. These trends emphasize the urgent need for innovative prevention and intervention strategies to improve oral health for this demographic worldwide.

Socioeconomic and mental health inequalities in global burden of type 2 diabetes: Evidence from the Global Burden of Disease Study 2021

AIM

To explore the holistic impact of socioeconomic and mental health inequalities on the global burden of type 2 diabetes.

MATERIALS AND METHODS

This cross-sectional study used data on the incidence, disability-adjusted life years (DALYs), and mortality of type 2 diabetes as well as DALYs attributable to risk factors during 1990-2021 from the Global Burden of Disease Study 2021. Average annual percent change (AAPC) was applied to assess the temporal trends from 1990 to 2021. Countries were categorised according to levels of sociodemographic index (SDI) and prevalence of depressive disorders or anxiety disorders.

RESULTS

In 2021, the highest age-standardised incidence rate (per 100 000 population) for type 2 diabetes was in countries with a higher prevalence of depressive or anxiety disorders (ranging from 466.35 to 517.08), wherein those with higher SDI experienced the fastest increase from 1990 to 2021 (AAPC ranging from 2.51% to 2.61%). The highest age-standardised rates of DALY and mortality (per 100 000 population) for type 2 diabetes in 2021 were in countries with lower SDI, of which countries with a higher prevalence of depressive or anxiety disorders exhibited the greatest burden (ranging from 1714.38 to 2012.12 for DALY; from 48.66 to 51.91 for mortality). The attributable risk factors for DALYs of type 2 diabetes varied across countries with different SDI levels and prevalence of mental disorders.

CONCLUSIONS

The results suggest that the imbalance of faster socioeconomic development but worse mental health underpins diabetes incidence, while slower socioeconomic development and worse mental health jointly contribute to the disability and mortality burdens of diabetes. It is imperative to promote mental health alongside economic and social development to address the public health challenge of type 2 diabetes.

Navigating the complexities of end-stage kidney disease (ESKD) from risk factors to outcome: insights from the UK Biobank cohort

BACKGROUND

The global prevalence of end-stage kidney disease (ESKD) is increasing despite optimal management of traditional risk factors such as hyperglycaemia, hypertension, and dyslipidaemia. This study examines the influence of cardiorenal risk factors, socioeconomic status, and ethnic and cardiovascular comorbidities on ESKD outcomes in the general population.

METHODS

This cross-sectional study analysed data from 502,408 UK Biobank study participants recruited between 2006 and 2010. Multivariable logistic regression models were fitted to assess risk factors for ESKD, with results presented as adjusted odds ratio (aOR) and 95% confidence intervals (95% CI).

RESULTS

A total of 1191 (0.2%) of the study participants reported ESKD. Diabetes increased ESKD risk by 62% [1.62 (1.36-1.93)], with early-onset diabetes (before age 40) conferring higher odds compared to later-onset (after age 40) [2.26 (1.57-3.24)]. Similarly, early-onset hypertension (before age 40), compared to later onset (after age 40), increased ESKD odds by 73% [1.73 (1.21-2.44)]. Cardiovascular comorbidities, including stroke, hypertension, myocardial infarction and angina, were strongly associated with ESKD [5.97 (3.99-8.72), 5.35 (4.38-6.56), 4.94 (3.56-6.78), and 4.89 (3.47-6.81)], respectively. Males were at 22% higher risk of ESKD than females [1.22 (1.04-1.43)]. Each additional year of diabetes duration increased ESKD odds by 2% [1.02 (1.01-1.03)]. Non-white ethnicity, compared to white and socioeconomically most deprived, compared to the least deprived quintiles, were at 70% and 83% higher odds of ESKD. Each unit of HbA1c rise increased the odds of ESKD by 2%. Compared to microalbuminuria, macroalbuminuria increased the odds of ESKD by almost 10-fold [9.47 (7.95-11.27)] while normoalbuminuria reduced the odds by 73% [0.27 (0.22-0.32)].

CONCLUSIONS

Early onset of diabetes and hypertension, male sex, non-white ethnicity, deprivation, poor glycaemic control, and prolonged hyperglycaemia are significant risk factors for ESKD. These findings highlight the complexity of ESKD and the need for multifactorial targeted interventions in high-risk populations.

CLINICAL TRIAL NUMBER

Not applicable.

Rising tide: the growing global burden and inequalities of early-onset type 2 diabetes among youths aged 15-34 years (1990-2021)

BACKGROUND

Type 2 diabetes mellitus (T2DM) is increasingly affecting people aged 15-34, posing a serious public health challenge due to its faster progression and higher complication risks. This study examines the global, regional, and national burden of early-onset T2DM from 1990 to 2021, emphasizing trends and disparities across different sociodemographic contexts.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) in people aged 15-34. Stratifications included age, sex, and the Socio-Demographic Index (SDI). Joinpoint regression significant temporal shifts, and decomposition analysis attributed changes in T2DM burden to factors such as prevalence, population growth, aging, and case fatality rates. Inequality was assessed with the Slope Index of Inequality and Concentration Index.

RESULTS

From 1990 to 2021, early-onset T2DM incidence and prevalence rose significantly worldwide, especially in high-SDI regions. Although global mortality and DALYs appeared relatively stable, low-SDI regions showed worrisome increases. Rising T2DM prevalence was the principal driver of mortality and DALYs, notably in low- and middle-SDI regions. Inequality analyses indicated widening disparities, with higher incidence and prevalence in high-SDI countries and more severe outcomes in low-SDI countries.

CONCLUSIONS

The global burden of early-onset T2DM among youths is escalating, with significant disparities across different sociodemographic levels. The findings underscore the urgent need for targeted public health interventions. Future research should focus on the underlying factors driving these trends and explore strategies for effective prevention and management of early-onset T2DM.

Efficacy and safety of intravitreal injection of aflibercept biosimilar for treating diabetic macular edema

Purpose

This study aimed to evaluate the efficacy and safety of intravitreal injection of aflibercept biosimilar in the treatment of diabetic macular edema (DME).

Methods

Clinical data were collected from 33 patients (40 eyes) newly diagnosed with DME in the ophthalmology department of our hospital between February and April 2024, all of whom were treated with the aflibercept biosimilar. Patients were managed according to the 3+ Pro re nata (PRN) regimen and completed a minimum follow-up period of 6 months. The best-corrected visual acuity (BCVA) testing, optical coherence tomography, optical coherence tomography angiography, and multifocal electroretinography were performed before and after treatment. BCVA and central retinal thickness (CRT) were compared at baseline and 1-, 3-, and 6-months post-treatment. Additionally, the changes in the foveal avascular zone area, vascular density (VD) of superficial and deep retinal capillaries in the macular region, and the first positive peak amplitude density in ring 1 were analyzed 6 months post-treatment.

Results

BCVA improved significantly from 0.53 ± 0.12 logMAR at baseline to 0.31 ± 0.12, 0.26 ± 0.10, and 0.26 ± 0.08 logMAR at 1-, 3-, and 6-months post-treatment, respectively, (p < 0.05). CRT decreased significantly from 422.4 ± 63.04 μm at baseline to 294.7 ± 47.89, 272.1 ± 47.43, and 281.0 ± 40.72 μm at 1-, 3-, and 6-months post-treatment, respectively, (p < 0.05). The foveal avascular zone area significantly reduced from 0.40 ± 0.08 mm2 at baseline to 0.35 ± 0.07 mm2 at 6 months post-treatment. Superficial VD increased significantly from 38.90 ± 7.88% at baseline to 41.21 ± 7.98% at 6 months post-treatment, while deep VD significantly increased from 35.67 ± 7.50% at baseline to 38.72 ± 6.90% (p < 0.05). The first positive peak amplitude improved significantly from 55.30 ± 9.45 to 72.90 ± 7.44 nv/deg2 at 6 months post-treatment (p < 0.05).

Conclusion

Intravitreal injections of aflibercept biosimilar can significantly reduce DME, improve BCVA, enhance macular perfusion, and restore macular function.

Accelerometer-derived "weekend warrior" physical activity pattern and incident type 2 diabetes

BACKGROUND

The guidelines provided by the World Health Organization (WHO) recommend a minimum of 150 min/week of moderate-to-vigorous physical activity (MVPA) for optimal overall health benefits. However, it remains unclear whether there are differential effects on the risk of incident type 2 diabetes (T2D) between concentrated and evenly distributed physical activity (PA) patterns. We aimed to investigate the associations of accelerometer-derived weekend warrior and regularly active pattern with risk of T2D.

METHODS

A total of 84,656 general participants from the UK Biobank with validated accelerometry data and free of T2D was included. Data on PA was collected using the Axivity AX3 wrist-based triaxial accelerometer worn for one week. Participants were categorized into three PA patterns: inactive (< 150 min/week of MVPA), weekend warrior (≥ 150 min/week with ≥ 50% of total MVPA occurring within 1-2 days), and regularly active (≥ 150 min/week but not meeting weekend warrior criteria).

RESULTS

During a median follow-up of 8.4 years, 2464 cases of T2D were documented. In multivariable-adjusted models, the weekend warrior pattern (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.67-0.84) and the regularly active pattern (HR 0.80, 95% CI 0.69-0.94) exhibited a comparable lower risk of T2D compared to physically inactive participants. When stratified by genetic risk score (PRS) of T2D, the weekend warrior pattern was associated with T2D in the higher PRS group (HR 0.78, 95% CI 0.67-0.91), intermediate PRS group (HR 0.78, 95% CI 0.62-0.97) and lowest PRS group (HR 0.59, 95% CI 0.43-0.80).

CONCLUSIONS

Engaging in the weekend warrior pattern is associated with a similarly lower risk of T2D to the regularly active pattern, even among individuals with high genetic risk. These findings highlight the weekend warrior pattern as a significant and flexible alternative in preventive intervention strategies for T2D, particularly for those unable to maintain daily activity routines.

Evaluating the global, regional, and national burden of congenital heart disease in infants younger than 1 year: a 1990-2021 systematic analysis for the GBD study 2021

Background

Previous estimates of congenital heart disease (CHD) have been constrained by limited data sources, narrow geographic focus, and a lack of specific assessment of infants younger than 1 year. As part of the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021, this research provides comprehensive estimates of mortality, prevalence, and disability attributable to CHD in infants under 1 year. The study encompasses data from 204 countries and territories, covering the period from 1990 to 2021.

Methods

This cross-sectional analysis utilized data from the 2021 GBD study, encompassing 204 countries and territories. The study focused on infants under 1 year of age with CHD. The GBD dataset was accessed on June 10, 2024.

Main outcome measures

The primary outcomes included prevalence, all-cause, and cause-specific mortality, disability-adjusted life years (DALYs), and the corresponding estimated annual percentage changes (EAPCs). Trends were stratified by region, country, age, and Sociodemographic Index (SDI).

Results

In 2021, CHD resulted in 250,811.32 deaths globally [95% uncertainty interval (UI), 207,821.56-304,084.49], representing a 52.58% decrease from 1990. Among these, 167,985.02 deaths (95% UI, 138,221.77-208,321.59) occurred in infants younger than 1 year. In infants under 1 year old, the 1990 mortality rate for CHD ranked behind neonatal encephalopathy due to birth asphyxia and trauma, diarrheal diseases, neonatal preterm birth, and lower respiratory infections. By 2021, its mortality rates had decreased to the eighth leading cause of death.

Interpretation

CHD remains a significant and rapidly escalating global challenge in child health. While it is difficult to significantly reduce the prevalence of CHD, especially in complex cases, advances in prenatal diagnosis and the availability of medical termination of pregnancy in certain regions have led to demographic changes. Additionally, birth rates, typically lower in high-SDI countries, also influence the prevalence of CHD. Given these factors, the focus should be on improving survival outcomes and quality of life for affected infants. Our findings reveal substantial global disparities in prevalence among infants under 1 year, emphasizing the need for policy reforms that address screening, treatment, and data collection to mitigate these disparities.

Identification and validation of endoplasmic reticulum stress-related diagnostic biomarkers for type 1 diabetic cardiomyopathy based on bioinformatics and machine learning

Background

Diabetic cardiomyopathy (DC) is a serious complication in patients with type 1 diabetes mellitus and has become a growing public health problem worldwide. There is evidence that endoplasmic reticulum stress (ERS) is involved in the pathogenesis of DC, and related diagnostic markers have not been well-studied. Therefore, this study aimed to screen ERS-related genes (ERGs) with potential diagnostic value in DC.

Methods

Gene expression data on DC were downloaded from the GEO database, and ERGs were obtained from The Gene Ontology knowledgebase. Limma package analyzed differentially expressed genes (DEGs) in the DC and control groups, and then integrated with ERGs to identify ERS-related DEGs (ERDEGs). The ERDEGs diagnostic model was developed based on a combination of LASSO and Random Forest approaches, and the diagnostic performance was evaluated by the area under the receiver operating characteristic curve (ROC-AUC) and validated against external datasets. In addition, the association of the signature genes with immune infiltration was analyzed using the CIBERSORT algorithm and the Spearman correlation test.

Results

Gene expression data on DC were downloaded from the GEO database and ERGs were obtained from the Gene Ontology Knowledgebase. Limma package analysis identified 3100 DEGs between DC and control groups and then integrated with ERGs to identify 65 ERDEGs. Four diagnostic markers, Npm1, Jkamp, Get4, and Lpcat3, were obtained based on the combination of LASSO and random forest approach, and their ROC-AUCs were 0.9112, 0.9349, 0.8994, and 0.8639, respectively, which proved their diagnostic potential in DC. Meanwhile, Npm1, Jkamp, Get4, and Lpcat3 were validated by external datasets and a mouse model of type 1 DC. In addition, Npm1 was significantly negatively correlated with plasma cells, activated natural killer cells, or quiescent mast cells, whereas Get4 was significantly positively correlated with quiescent natural killer cells and significantly negatively correlated with activated natural killer cells (P < 0.05).

Conclusions

This study provides novel diagnostic biomarkers (Npm1, Jkamp, Get4, and Lpcat3) for DC from the perspective of ERS, which provides new insights into the development of new targets for individualized treatment of type 1 diabetic cardiomyopathy.

Association of eating out of home and type 2 diabetes mellitus in Chinese urban workers: A nationwide study

Background

The prevalence of type 2 diabetes mellitus (T2DM) has been rapidly growing in Chinese populations in recent decades, and the shift in eating habits is a key contributing factor to this increase. Eating out of home (EOH) is one of the major shifts in eating habits during this period. However, the influence of EOH on the incidence of T2DM among Chinese urban workers is unknown.

Methods

The cross-sectional study involved an analysis of 13,904 urban workers recruited from 11 health examination centers in the major cities of China to explore the relationship between EOH and T2DM between 2013 September and 2016 March.

Results

Average weekly EOH frequency ≥10 times was positively associated with increased incidence of T2DM in the sampled population (OR: 1.31 [1.11-1.54], p < 0.01), most notably in participants ≤45 years old (OR: 1.41[1.11-1.80], p < 0.01]) and in males (OR:1.26 [1.06-1.51], p < 0.01). An EOH frequency of 5 times/week appears as a threshold for a significant increase in the odds of T2DM. Weekly EOH frequency ≥5 times was associated with increased odds of T2DM in a dose-response manner in the total population and almost all subgroups (p overall association < 0.05 and p nonlinearity ≤ 0.05).

Conclusion

This study showed that a frequency of EOH (≥5 times/week) was associated with a frequency-dependent increase in the odds of T2DM urban workers in China. More nutrition promotion is needed to improve the eating behavior of Chinese urban workers to reduce T2DM risk.

Subnational Evidence for the Attributable Burden of Respiratory Infections in China's Population under 20: Challenges from Particulate Matter Pollution

Respiratory infections and tuberculosis ranked as the second leading global causes of mortality in 2021. Following the methodology from the Global Burden of Disease Study (GBD) 2021, we aimed to estimate the attributable burden and risk factors of respiratory infections and tuberculosis among China's population under 20 from 1990 to 2021. In 2021, there were 652 million new cases and 12 699 deaths of respiratory infections and tuberculosis among people under 20 years old in China. We estimated 9054 (71.2%) deaths and 818 498 (54.6%) disability-adjusted life years (DALYs) from respiratory infections attributed to all evaluated risk factors. Mortality rates were the highest in Xizang, Xinjiang, and Qinghai in 2021, while they constantly decreased since 1990. Ambient particulate matter pollution was the second leading cause of death among males and first among females, accounting for nearly 1/5 of deaths from respiratory infections and tuberculosis in 2021. In 23 of 33 provinces, ambient particulate matter pollution was the first leading cause of death and DALY, while in Xizang and Gansu, it was not the major contributor to the burden. From 1990 to 2021, the burden from household air pollution declined remarkably in all 33 provinces except for Xizang and Gansu, while the population attributable fraction (PAF) of ambient particulate matter pollution continuously increased. The overall burden of respiratory infections and tuberculosis showed a declining trend, while it remained a fatal threat to infants in relatively less developed regions. The raised hazard of ambient particulate matter pollution underscored the necessity of the shift into the formulation of prevention and intervention strategies.

Comparison of incidence trends of early-onset and late-onset type 2 diabetes in the Asia-Pacific region, 1990-2021: a join point regression analysis based on the global burden of disease study 2021

Introduction

This study evaluated the incidence trends of early-onset (diagnosed at ages 15-39) and late-onset (diagnosed at age 40 and above) type 2 diabetes mellitus (T2DM) in the Asia-Pacific region, including the World Health Organization (WHO) South-East Asia Region (SEARO) and Western Pacific Region (WPRO), and assessed the impact of the COVID-19 pandemic.

Methods

Using data from the Global Burden of Diseases Study (GBD) 2021, we analyzed trends in age-standardized incidence rate (ASIR) using Join point regression to determine annual percentage change (APC). To assess the pandemic's impact, we calculated excess incidence for 2020 and 2021 by subtracting predicted ASIR from observed ASIR.

Results

In recent years, particularly during the COVID-19 pandemic, the ASIR for early-onset T2DM in the Asia-Pacific region accelerated significantly. SEARO's APC rose from 2.24% between 2011-2019 to 5.45% between 2019-2021. Similarly, WPRO's APC increased from 1.71% between 1999-2017 to 5.01% between 2017-2021. In 2021, the ASIR for early-onset T2DM was 269.6 per 100,000 in WPRO and 248.4 per 100,000 in SEARO. Conversely, late-onset T2DM ASIR growth in SEARO slowed after 2017 (APC 1.92% for 2005-2017 vs. 1.04% for 2017-2021), while WPRO saw a decline (APC 1.06% for 2007-2017 vs. -1.10% for 2017-2021). During the COVID-19 pandemic in 2020 and 2021, the observed ASIR of early-onset T2DM in the Asia-Pacific region exceeded historical predictions, showing a positive excess in ASIR.

Conclusions

This study reveals a significant recent increase in early-onset T2DM incidence in the Asia-Pacific region, highlighting the need for targeted public health interventions.

Multiple long-term conditions as the next transition in the global diabetes epidemic

Several transitions, or new patterns and dynamics in the contributors and health outcomes, have altered the character and burden of the multi-decade, worldwide growth in prevalence of type 2 diabetes (T2DM). These changes have led to different needs for prevention and care. These dynamics have been driven by diverse demographic, socio-economic, behavioural, and health system response factors. In this Perspective, we describe these transitions and how their attributes have set the stage for multimorbidity, or multiple long-term conditions (MLTCs), to be the next major challenge in the diabetes epidemic. We also describe how the timing and character of these stages differ in high-, middle-, and low-income countries. These challenges call for innovation and a stronger focus on MLTCs across the spectrum of cause, effectiveness, and implementation studies to guide prevention and treatment priorities.

TCF7L2 as a target of peripheral artery disease in patients with type 2 diabetes: A 2-sample Mendelian randomization and bioinformatics study

This study examines the causal relationship between type 2 diabetes (T2D) and peripheral artery disease (PAD) and their potential mechanisms based on the analysis of the Gene Expression Omnibus database and 2-sample Mendelian randomization (MR). The first part involved a 2-sample MR study and a comprehensive meta-analysis. Differences in the results were assessed using inverse-variance weighting. Heterogeneity was examined using the Cochrane Q statistical test. The leave-one-out method was applied for sensitivity analysis. The potential horizontal pleiotropic effect was assessed using the MR-Egger intercept technique. The second part involved differential gene analysis and weighted gene coexpression network analysis. Subsequently, we overlapped and consolidated the results from the 2 parts to identify the key genes between them. MR analysis results suggested a statistically significant correlation between the incidence of PAD and T2D (odds ratio: 1.22, 95% confidence interval: 1.13-1.32, P = 3.74e-07). We anticipated a pivotal role for TCF7L2 in PAD and T2D. T2D was significantly associated with PAD risk. Simultaneously, the study deepened our understanding of the underlying mechanisms of both diseases, proposing TCF7L2 as a promising target.

Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with predictions to 2046

BACKGROUND

Metabolic risks are significant factors associated with colorectal cancer. This study aimed to assess global, regional and national burden for CRC attributable to metabolic risks from 1990 to 2021 and to predict mortality by 2046.

METHODS

Data from the Global Burden of Disease Study 2021 were used to quantify deaths, disability-adjusted life years (DALYs), and age-standardized rates of CRC due to metabolic risk factors, disaggregated by sex, age, region, country/territory, and sociodemographic index (SDI). The average annual percentage change (AAPC) was used to analyze temporal trends from 1990 to 2021. Metabolic risks include high fasting plasma glucose (FPG) and high body mass index (BMI). Future mortality trends up to 2046 were forecast using age-period-cohort models.

RESULTS

Globally, CRC deaths attributable to metabolic risks increased 2.47-fold, rising from 73,443 in 1990 to 181,689 in 2021. The global age-standardized mortality rates (ASMRs) and age-standardized rates of DALYs (ASDRs) of CRC attributable to high FPG and ASDRs attributable to high BMI increased from 1990 to 2021. The ASMRs and ASDRs of males was higher than that of females, with increasing trends. Central Europe had the highest ASMRs and ASDRs of CRC attributable to metabolic risks in 2021. Most regions and countries showed increasing trends in ASMR and ASDR for CRC due to metabolic risks, with Andean Latin America, Southeast Asia, and Cabo Verde increasing the most. High-SDI regions had the largest burden of CRC attributable to metabolic risks, while burden of other SDI regions have been significantly increased. A positive association was observed between SDI and age-standardized rates (ASMR: RFPG = 0.803, RBMI = 0.752; ASDR: RFPG = 0.812, RBMI = 0.756). By 2046, the ASMR of CRC attributable to high FPG was projected to remain stable and the ASMR due to high BMI was expected to see a slightly increase.

CONCLUSION

Colorectal cancer deaths and DALYs attributable to metabolic risk factors remain high, particularly in males and high-SDI regions. Further researches into the metabolic mechanisms of CRC and effective treatment strategies are needed.

Identification and study of mood-related biomarkers and potential molecular mechanisms in type 2 diabetes mellitus

A significant correlation between type 2 diabetes mellitus (T2DM) and mood has been reported. However, the specific mechanism of mood's role in T2DM is unclear. This study aims to discover mood-related biomarkers in T2DM and further elucidate their underlying molecular mechanisms. The GSE81965 and GSE55650 datasets were sourced from public databases, and mood-related genes (MRGs) were retrieved from previous literature. Initially, differentially expressed MRGs (DE-MRGs) were obtained by combining differential expression analysis and weighted gene co-expression network analysis (WGCNA). Subsequently, the DE-MRGs were incorporated into the LASSO and SVM to identify diagnostic biomarkers for T2DM. Four machine learning methods were utilized to construct the diagnostic models in T2DM, and the model with the optimal algorithm was screened. Further, based on biomarkers, functional enrichment, immune infiltration, and regulatory network analyses were conducted to excavate deeper into the pathogenesis of T2DM. In vivo experiments were used to validate the expression of the biomarkers. A total of 23 DE-MRGs were identified by overlapping 723 DEGs and 64 key modules, and there were strong positive correlations between these DE-MRGs. Afterward, KCTD16, SLC8A1, RAB11FIP1, and RASGEF1B were identified as biomarkers associated with mood in T2DM, and they had favorable diagnostic performance. Meanwhile, the RF diagnostic model constructed based on biomarkers was performed optimally and had high diagnostic accuracy for T2DM patients. Animal experiments indicated that expression levels of SLC8A1, RAB11FIP1, and RASGEF1B in T2DM were consistent with the microarray results. In conclusion, KCTD16, SLC8A1, RAB11FIP1, and RASGEF1B were identified as biomarkers related to mood in T2DM.

Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: sex differences and global burden projections to 2046-a systematic analysis of the Global Burden of Disease Study 2021

AIMS

Atrial fibrillation and atrial flutter (AF/AFL) are critical global health concerns, yet studies on burden trends and sex differences remain limited. This study aims to investigate the global burden trends of AF/AFL, with an in-depth analysis of differences between sexes and future trends, in order to address gaps in the current research field.

METHODS AND RESULTS

This study utilized data from the Global Burden of Disease 2021 study, applying methods such as age-period-cohort analysis and joinpoint regression models to evaluate trends and sex differences in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of AF/AFL among individuals aged 30 and above from 1990 to 2021, and employed Bayesian age-period-cohort (BAPC) analysis to predict future trends from 2022 to 2046. In 2021, AF/AFL affected around 52.6 million people globally, with significant increases in cases, deaths, and DALYs since 1990. While the age-standardized prevalence rate (ASPR) remained stable, the age-standardized incidence rate (ASIR) slightly declined, and the age-standardized mortality rate (ASMR) increased. Moreover, there were significant differences in the disease burden between male and female patients. Males had higher prevalence and DALYs, with older age contributing to higher rates. Key risk factors included high systolic blood pressure, body mass index (BMI), and alcohol use, with female patients exhibiting a higher age-standardized rates associated with elevated BMI compared with their male counterparts. Bayesian age-period-cohort predicted stable ASPR and ASIR in males but rising rates in females, with ASMR expected to decline for both sexes.

CONCLUSION

The global burden of AF/AFL is rising, particularly among women, and in low-socio-demographic index regions. This underscores the urgent need for targeted prevention strategies and optimized management of modifiable risk factors, with a specific focus on these vulnerable groups.

Temporal Trends in the Burden of Diabetes and Its Risk Factors Across the Western Pacific Region Between 1990 and 2044: A Systematic Analysis of the Global Burden of Disease Study 2019

AIMS

We aimed to assess changes in the burden of diabetes in the Western Pacific region (WPR) between 1990 and 2019, project future trends for 2020-2044, and identify the factors influencing these trends.

MATERIALS AND METHODS

Data from the Global Burden of Disease Study 2019 were used to calculate the age-standardised incidence rate (ASIR), age-standardised death rate (ASDR) and age-standardised disability-adjusted life years (DALYs) rate for diabetes in the region. The Nordpred model was used to predict diabetes-related ASIR and ASDR trends over the next 25 years, and an age-period-cohort (APC) model analysed the effects of age, period and cohort. We examined the associations of ASIR, ASDR and age-standardised DALYs rate per 100,000 population with the socio-demographic index (SDI).

RESULTS

We observed an increasing trend in the incidence. Mortality increased in the lower-middle income group and decreased slowly in the high- and upper-middle income groups. High body mass index significantly affected diabetes, with an increasing influence over time, whereas that of tobacco showed a decreasing trend. The incidence of diabetes showed a trend towards occurring at a younger age, in a manner consistent with the economic development trend. Diabetes incidence and mortality showed the opposite trend in the high-income group, with an increase in SDI.

CONCLUSIONS

The burden of diabetes is increasing in the WPR, in association with urbanisation and unhealthy lifestyles. Targeting the risk factors that affect all stages of the disease and managing them through multi-agency collaboration may improve the quality of life in patients living with the condition.

Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021

BACKGROUND

Adolescent diabetes is one of the major public health problems worldwide. This study aims to estimate the burden of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in adolescents from 1990 to 2021, and to predict diabetes prevalence through 2030.

METHODS

We extracted epidemiologic data from the Global Burden of Disease (GBD) on T1DM and T2DM among adolescents aged 10-24 years in 204 countries and territories worldwide. This study calculated the age-standardized prevalence rate (ASPR) and age-standardized DALY rate (ASDR) in adolescents based on the world standard population for cross-country comparisons. Average annual percentage changes (AAPC) in age-standardized rate were calculated by linkage point regression. Correlation analyses were used to identify the relationship between age-standardized rate and sociodemographic index (SDI). The Bayesian age-period-cohort (BAPC) model was used to predict changes in the diabetes prevalence among adolescents from 2022 to 2030.

RESULTS

In 2021, 3.4 million adolescents were living with T1DM, with an ASPR of 180.96 (95% CI 180.77-181.15), and 14.6 million were living with T2DM, with ASPR of 1190.73 (1190.13-1191.34). As national and territory SDI levels rise, the prevalence rate of T1DM increases (r = 0.44, p < 0.01), and the prevalence rate of T2DM decreases (r = - 0.18, p < 0.01). Compared with males, females had a greater age-standardized prevalence of T1DM (185.49 [185.21-185.76] vs. 176.66 [176.39-176.92]), whereas males had a greater ASPR of T2DM than females did (1241.45 [1240.58-1242.31] vs. 1138.24 [1137.40-1139.09]). This study found a negative correlation between the SDI and the ASDR for both T1DM (r = - 0.51, p < 0.01) and T2DM (r = - 0.62, p < 0.01) in adolescents. For T2DM patients, 32.84% of DALYs were attributed to high BMI, which increased by 40.78% during the study period. By 2030, 3.7 million people are projected to have T1DM, and 14.6 million are projected to have T2DM.

CONCLUSIONS

Among adolescents, the burden of T1DM and T2DM is increasing and varies by region, sex, and SDI. Therefore, targeted interventions based on regional features are needed to prevent and control adolescent diabetes. Moreover, more efforts are needed to control climate change and obesity to reduce the adolescent diabetes burden.

Early-onset atherosclerotic cardiovascular disease

Recent trends indicate a concerning increase in early-onset atherosclerotic cardiovascular disease (ASCVD) among younger individuals (men aged <55 years women aged <65 years). These findings highlight the pathobiology of ASCVD as a disease process that begins early in life and underscores the need for more tailored screening methods and preventive strategies. Increasing attention has been placed on the growing burden of traditional cardiometabolic risk factors in young individuals while also recognizing unique factors that mediate risk of pre-mature atherosclerosis in this demographic such as substance use, socioeconomic disparities, adverse pregnancy outcomes, and chronic inflammatory states that contribute to the increasing incidence of early ASCVD. Additionally, mounting evidence has pointed out significant disparities in the diagnosis and management of early ASCVD and cardiovascular outcomes based on sex and race. Moving towards a more personalized approach, emerging data and technological developments using diverse tools such as polygenic risk scores and coronary artery calcium scans have shown potential in earlier detection of ASCVD risk. Thus, we review current evidence on causal risk factors that drive the increase in early ASCVD and highlight emerging tools to improve ASCVD risk assessment in young individuals.

Sociodemographic index-age differences in the global prevalence of cardiovascular diseases, 1990-2019: a population-based study

BACKGROUND

This study aims to assess the global burden and trends in cardiovascular diseases (CVDs) prevalence, stratified by sociodemographic index (SDI) categories and age groups, across 204 countries and territories.

METHODS

Utilizing data from the Global Burden of Disease Study 2019, this study analyzed trends in the age-standardized prevalence rate of overall and type-specific CVDs, including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, peripheral artery disease, endocarditis, and other cardiovascular and circulatory diseases. Age-standardized prevalence rates were stratified by SDI categories (low, low-middle, middle, high-middle, and high) and age groups (0-14, 15-49, 50-69, and ≥ 70 years). The corresponding average annual percentage change was calculated to assess temporal trends.

RESULTS

From 1990 to 2019, the global age-standardized prevalence rate per 100,000 population for CVD decreased from 6728.04 (95% UI 6394.55 to 7059.66) to 6431.57 (95% UI 6109.95 to 6759.8), with an average annual percent change of -0.15% (95% CI -0.17 to -0.13). When stratified by SDI category, the age-standardized prevalence rate of CVD decreased significantly in high-middle and high SDI countries but increased in middle, low-middle, and low SDI countries. By age group, the age-standardized prevalence rate of CVD declined in the 50-69 and ≥ 70 years groups but increased in the 0-14 and 15-49 years groups. SDI levels were negatively associated with faster increases in the age-standardized prevalence rate of CVD across all ages and age groups. Low SDI countries consistently showed the highest age-standardized prevalence rates of CVD in the younger age groups (0-14 and 15-49 years), while high-middle SDI countries had the highest rates in the older age groups (50-69 and ≥ 70 years). The age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0-14 and 15-49 years groups and positively associated with SDI levels in the 50-69 and ≥ 70 years groups. Type-specific CVDs such as rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and hypertensive heart disease showed increased age-standardized prevalence rates from 1990 to 2019.

CONCLUSIONS

This study highlights significant disparities in CVD prevalence across sociodemographic and age groups. While the global prevalence of CVD has generally decreased, the rise in CVD prevalence in lower SDI countries and younger populations calls for tailored intervention strategies. Addressing these disparities is crucial to mitigating the growing burden of CVD and promoting cardiovascular health on a global scale.

Causality between insulin use and malignant tumors of the digestive system: a two-sample mendelian randomized study

BACKGROUND

Existing cohort studies show no association between insulin use and cancers of the digestive system, while numerous meta-analyses suggest that insulin use increases the risk of digestive system tumours. This study uses two-sample Mendelian randomization (MR) to further investigate the causal relationship between the two.

METHODS

We selected single nucleotide polymorphisms (SNPs) strongly associated with insulin use as instrumental variables and used aggregated statistics on digestive system neoplasms as the outcome event. The primary method of analysis was inverse variance weighting (IVW), supplemented by weighted median, MR-Egger regression, weighted mode and simple mode methods. The reliability of the study was assessed by heterogeneity testing, pleiotropy analysis and sensitivity analysis.

RESULT

A total of 8 SNPs associated with insulin use were included as instrumental variables. Random-effects IVW analysis showed an association between insulin use and increased risk of colorectal cancer (OR = 1.1037, 95%CI = 1.0183-1.1962, P = 0.016). No statistically significant association was found between insulin use and the development of other digestive system tumours. The results were unaffected by pleiotropy and heterogeneity, and the reliability of the findings was confirmed by sensitivity analysis.

CONCLUSION

Our Mendelian randomization study suggests an association between insulin use and an increased risk of CRC, with no clear association observed for other digestive system tumours. However, further MR studies with larger sample sizes from genome-wide association study (GWAS) data are needed to verify this association.

Global burden and trends in pre- and post-menopausal gynecological cancer from 1990 to 2019, with projections to 2040: a cross-sectional study

BACKGROUND

The global burden and trends in gynecological cancer (GC) by menopausal status worldwide remain unclear.

METHODS

Data on the number of incident cases and deaths, as well as age-standardized rates (ASR) and risk factors for GC in pre- and post-menopausal women were obtained from the Global Burden of Disease (GBD) Study 2019. The estimated annual percent change was calculated to quantify the temporal trend of GC burden by menopausal status between 1990 and 2019. The Bayesian age-period-cohort model was used to predict the trends in age-standardized incidence and mortality rates for pre- and post-menopausal GC during 2020-2040.

RESULTS

In 2019, an estimated 400 146 pre-menopausal and 879 476 post-menopausal GC cases were newly diagnosed worldwide, with ~111 420 and 442 821 GC-related deaths occurring in each menopausal group, respectively. The majority of both pre- and post-menopausal GC cases in low-to-middle-SDI regions was due to cervical cancer. In high- and high-middle-SDI regions, pre-menopausal GC was primarily attributed to cervical cancer, while post-menopausal GC was mainly attributed to uterine cancer. Additionally, the contribution of uterine cancer to GC was higher among post-menopausal women than pre-menopausal women, across all SDI levels and geographical regions. ASIRs either remained stable or increased from 1990 to 2019 worldwide for both pre- and post-menopausal GC [an average change of 0.03% (95% CI -0.02 to 0.08) and 0.09% (0.05-0.13) per year, respectively]. However, the age-standardized mortality rates (ASMRs) declined by an annual average of 0.86% (95% CI -0.92 to -0.8) and 0.63% (95% CI -0.66 to -0.6) globally during the same period. The risk-attributable proportion of post-menopausal GC deaths was higher than that of pre-menopausal GC and increased with increasing SDI. The projections indicate an increasing trend in the burden of pre-menopausal GC from 2020 to 2040, while the burden of post-menopausal GC is expected to decline.

CONCLUSIONS

GC continues to be a significant public health concern worldwide, with notable regional and demographic disparities in the burden based on menopausal status. Policymakers and healthcare providers must be proactively aware of these evolving trends and tailor age-appropriate and region-specific screening strategies, as well as allocate resources accordingly.

Factors Associated with the Incidence of Prediabetes in Bogor, Indonesia: A Cohort Study

BACKGROUND

Prediabetes is a golden period because the blood sugar levels can be lowered to normal levels, unlike diabetes mellitus. Studies on risk factors of prediabetes in Indonesia have never been conducted before, especially with cohort study design. The purpose of this study was to identify risk factors associated with prediabetes in Indonesia based on a cohort study conducted in Bogor, Indonesia. Study Design: A retrospective cohort study.

METHODS

This study was conducted using data from the Bogor Cohort Study done by the Ministry of Health of Indonesia, which included individuals aged more than 25 years. Individuals who had impaired fasting glucose (IFG) (100-125 mg/dL) and/or impaired glucose tolerance (IGT) (140-199 mg/dL) at baseline screening were excluded from the study. Demographic characteristics, risk factors, and clinical observations were extracted using a questionnaire. Cox regression was used for data analysis.

RESULTS

The cumulative incidence of prediabetes in Bogor was 50.3%. Factors associated with prediabetes were old age (RR: 1.33; 95% CI 1.19, 1.47), female gender (RR: 1.32; 95% CI 1.18, 1.48), overweight (RR: 1.17; 95% CI 1.01, 1.36), obesity (RR: 1.26; 95% CI 1.08, 1.46), central obesity (RR: 1.17; 95% CI 1.02, 1.34), high cholesterol levels (RR: 1.11; 95% CI 1.00, 1.22), and hypertension (RR: 1.27; 95% CI 1.14, 1.42).

CONCLUSION

Age is a dominant risk factor for prediabetes. Therefore, it is important to stick to a healthy lifestyle by doing more physical activities and maintaining a balanced diet since young age to prevent prediabetes.

Research Progress in the Relationship between Intestinal Flora and Diabetes Mellitus

Diabetes mellitus is a common chronic metabolic disease characterized by a high incidence and disability rate. Intestinal flora refers to the microbial community that lives in the intestines and plays a crucial role in maintaining intestinal health and the human immune system. In recent years, an increasing body of research has revealed a close relationship between intestinal flora and diabetes. The pathophysiological mechanisms between them have also been constantly uncovered, and the regulation of intestinal flora has shown promising efficacy in the adjuvant treatment of diabetes. This study mainly summarized the characteristics and mechanisms of intestinal flora in patients with diabetes in recent years, as well as the methods of regulating intestinal flora to prevent and treat diabetes, and prospected the future research direction. This will offer a theoretical basis for the clinical adjuvant treatment of diabetes with intestinal flora and the development of new drugs.

Trends and prevalence of eating disorders in children and adolescents

BACKGROUND

Eating disorders (EDs) have increasingly become a public health problem globally, especially among children and adolescents.

AIM

To estimate the burden of EDs in children and adolescents (ages 5-19 years) at the global, regional, and national levels.

METHODS

Retrieved from Global Burden of Disease Study 2019 for EDs, including anorexia nervosa and bulimia nervosa, we extracted the disability-adjusted life years (DALYs) and prevalence rates with 95% uncertainty intervals between 1990-2019. The temporal trends of the DALYs and prevalence rates of EDs were assessed according to the estimated annual percentage changes.

RESULTS

In our study, we found that the burden of EDs continuously increased globally from 1990 to 2019. Although females accounted for more EDs cases, the burden of EDs in males had a greater increment. Meanwhile, the burden of EDs was associated with the high sociodemographic index (SDI) over the past 30 years and the human development indexes in 2019.

CONCLUSION

EDs, predominantly in high-income countries, are rising globally, especially in Asia, highlighting the need for resource planning and medical policy prioritization across all SDI quintiles.

The Burden of Type 2 Diabetes in Adolescents and Young Adults in China: A Secondary Analysis from the Global Burden of Disease Study 2021

Background: Early-onset type 2 diabetes (T2D) is an increasingly serious public health issue, particularly in China. This study aimed to analyze the characteristics of disease burden, secular trend, and attributable risk factors of early-onset T2D in China. Methods: Using data from the Global Burden of Disease (GBD) 2021, we analyzed the age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), and mortality rates of T2D among individuals aged 15 to 39 years in China from 1990 to 2021. Joinpoint regression analysis was employed to analyze secular trend, calculating the average annual percent change (AAPC). We also examined changes in the proportion of early-onset T2D within the total T2D burden and its attributable risk factors. Results: From 1990 to 2021, the ASR of incidence of early-onset T2D in China increased from 140.20 [95% uncertainty interval (UI): 89.14 to 204.74] to 315.97 (95% UI: 226.75 to 417.55) per 100,000, with an AAPC of 2.67% (95% CI: 2.60% to 2.75%, P < 0.001). DALYs rose from 116.29 (95% UI: 78.51 to 167.05) to 267.47 (95% UI: 171.08 to 387.38) per 100,000, with an AAPC of 2.75% (95% CI: 2.64% to 2.87%, P < 0.001). Mortality rates slightly decreased from 0.30 (95% UI: 0.24 to 0.38) to 0.28 (95% UI: 0.23 to 0.34) per 100,000, with an AAPC of -0.22% (95% CI: -0.33% to -0.11%, P < 0.001). The 15 to 19 years age group showed the fastest increase in incidence (AAPC: 4.08%, 95% CI: 3.93% to 4.29%, P < 0.001). The burden was consistently higher and increased more rapidly among males compared to females. The proportion of early-onset T2D within the total T2D burden fluctuated but remained higher than global levels. In 2021, high body mass index (BMI) was the primary attributable risk factor for DALYs of early-onset T2D (59.85%, 95% UI: 33.54% to 76.65%), and its contribution increased substantially from 40.08% (95% UI: 20.71% to 55.79%) in 1990, followed by ambient particulate matter pollution (14.77%, 95% UI: 8.24% to 21.24%) and diet high in red meat (9.33%, 95% UI: -1.42% to 20.06%). Conclusion: The disease burden of early-onset T2D in China is rapidly increasing, particularly among younger populations and males. Despite a slight decrease in mortality rates, the continued rapid increase in incidence and DALYs indicates a need for strengthened prevention and management strategies, especially interventions targeting younger age groups. High BMI and environmental pollution emerge as primary risk factors and should be prioritized in future interventions.

Young-Onset Diabetes in Sri Lanka: Experience From the Developing World

Background: Young-onset diabetes (YOD) is characterised by unique diagnostic and management challenges more pronounced in resource-limited settings like Sri Lanka. Aims: We aimed to ascertain the prevalence, patterns and characteristics of YOD in Sri Lanka and describe the state of care. Methods: Retrospective review of baseline data of all patients enrolled in the prospective multicentre Database for Young-Onset Diabetes, Sri Lanka (DYOD-SL), was performed, from April 2021 to April 2023. Results: A total of 2531 patient data were included from 28 centres island-wide. Females were 57.6%. The median age was 20 years (interquartile range (IQR) 17, 23), and the age at diagnosis was 15 years (IQR 12, 18). Type 1 diabetes (T1D) was the commonest (57.6%), followed by Type 2 diabetes (T2D) at 34.3%. Younger age at disease onset (p < 0.001), lower BMI (p < 0.001), and diabetic ketoacidosis (DKA) at presentation (p < 0.001) favoured T1D. In the total cohort, the median HbA1c was 9.8% (IQR 7.8, 12.1) with younger patients having poorer control (p = 0.001). Prevalence of nephropathy was 8.1%, retinopathy was 6.6%, neuropathy was 4.1%, moderate-high-risk diabetic foot disease was 1.9%, and macrovascular complications were 0.5%. Hypertension and dyslipidaemia occurred in 2.7% and 14%, respectively. Among patients > 18 years, overweight and obese were 22.2% and 10.4%. Corresponding prevalence in the 5-18-year age group was 20% and 14.7%. Among the insulin users (76%) in the total cohort, the majority (64.7%) were on premixed-based insulin regimens delivered by syringes. Self-monitoring of blood glucose (BG) was reported in 71.3% of the total population. None were on continuous/flash glucose monitoring or insulin pumps. Conclusion: T1D was the commonest subtype of YOD in this hospital-based population. However, T2D was notably higher and is of significant concern. Overall, suboptimal glycaemic control and high rate of complications were noted along with substandard insulin regimens and BG monitoring.

Association between type 2 diabetes mellitus and Klebsiella pneumoniae colonization: construction of nomogram model

OBJECTIVE

To investigate the association between the basic and clinical characteristics of patients with type 2 diabetes mellitus (T2DM) and their susceptibility to Klebsiella pneumoniae colonization (KPC). Additionally, a clinical prediction model was developed to identify high-risk patients for KPC.

METHODS

Data from 486 T2DM patients who visited Shanghai Fifth People's Hospital from December 2020 to December 2022 were retrospectively collected. Patients were classified into the KPC group and normal group based on their Klebsiella pneumoniae test results. Differences between the two groups were analyzed using t-test and chi-square test. Logistic regression was performed to identify factors influencing KPC susceptibility in T2DM patients, with odds ratios (ORs) calculated. A clinical prediction model was constructed using a nomogram and evaluated through the area under the receiver operating characteristic (ROC) curve (AUC), Hosmer-Lemeshow test, calibration curve, and decision curve analysis (DCA).

RESULTS

Of the 486 T2DM patients, 124 were found to have KPC, with a colonization rate of 25.51%. Logistic regression analysis revealed that hospitalization within the past six months, elevated white blood cell count, decreased hemoglobin, and elevated ferritin levels were independent risk factors for KPC. Thyroid and liver function indicators were also associated with KPC susceptibility. The clinical prediction model achieved an AUC of 0.74 (95% CI: 0.68-0.80). The calibration curve indicated no significant differences between observed and predicted values, suggesting that the model effectively identifies high-risk KPC patients.

CONCLUSION

T2DM patients are at an increased risk of secondary KPC. Identifying key risk factors for KPC in T2DM patients has significant clinical implications for early identification, targeted interventions, and individualized treatment strategies.

ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents

Youth-onset type 2 diabetes (T2D) results from genetic, environmental, and metabolic causes that differ among individuals and populations. This chapter builds on the 2022 ISPAD guidelines and summarizes recent advances in the management of T2D in children and adolescents. Updates include diagnostic algorithm for youth with new onset T2D, algorithms and tables for treatment, management, and assessment of comorbidities and complications and recommendations on recently approved pharmacologic therapies for the treatment of youth-onset T2D and management strategies. Youth-onset type 2 diabetes (T2D) results from genetic, environmental, and metabolic causes that differ among individuals and populations. This chapter builds on the 2022 ISPAD guidelines and summarizes recent advances in the management of T2D in children and adolescents. Updates include diagnostic algorithm for youth with new onset T2D, algorithms and tables for treatment, management, and assessment of comorbidities and complications and recommendations on recently approved pharmacologic therapies for the treatment of youth-onset T2D and management strategies.

The role of moderate to vigorous physical activity level and number of treatments/medications in mediating the effect of body mass index on diabetic nephropathy: a Mendelian randomization study

BACKGROUND

Body mass index (BMI) is associated with diabetic nephropathy (DN). However, the mediator factors in the BMI-DN effects remain unclear.

METHODS

Univariate and multivariate Mendelian randomization (MR) analysis were performed to estimate the association between six lifestyles (moderate to vigorous physical activity levels, years of schooling, BMI, nap during day, number of treatments/medications taken and coffee intake) and DN. MR Egger, Weighted median, Simple mode, and Weighted mode was supplemental methods to Inverse variance weighted. Sensitivity analysis included heterogeneity test, horizontal pleiotropy test, and Leave-One-Out. Additionally, mediation MR was conducted to evaluate the mediating role of lifestyles between BMI and DN. Finally, functional enrichment analysis based on the mediation MR results was performed.

RESULTS

univariate and multivariate Mendelian randomization (MR) analysis were performed to estimate the association between six lifestyles (moderate to vigorous physical activity levels, years of schooling, BMI, nap during day, number of treatments/medications taken and coffee intake) and DN. MR Egger, Weighted median, Simple mode, and Weighted mode was supplemental methods to Inverse variance weighted. Sensitivity analysis included heterogeneity test, horizontal pleiotropy test, and Leave-One-Out. Additionally, mediation MR was conducted to evaluate the mediating role of lifestyles between BMI and DN. Finally, functional enrichment analysis based on the mediation MR results was performed.

CONCLUSION

our results supported mediation role of vigorous physical activity level and number of treatments/medications in BMI-DN effects.

Type 2 diabetes and colorectal cancer: genetic causality explored via Mendelian randomization

BACKGROUND

The global burden of type 2 diabetes (T2D) and colorectal cancer (CRC) continues to rise. Observational studies have suggested a link between T2D and an elevated risk of CRC. However, these studies are often susceptible to confounding factors and reverse causation, leading to inconsistent findings. There is a specific gap in knowledge regarding the causal nature of the relationship between T2D and CRC, which this study aims to address using a more robust approach. To fill this gap, we employed Mendelian randomization (MR), a method that uses genetic variants as instrumental variables (IVs) to infer causality, providing clearer insight into the genetic links between T2D and CRC.

METHODS

A bidirectional MR study was conducted to investigate the causal links between T2D and CRC. Genetic instruments for T2D were derived from two large genome-wide association studies (GWAS) with a total sample size of X individuals, and CRC genetic instruments were obtained from a GWAS with Y individuals. The MR analysis utilized the inverse-variance weighted (IVW) method as the primary analysis, alongside sensitivity analyses such as heterogeneity and pleiotropy analysis to account for potential pleiotropy and bias. Additionally, to enhance the robustness of the findings and minimize the influence of data from different GWAS sources, we performed a meta-analysis of the IVW results.

RESULTS

The MR analysis and meta-analysis revealed that genetically predicted T2D is associated with an increased risk of CRC (Pooled ORIVW = 1.07, 95% CI 1.02-1.12, P = 0.003). However, the reverse analysis did not indicate a causal effect of genetically predicted CRC on T2D risk (Pooled ORIVW = 1.02, 95% CI 0.96-1.09, P = 0.469). Sensitivity analyses supported the robustness of these findings, indicating no evidence of heterogeneity or pleiotropic effects that could bias the results (all P > 0.05).

CONCLUSION

Our bidirectional MR study and meta-analysis provide evidence that T2D increases the risk of colorectal cancer. However, there is no evidence to support a reverse causal relationship. These findings highlight the importance of monitoring and managing T2D as part of CRC prevention strategies.

Trends and Motivations in Dietary Supplement Use Among People with Diabetes: A Population-Based Analysis Using National Health and Nutrition Examination Survey Data from the 2009-2020 Period

OBJECTIVES

Dietary supplements have gained attention among people with diabetes as an alternative and complementary treatment, yet there is a limited understanding of supplement use and the motivations behind it.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) from the 2009-2020 period were analyzed, including data on 5784 people with diabetes aged 20 years or older. Dietary supplement use was self-reported. Trends in supplement use were examined across three periods: 2009-2012, 2013-2016, and 2017-2020. Statistical analyses were conducted while considering NHANES's complex survey design to provide nationally representative estimates for the general noninstitutionalized population of the United States.

RESULTS

A total of 61.72% of individuals reported using dietary supplements with a notable increase over time. Supplement users were generally older, more likely to be female, better educated, and had superior blood glucose control with lower smoking rates compared to non-users. Common supplements included multivitamins, multimineral supplements, vitamin D, calcium, zinc, vitamin C, and fish oil. Only 44.58% of individuals used dietary supplements based on medical advice, with the rest opting for self-directed usage. The primary specific health reasons for supplement use were to improve bone health and heart health and enhance the immune system.

CONCLUSIONS

Dietary supplement use is prevalent among people with diabetes, and most diabetic supplement use is self-directed, which reflects a growing trend toward complementary therapies. Healthcare providers are encouraged to inquire about patients' use of supplements and offer appropriate guidance as an integral component of comprehensive diabetes management.

Income-Related Disparities in Mortality Among Young Adults With Type 2 Diabetes

Importance

Previous studies have indicated an inverse association between income and mortality. However, differences in health outcomes according to the income level of young adults with type 2 diabetes (T2D) compared with older adults with T2D have not been elucidated.

Objective

To estimate the overall and cause-specific mortality risks among patients with T2D according to income and age.

Design, Setting, and Participants

This retrospective nationwide cohort study in South Korea included adults aged 20 to 79 years who were diagnosed with T2D between January 1, 2008, and December 31, 2013, and followed up until December 31, 2019, and age- and sex-matched controls without diabetes. Data were analyzed between January 1, 2023, and August 27, 2024.

Main Outcomes and Measures

Risks of all-cause, cardiovascular, and cancer mortality were estimated according to participants' income, which was categorized into 3 levels (low, middle, and high) based on the health insurance premium. Logistic regression analyses and Cox proportional hazard regression analyses were performed according to age groups (20-39, 40-59, and 60-79 years).

Results

A total of 1 240 780 adults (604 975 patients with T2D and 635 805 age- and sex-matched controls without diabetes) were included in the analyses. Their mean (SD) age was 56.9 (11.8) years, and 626 176 (50.5%) were men. Overall, the risk of mortality increased with lower income among patients with T2D, as well as in comparison with controls without diabetes. There was an inverse association between income and mortality risk in younger individuals (adjusted hazard ratios of all-cause mortality in the low income vs high income subgroups with T2D were 2.88 [95% CI, 2.25-3.69] in those aged 20 to 39 years, 1.90 [95% CI, 1.81-2.00] in those aged 40 to 59 years, and 1.26 [95% CI, 1.23-1.29] in those aged 60 to 79 years; P < .001 for comparing risk ratios between age groups). The pattern of income-related disparities in younger individuals was observed in cardiovascular mortality but less in cancer mortality.

Conclusions and Relevance

In this cohort study of 1 240 780 individuals aged 20 to 79 years, the risk of mortality with low income was most prominent among individuals with T2D aged 20 to 39 years. These findings highlight the need for socioeconomic support to reduce income-related health disparities in younger individuals.

Burden of diabetes mellitus in Weifang: Changing trends in prevalence and deaths from 2010 to 2021

OBJECTIVE

The objective of this study is to analyze the death characteristics and burden of disease (BOD) in diabetes mellitus (DM) patients in Weifang from 2010 to 2021. The findings will serve as a foundational data source and theoretical framework for public health administrative departments in the formulation of DM-related policies.

METHODS

The annual percent change (APC) and average annual percent change (AAPC) of the disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD) in DM residents from 2010 to 2021 were analyzed using the Joinpoint software to reflect the changing trend of the BOD in DM patients. Additionally, we conducted an analysis of the various causes of death among these patients and compared BOD in diabetic patients with different backgrounds.

RESULTS

From 2010 to 2021, the burden of disease, which includes DALY, YL, and YLD, has been increasing among patients with DM in Weifang. It is noteworthy that the burden of disease is particularly pronounced among male patients and those aged 75 or above. Additionally, it is observed that widowed and illiterate DM patients have comparatively longer survival times. Furthermore, among the DM patients who have unfortunately passed away, it has been identified that unspecified DM with ketoacidosis accounts for 10.03% of the deaths as a direct cause of death. In contrast, type 2 diabetes mellitus (T2DM) with kidney complications contributes to 10.23% of the deaths as the fundamental cause of death.

CONCLUSION

The city is faced with a significant challenge of diabetes, which is influenced by factors such as gender, age, cultural background, and marital status. Unspecified diabetes mellitus (DM) with ketoacidosis (10.03%) and T2DM with renal complications (0.23%) are identified as the primary direct and underlying causes of death among diabetic patients, respectively. This study serves as a valuable reference for other regions in terms of diabetes prevention, control, and the management of chronic diseases.