Global burden of diabetes in women from 1990 to 2021, with projections to 2050: population-based study

Abstract

Background: The global burden of women's health is underestimated, with diabetes disproportionately affecting women due to sex-specific health conditions, unequal healthcare access, and underrepresentation in clinical trials. However, none has comprehensively examined the global burden of diabetes in women.

Methods: Diabetes data were extracted from Global Burden of Disease 2021. Age-standardized incidence, mortality, and disability-adjusted life years (DALY), with the corresponding average annual percent change (AAPC), were calculated at global, sociodemographic index (SDI), regional, and national levels. Age-specific patterns, DALY attributable to risk factors, and DALY projections to 2050 were also examined.

Results: In women, the global age-standardized incidence of diabetes was 273 (95% uncertainty interval 253 to 294) per 100 000 population in 2021, with 2.5% being type 1 diabetes (T1D). From 1990 to 2021, age-standardized incidence of T1D increased, with an AAPC of 0.48% (p < 0.001); while mortality and DALY decreased (p < 0.001). High SDI showed a T1D incidence 1.4 to 2.3 times that of other SDI levels, with a six-fold faster growth in incidence compared to Low-middle SDI (1.07% vs 0.18% per year). T1D incidence exhibited an approximately U-shaped association with age, peaking in women aged < 25 and > 80 years. For type 2 diabetes (T2D) in women, the global age-standardized incidence, mortality, and DALY all significantly increased over time, despite declining mortality at High and High-middle SDI levels (p < 0.001). Notably, every 5-year decrease in age was associated with a 0.30% (95% confidence interval 0.27% to 0.33%) higher AAPC in incidence rate and a 0.08% (0.06% to 0.10%) higher AAPC in DALY rate for T2D in women. By 2050, the age-standardized DALY of T1D and T2D are expected to decline and rise respectively, with both experiencing an increasing proportion of their burden attributed to non-fatal ones.

Conclusions: Diabetes imposes a significant burden on women throughout their lifespan. Despite improved survival, T1D incidence in women has increased, especially at High SDI. The growing incidence and DALY of T2D represent another concern, with a notable shift toward younger women. The proportional non-fatal burden of T1D and T2D is forecasted to increase by 2050, highlighting the need for effective prevention and long-term management.

Keywords: Global burden of disease; Projection; Type 1 diabetes; Type 2 diabetes; Women.