Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings

Dianna J Magliano; Lei Chen; Rakibul M Islam; Bendix Carstensen; Edward W Gregg; Meda E Pavkov; Linda J Andes; Ran Balicer; Marta Baviera; Elise Boersma-van Dam; Gillian L Booth; Juliana C N Chan; Yi Xian Chua; Sandrine Fosse-Edorh; Sonsoles Fuentes; Hanne L Gulseth; Romualdas Gurevicius; Kyoung Hwa Ha; Thomas R Hird; György Jermendy; Mykola D Khalangot; Dae Jung Kim; Zoltán Kiss; Victor I Kravchenko; Maya Leventer-Roberts; Chun-Yi Lin; Andrea O Y Luk; Manel Mata-Cases; Didac Mauricio; Gregory A Nichols; Mark M Nielen; Deanette Pang; Sanjoy K Paul; Catherine Pelletier; Santa Pildava; Avi Porath; Stephanie H Read; Maria Carla Roncaglioni; Paz Lopez-Doriga Ruiz; Marina Shestakova; Olga Vikulova; Kang-Ling Wang; Sarah H Wild; Naama Yekutiel; Jonathan E Shaw

doi:10.1016/S2213-8587(20)30402-2

Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings

Dianna J Magliano, Lei Chen, Rakibul M Islam, Bendix Carstensen, Edward W Gregg, Meda E Pavkov, Linda J Andes, Ran Balicer, Marta Baviera, Elise Boersma-van Dam, Gillian L Booth, Juliana C N Chan, Yi Xian Chua, Sandrine Fosse-Edorh, Sonsoles Fuentes, Hanne L Gulseth, Romualdas Gurevicius, Kyoung Hwa Ha, Thomas R Hird, György JermendyMykola D Khalangot, Dae Jung Kim, Zoltán Kiss, Victor I Kravchenko, Maya Leventer-Roberts, Chun-Yi Lin, Andrea O Y Luk, Manel Mata-Cases, Didac Mauricio, Gregory A Nichols, Mark M Nielen, Deanette Pang, Sanjoy K Paul, Catherine Pelletier, Santa Pildava, Avi Porath, Stephanie H Read, Maria Carla Roncaglioni, Paz Lopez-Doriga Ruiz, Marina Shestakova, Olga Vikulova, Kang-Ling Wang, Sarah H Wild, Naama Yekutiel, Jonathan E Shaw

Research output: Contribution to journal › Article › peer-review

92 Citations (SciVal)

Abstract

BACKGROUND: Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time.

METHODS: In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time.

FINDINGS: Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions.

INTERPRETATION: The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources.

FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.

Original language	English
Pages (from-to)	203-211
Number of pages	9
Journal	The Lancet Diabetes & Endocrinology
Volume	9
Issue number	4
Early online date	23 Feb 2021
DOIs	https://doi.org/10.1016/S2213-8587(20)30402-2
Publication status	Published - 30 Apr 2021

Funding

The study was funded by the US Centers for Disease Control and Prevention and a Diabetes Australia Research Program grant. This work was also partly supported by the Victoria State Government Operational Infrastructure Support Program. Acquisition of Italian data was supported by grants from the Regional Health Ministry of the Lombardy Region (Italy) as part of the EPIFARM Pharmacoepidemiology Agreement between the Mario Negri Institute for Pharmacological Research IRCCS and the Lombardy Region. Data for Scotland are submitted on behalf of the Scottish Diabetes Research Network epidemiology group; this network is supported by National Health Service (NHS) Research Scotland. The National Diabetes Register of the Russian Federation, which was the source of the data from Russia, is supported by the Russian Ministry of Science and Higher Education (number 075-15-2020-899). We thank the people with diabetes, health service staff, and organisations involved in providing data and setting up, maintaining, and overseeing collation of data for people with diabetes in Scotland. Scottish data linkage and provision were provided by the Information Services Division of NHS National Services Scotland. We acknowledge the work from those at Diabetes Australia and the Australian Institute of Health and Welfare for supplying the Australian data. We also acknowledge Ida Fortino, from the Regional Health Ministry of the Lombardy Region, for acquisition of Italian data, and Yu-Ru Jiang, for her help with the preparation of the Taiwanese data. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

Funders	Funder number
Centers for Disease Control and Prevention
Regional Health Ministry of the Lombardy Region
IRCCS Istituto di Ricerche Farmacologiche Mario Negri
National Diabetes Register of the Russian Federation
Russian Ministry of Science and Higher Education	075-15-2020-899
Diabetes Australia

Keywords

Data Aggregation
Diabetes Mellitus, Type 2/diagnosis
Global Health/trends
Humans
Incidence
Income/trends
Internationality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/S2213-8587(20)30402-2

https://www.research.ed.ac.uk/en/publications/trends-in-the-incidence-of-diagnosed-diabetes-a-multicountry-anal

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Magliano, D. J., Chen, L., Islam, R. M., Carstensen, B., Gregg, E. W., Pavkov, M. E., Andes, L. J., Balicer, R., Baviera, M., Boersma-van Dam, E., Booth, G. L., Chan, J. C. N., Chua, Y. X., Fosse-Edorh, S., Fuentes, S., Gulseth, H. L., Gurevicius, R., Ha, K. H., Hird, T. R., ... Shaw, J. E. (2021). Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings. The Lancet Diabetes & Endocrinology, 9(4), 203-211. https://doi.org/10.1016/S2213-8587(20)30402-2

Magliano, DJ, Chen, L, Islam, RM, Carstensen, B, Gregg, EW, Pavkov, ME, Andes, LJ, Balicer, R, Baviera, M, Boersma-van Dam, E, Booth, GL, Chan, JCN, Chua, YX, Fosse-Edorh, S, Fuentes, S, Gulseth, HL, Gurevicius, R, Ha, KH, Hird, TR, Jermendy, G, Khalangot, MD, Kim, DJ, Kiss, Z, Kravchenko, VI, Leventer-Roberts, M, Lin, C-Y, Luk, AOY, Mata-Cases, M, Mauricio, D, Nichols, GA, Nielen, MM, Pang, D, Paul, SK, Pelletier, C, Pildava, S, Porath, A, Read, SH, Roncaglioni, MC, Lopez-Doriga Ruiz, P, Shestakova, M, Vikulova, O, Wang, K-L, Wild, SH, Yekutiel, N & Shaw, JE 2021, 'Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings', The Lancet Diabetes & Endocrinology, vol. 9, no. 4, pp. 203-211. https://doi.org/10.1016/S2213-8587(20)30402-2

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abstract = "BACKGROUND: Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time.METHODS: In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time.FINDINGS: Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions.INTERPRETATION: The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources.FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.",

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T1 - Trends in the incidence of diagnosed diabetes

T2 - a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings

AU - Magliano, Dianna J

AU - Chen, Lei

AU - Islam, Rakibul M

AU - Carstensen, Bendix

AU - Gregg, Edward W

AU - Pavkov, Meda E

AU - Andes, Linda J

AU - Balicer, Ran

AU - Baviera, Marta

AU - Boersma-van Dam, Elise

AU - Booth, Gillian L

AU - Chan, Juliana C N

AU - Chua, Yi Xian

AU - Fosse-Edorh, Sandrine

AU - Fuentes, Sonsoles

AU - Gulseth, Hanne L

AU - Gurevicius, Romualdas

AU - Ha, Kyoung Hwa

AU - Hird, Thomas R

AU - Jermendy, György

AU - Khalangot, Mykola D

AU - Kim, Dae Jung

AU - Kiss, Zoltán

AU - Kravchenko, Victor I

AU - Leventer-Roberts, Maya

AU - Lin, Chun-Yi

AU - Luk, Andrea O Y

AU - Mata-Cases, Manel

AU - Mauricio, Didac

AU - Nichols, Gregory A

AU - Nielen, Mark M

AU - Pang, Deanette

AU - Paul, Sanjoy K

AU - Pelletier, Catherine

AU - Pildava, Santa

AU - Porath, Avi

AU - Read, Stephanie H

AU - Roncaglioni, Maria Carla

AU - Lopez-Doriga Ruiz, Paz

AU - Shestakova, Marina

AU - Vikulova, Olga

AU - Wang, Kang-Ling

AU - Wild, Sarah H

AU - Yekutiel, Naama

AU - Shaw, Jonathan E

PY - 2021/4/30

Y1 - 2021/4/30

N2 - BACKGROUND: Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time.METHODS: In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time.FINDINGS: Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions.INTERPRETATION: The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources.FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.

AB - BACKGROUND: Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time.METHODS: In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time.FINDINGS: Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1·1% to -10·8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0·9% to 5·6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions.INTERPRETATION: The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources.FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.

KW - Data Aggregation

KW - Diabetes Mellitus, Type 2/diagnosis

KW - Global Health/trends

KW - Humans

KW - Incidence

KW - Income/trends

KW - Internationality

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JO - The Lancet Diabetes & Endocrinology

JF - The Lancet Diabetes & Endocrinology

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Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings

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Funding

Keywords

UN SDGs

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