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

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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 languageEnglish
Pages (from-to)203-211
Number of pages9
JournalThe Lancet Diabetes & Endocrinology
Issue number4
Early online date23 Feb 2021
Publication statusPublished - 30 Apr 2021


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


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