Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants.

Background: One of the global targets on non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes compared to its 2010 levels. There is limited information on how the prevalence of diabetes has changed globally, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of people with diabetes.
Methods: We pooled 751 population-based measurement studies conducted from 1980 to 2014, with over 4.4 million participants aged 18 years and older. We used a Bayesian hierarchical model to estimate trends in the prevalence of diabetes, defined as fasting plasma glucose ≥7.0 mmol/L or history of diagnosis with diabetes or using insulin or oral hypoglycaemic drugs, in 200 countries and territories in 21 regions. We calculated the posterior probability of meeting the global diabetes target, if post-2000 trends continue.
Findings: Age-standardised adult diabetes prevalence in the world increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014, with contributions of 28% from the rise in prevalence, 40% from population growth and ageing, and 32% from the interaction of these two factors. Age-standardised adult diabetes prevalence in 2014 was lowest in North Western Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and North Africa. From 1980 to 2014, there was virtually no change in age-standardised diabetes prevalence among adult women in continental Western Europe, although crude prevalence rose due to ageing of the population. In contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes) with age-standardised adult prevalence also >25% in a few other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level is <1% for men and 1% for women in the world as a whole. Only men in nine countries and women in 29 countries, mostly in Western Europe, have a 50% or more probability of meeting the global target.
Interpretation: Since 1980, age-standardised diabetes prevalence in adults increased or at best remained unchanged in every country. Together with population growth and ageing, this rise has led to a quadrupling of the number of people with diabetes in the world. The burden of diabetes, in terms of both prevalence and number of people, has increased faster in low- and middle-income countries than in high-income countries.
Funding: Wellcome Trust