HERD International, Kathmandu, Nepal.
Public Health Promotion and Development Organization, Kathmandu, Nepal.
J Diabetes Res. 2022 Dec 20;2022:4701796. doi: 10.1155/2022/4701796. eCollection 2022.
Globally, the number of people living with diabetes mellitus (DM) increased by 62% between 1990 and 2019, affecting 463 million people in 2019, and is projected to increase further by 51% by 2045. The increasing burden of DM that requires chronic care could have a considerable cost implication in the health system, particularly in resource constraint settings like Nepal. In this context, this study attempts to present the burden of DM in terms of prevalence, mortality, and disability adjusted life years (DALYs). The study is based on the Global Burden of Disease Study 2019, a multinational collaborative research, led by the Institute for Health Metrics and Evaluations. In the study, the overall prevalence of DM was estimated using DisMod MR-2.1, a Bayesian metaregression model. DALYs were estimated summing years of life lost due to premature death and years lived with disability. There were a total of 1,412,180 prevalent cases of DM, 3,474 deaths and 189,727 DALYs, due to DM in 2019. All-age prevalence rate and the age-standardized prevalence rate of DM stood at 4,642.83 (95% uncertainty interval (UI): 4,178.58-5,137.74) and 5,735.58 (95% UI: 5,168.74-6327.73) cases per 100,000 population, respectively, in 2019. In 2019, 1.8% (95% UI: 1.54, 2.07) of total deaths were from DM, which is a more than three-fold increase from the proportion of deaths attributed in 1990 (0.43%, 95% UI: 0.36, 0.5) with most of these deaths being from DM type 2. In 2019, a total of 189,727 disability adjusted life years (DALYs) were attributable to DM of which 105,950 DALYs were among males, and the remaining 83,777 DALYs were among females. Overall, between 1990 and 2019, the DALYs, attributable to Type 1 and 2 DM combined and for Type 2 DM only, have increased gradually across both sexes. However, the DALYs per 100,000 attributable to DM have slightly reduced across both sexes in that time. There is a high burden of DM in Nepal in 2019 with a steep increase in the proportion of deaths attributable to DM in Nepal which could pose a serious challenge to the health system. Primary prevention of DM requires collaborative efforts from multiple sectors. Meanwhile, the current federal structure could be an opportunity for integrated, locally tailored public health and clinical interventions for the prevention of the disease and its consequences.
全球范围内，1990 年至 2019 年间，糖尿病患者人数增加了 62%，2019 年达到 4.63 亿人，预计到 2045 年将进一步增加 51%。糖尿病这种需要长期护理的疾病负担不断增加，这可能会对卫生系统造成相当大的影响，尤其是在尼泊尔等资源有限的国家。在这种情况下，本研究试图从患病率、死亡率和伤残调整生命年（DALYs）方面来展示糖尿病的负担。该研究基于全球疾病负担研究 2019 年，这是一个由健康指标与评估研究所领导的多国合作研究。在该研究中，糖尿病的总体患病率是使用 DisMod MR-2.1 来估计的，这是一个贝叶斯荟萃回归模型。DALYs 是通过将因过早死亡而损失的年限和因残疾而生活的年限相加来计算的。2019 年，尼泊尔共有 141.218 例糖尿病现患病例、3474 例死亡和 189727 例 DALYs。2019 年，所有年龄的患病率和年龄标准化患病率分别为每 10 万人中 4642.83（95%置信区间（UI）：4178.58-5137.74）和 5735.58（95% UI：5168.74-6327.73）例。2019 年，糖尿病导致的死亡占总死亡人数的 1.8%（95% UI：1.54-2.07），这比 1990 年归因于死亡的比例（0.43%，95% UI：0.36-0.5）增加了两倍多，其中大部分死亡是由 2 型糖尿病引起的。2019 年，共有 189727 个伤残调整生命年（DALYs）归因于糖尿病，其中 105950 个 DALYs 发生在男性，其余 83777 个 DALYs 发生在女性。总的来说，1990 年至 2019 年间，1 型和 2 型糖尿病以及 2 型糖尿病单独导致的 DALYs 逐渐增加，在这期间，两性的糖尿病导致的 DALYs 每 10 万人略有减少。2019 年尼泊尔的糖尿病负担很高，糖尿病导致的死亡比例急剧上升，这可能对卫生系统造成严重挑战。糖尿病的一级预防需要多个部门的共同努力。同时，目前的联邦结构可能是一个机会，可以为预防疾病及其后果提供综合的、因地制宜的公共卫生和临床干预。
