Department of Endocrinology and Metabolism and the Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, China.
Department of Rheumatology and Immunology, First Hospital of China Medical University, Shenyang, China.
BMJ. 2024 Jun 12;385:e078432. doi: 10.1136/bmj-2023-078432.
OBJECTIVES: To estimate the burden, trends, and inequalities of type 1 diabetes mellitus (T1DM) among older adults at global, regional, and national level from 1990 to 2019. DESIGN: Population based study. POPULATION: Adults aged ≥65 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2019)from 1990 to 2019. MAIN OUTCOME MEASURES: Primary outcomes were T1DM related age standardised prevalence, mortality, disability adjusted life years (DALYs), and average annual percentage change. RESULTS: The global age standardised prevalence of T1DM among adults aged ≥65 years increased from 400 (95% uncertainty interval (UI) 332 to 476) per 100 000 population in 1990 to 514 (417 to 624) per 100 000 population in 2019, with an average annual trend of 0.86% (95% confidence interval (CI) 0.79% to 0.93%); while mortality decreased from 4.74 (95% UI 3.44 to 5.9) per 100 000 population to 3.54 (2.91 to 4.59) per 100 000 population, with an average annual trend of -1.00% (95% CI -1.09% to -0.91%), and age standardised DALYs decreased from 113 (95% UI 89 to 137) per 100 000 population to 103 (85 to 127) per 100 000 population, with an average annual trend of -0.33% (95% CI -0.41% to -0.25%). The most significant decrease in DALYs was observed among those aged <79 years: 65-69 (-0.44% per year (95% CI -0.53% to -0.34%)), 70-74 (-0.34% per year (-0.41% to -0.27%)), and 75-79 years (-0.42% per year (-0.58% to -0.26%)). Mortality fell 13 times faster in countries with a high sociodemographic index versus countries with a low-middle sociodemographic index (-2.17% per year (95% CI -2.31% to -2.02%) -0.16% per year (-0.45% to 0.12%)). While the highest prevalence remained in high income North America, Australasia, and western Europe, the highest DALY rates were found in southern sub-Saharan Africa, Oceania, and the Caribbean. A high fasting plasma glucose level remained the highest risk factor for DALYs among older adults during 1990-2019. CONCLUSIONS: The life expectancy of older people with T1DM has increased since the 1990s along with a considerable decrease in associated mortality and DALYs. T1DM related mortality and DALYs were lower in women aged ≥65 years, those living in regions with a high sociodemographic index, and those aged <79 years. Management of high fasting plasma glucose remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed.
目的：在全球、区域和国家层面上，估计从 1990 年到 2019 年老年人群中 1 型糖尿病（T1DM）的负担、趋势和不平等。 设计：基于人群的研究。 人群：来自 21 个地区和 204 个国家和地区（2019 年全球疾病负担和风险因素研究）的年龄≥65 岁的成年人。 主要观察指标：主要结局为 T1DM 相关年龄标准化患病率、死亡率、残疾调整生命年（DALYs）和年平均百分比变化。 结果：全球≥65 岁成年人 T1DM 的年龄标准化患病率从 1990 年的每 10 万人 400（95%置信区间（CI）332 至 476）增加到 2019 年的每 10 万人 514（417 至 624），年平均趋势为 0.86%（95%CI 0.79%至 0.93%）；而死亡率从每 10 万人 4.74（95%CI 3.44 至 5.9）下降到每 10 万人 3.54（2.91 至 4.59），年平均趋势为-1.00%（95%CI-1.09%至-0.91%），年龄标准化 DALYs 从每 10 万人 113（95%CI 89 至 137）下降到每 10 万人 103（85 至 127），年平均趋势为-0.33%（95%CI-0.41%至-0.25%）。在 DALYs 方面，下降幅度最大的是年龄<79 岁的人群：65-69 岁（每年减少 0.44%（95%CI 0.53%至 0.34%）），70-74 岁（每年减少 0.34%（95%CI 0.41%至 0.27%））和 75-79 岁（每年减少 0.42%（95%CI 0.58%至 0.26%））。与低中社会人口指数国家相比，高社会人口指数国家的死亡率下降速度快 13 倍（每年减少 2.17%（95%CI 2.31%至 2.02%）-每年减少 0.16%（95%CI 0.45%至 0.12%））。虽然高收入北美、澳大拉西亚和西欧的患病率仍然最高，但南部撒哈拉以南非洲、大洋洲和加勒比地区的 DALY 率最高。高空腹血糖水平仍然是 1990-2019 年老年人群 DALYs 的最高风险因素。 结论：自 20 世纪 90 年代以来，老年 T1DM 患者的预期寿命有所延长，同时相关死亡率和 DALYs 显著下降。年龄≥65 岁的女性、生活在高社会人口指数地区以及年龄<79 岁的人群中，T1DM 相关死亡率和 DALYs 较低。管理高空腹血糖仍然是老年 T1DM 患者面临的主要挑战，需要制定有针对性的临床指南。
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