Diagnosed Diabetes Incidence Stable or Declining in High-Income Countries

Dianna Magliano, PhD

New findings show a stabilization or declining trend in the incidence of diagnosed diabetes in numerous high-income countries.

“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,” wrote the investigators.

The investigative team, led by Dianna Magliano, PhD, Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, Australia, conducted a multi-country analysis that included data from 24 population-based sources and 21 countries or jurisdictions.

Aggregated data described trends in diagnosed total or type 2 diabetes incidence and were collected 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,” wrote Magliano and colleagues.

Thus, their data included roughly 22 million diabetes diagnoses from 5 billion person-years of follow-up.

Among the countries or jurisdictions assessed, 19 were high-income and 2 were middle-income.

Further, 23 data sources included information and data from 2010 and afterward. Of these sources, 19 were noted to have a downward or stable trend, with an annual estimated change in incidence ranging from −1.1% to −10.8%.

Nonetheless, they found that the increasing incidence trends in the remaining 4 sources had an annual estimated change that ranged from 0.9%-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,” the investigators wrote.

They noted that future investigators are needed to determine the reasons for these declines in incidence.

Preventative Efforts

Research in this domain, as well as in cardiovascular care, has largely focused on prevention and improved diagnostics.

A recent community-based cohort study found that despite the high prevalence of prediabetes among older adults, most participants achieved normoglycemia or died rather than progress to diabetes.

“These findings suggest that prediabetes may not be a robust diagnostic entity in older age,” wrote the study investigators.

A new systematic review and meta-analysis suggested that increased collaboration between healthcare providers in a primary care setting was largely associated with improved outcomes in patients with hypertension and diabetes.

The study in particular assessed the concept of interprofessional collaborative practice (ICP) as defined by the World Health Organization.

Furthermore, digital and remote monitoring of patients with diabetes or prediabetes may play an increasing role in management, treatment, and ultimately prevention, as indicated by several recent studies.

The study, “Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings,” was published online in The Lancet: Diabetes and Endocrinology.