Global 30-Year Trajectory and Socioeconomic Disparities of Type 2 Diabetes Mellitus in Older Adults (1990-2021).

Abstract

Background Type 2 diabetes mellitus (T2DM) is an escalating global health crisis among aging populations, warranting a comprehensive epidemiological assessment to support evidence-based policy development. Methods Using data from the Global Burden of Disease Study 2021, we examined age-standardized rates of prevalence, incidence, mortality, and disability-adjusted life-years among populations aged ≥55 years from 1990 to 2021. Temporal patterns were quantified using estimated annual percentage change (EAPC). Decomposition analysis was used to identify drivers of burden change, and Bayesian age-period-cohort models were used to project trends through 2040. Results Global T2DM cases among adults aged ≥55 years reached 305.6 million in 2021 (95% uncertainty interval, 282.3-331.7 million), representing a 244% increase since 1990. The age-standardized prevalence rate reached 19,298.52 per 100,000, with a sustained upward trajectory (EAPC: 1.217; 95% confidence interval, 1.172 to 1.262). Regional disparities were pronounced, ranging from 32,846.21 per 100,000 in North Africa and the Middle East to 10,400.58 per 100,000 in Eastern Sub-Saharan Africa. Males and populations in low-middle-income region experienced a disproportionately high burden. Risk factor analysis identified high body mass index as the dominant contributor (46.0%), followed by ambient particulate matter pollution (11.8%) and low physical activity (8.8%). Projections indicate continued increases in prevalence rates to 25,706.8 and 21,693.4 per 100,000 in men and women, respectively, by 2040. Conclusion The T2DM burden among older adults has expanded dramatically, revealing substantial regional and socioeconomic disparities. These findings underscore the urgent need for evidence-based interventions targeting obesity prevention and age-specific healthcare frameworks.