Trends in Diabetes Mellitus Burden and Changes in Attributable Risk Factors in Asia from 1990 to 2021: Results from the Global Burden of Disease Study 2021.

BACKGROUND: The burden of diabetes mellitus (DM) in Asia has been increasing; however, systematic assessments of long-term incidence trends, subtype-specific differences, and modifiable risk factors remain limited. Using Global Burden of Disease Study 2021 data, we evaluated incidence trends in DM and its subtypes (type 1 diabetes mellitus [T1DM] and type 2 diabetes mellitus [T2DM]) in Asia from 1990 to 2021 and quantified the risk-attributable burden.

METHODS: We analyzed the number of cases, age-standardized incidence rate (ASIR), estimated annual percentage change (EAPC), and risk-attributable age-standardized disability-adjusted life year rate (ASDR) for DM and its subtypes. Decomposition analysis was also performed to quantify the contributions of population growth, aging, and epidemiological changes to increases in case numbers.

RESULTS: From 1990 to 2021, DM and T2DM incidence in Asia increased, with T2DM showing the most pronounced rise (ASIR increased by 65.03%, EAPC=1.53; T1DM: 27.04%, EAPC=0.80). Substantial heterogeneity was observed across sex, region, and age group. Decomposition analysis indicated that the increase in T2DM cases was primarily driven by epidemiological changes (contributing 99.03%) and population growth (97.84%). Environmental particulate matter pollution, alcohol consumption, and high sugar-sweetened beverage intake were the fastest-rising risk factors, with ASDR increases of 219.61%, 202.01%, and 182.94%, respectively.

CONCLUSION: Over three decades, Asia's DM burden has increased, with T2DM as the primary growth source driven by epidemiological changes. Future prevention and control efforts should focus on environmental and behavioral risk factors and implement tiered intervention strategies tailored to population characteristics.