The evolving burden of type 2 diabetes mellitus in Asia, 1990-2023: A Global Burden of Disease Study 2023.

Abstract

Asia accounts for over half of the global prevalence of type 2 diabetes mellitus (T2DM), yet subregional evidence remains limited. We assessed trends, regional disparities and risk-attributable burdens across Asia from 1990 to 2023. We analysed the burden of T2DM across 34 countries and five regions across Asia, including Central, East, South and Southeast Asia and the high-income Asia Pacific region, using the Global Burden of Disease Study (GBD) 2023 from 1990 to 2023. T2DM was defined as a metabolic disorder characterised by insulin resistance and persistent hyperglycemia and was identified using ICD-10 codes E11-E11.1 and E11.3-E11.9. Age-standardised prevalence rate (ASPR) and disability-adjusted life year (DALY) rate (ASDR) with 95% uncertainty intervals (UIs) per 100,000 population were evaluated, and total percent changes (TPC) over the study period were calculated. Analyses were stratified by age group, sex and Socio-demographic Index (SDI). Additionally, we assessed the burden attributable to established risk factors for T2DM. ASPRs and ASDRs of T2DM increased across most Asian regions, with the largest increase exhibited in South Asia (ASPR TPC, 66.53 [95% UI, 61.77 to 71.77]; ASDR TPC, 75.59 [35.99 to 123.99] per 100,000 population). In contrast, High-income Asia Pacific showed a declining trend of ASDR (TPC, -2.42 [95% UI, -8.55 to 3.95]) per 100,000 population in 2023. Age-specific incidence rates generally peaked at 55-59 years in most Asian regions; however, East Asian males showed a distinct early peak at 20-24 years (509.61 [95% UI, 399.38 to 615.84] per 100,000 population). Particulate matter pollution was the leading attributable risk factor in all Asian regions. However, a diet low in fruits was the leading contributor in South Asia (157.12 [95% UI, 27.26 to 277.06] per 100,000 population), whereas processed meat consumption increased across most Asian regions, particularly in Central Asia. In most Asian countries, ASPRs increased with SDI, whereas ASDRs declined, although several South Asian countries showed disproportionately high prevalence for their SDI levels. Our findings provide updated regional insights into the heterogeneous epidemiology of T2DM in Asia and may inform targeted prevention and control strategies.