Burden of type 2 diabetes mellitus and risk factor attribution among older adults: A global, regional, and national analysis from 1990 to 2021, with projections up to 2040.

Aims: To investigate the global, regional, and national burden and risk factors of type 2 diabetes mellitus (T2DM) among older adults aged ≥65 years from 1990 to 2021, with projections to 2040.

Materials and methods: Using the Global Burden of Disease database, this study analysed global, regional, and national T2DM burden and risk factors across sex, age groups, and Socio-Demographic Index (SDI) levels. Annual percentage changes were calculated, and predictions used a Bayesian age-period-cohort model.

Results: Among older adults aged ≥65 years, the global age-standardized prevalence and mortality of T2DM rose by 1.9% and 0.32% per year, respectively, from 1990 to 2021. T2DM's proportion of total disability-adjusted life years (DALYs) and mortality from all diseases increased, as did its share of T2DM cases across all age groups. Mortality rose fastest in the 85-89 group (0.52% annually). High SDI regions exhibited the highest prevalence, whereas lower SDI correlated with higher mortality rates. Eastern Europe and Uzbekistan experienced the fastest DALYs growth. The global burden of T2DM in older adults is projected to continue increasing by 2040. Globally, high body mass index contributed most to T2DM burden, while high temperature and sugar-sweetened beverages (SSBs) showed the fastest-growing DALYs rates. The fastest-growing risk factor in high-SDI regions was sugar-sweetened beverages, while high temperature was the fastest-growing risk in low-SDI regions.

Conclusions: Diabetes cases among older adults have tripled globally since 1990 and are projected to keep increasing. Wealthier nations face diet-related risks, while poorer regions are more affected by environmental factors. Region-specific prevention strategies are urgently needed.