Trends in incidence of total or type 2 diabetes: systematic review.

Dianna J Magliano, Rakibul M Islam, Elizabeth L M Barr, Edward W Gregg, Meda E Pavkov, Jessica L Harding, Maryam Tabesh, Digsu N Koye, Jonathan E Shaw

Journal: BMJ (Clinical research ed.) 2019;366():l5003

PMID: 31511236

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Plain Language Summary

Incidence measures the proportion of people who develop diabetes over a period of time among the population at risk. The aim of this study is to systematically review literature which reports diabetes incidence trends. This study is a systemic review of 47 studies. A total of 62% (n=29) of the studies exclusively reported on type 2 diabetes, and 38% (n=18) reported on total diabetes. Findings show that the incidence of diagnosed diabetes increased in most populations from the 1960s to the early 2000s, after which a pattern emerged of levelling trends in 30% and declining trends in 36% of the reported populations. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Authors conclude that improvement of the collection, availability, and analysis of incidence data will be important to effectively monitor the epidemic and guide prevention efforts into the future.

Abstract

OBJECTIVE

To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes.

DESIGN

Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines.

DATA SOURCES

Medline, Embase, CINAHL, and reference lists of relevant publications.

ELIGIBILITY CRITERIA

Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year.

RESULTS

Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively.

CONCLUSIONS

The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different.

SYSTEMATIC REVIEW REGISTRATION

Prospero CRD42018092287.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Address: Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia [email protected].; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.; Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.; Centres for Diseases Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA.; School of Public Health, Epidemiology and Biostatistics, Imperial College London, London, UK.

DOI: 10.1136/bmj.l5003