Burden of T1DM and T2DM among adolescents in Western Europe, 1990-2019: results from the GBD 2019

BACKGROUND: Type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are major causes of global morbidity and mortality. As little is known about the burden of DM in adolescents in Western Europe (WE), we aimed to explore the epidemiology of T1DM and T2DM among 10-24-year-olds, including temporal trends. METHODS: Estimates were retrieved from the Global Burden of Diseases study 2019 (GBD 2019). We reported counts, rates per 100,000 population, and percentage changes from 1990 to 2019 for incidence, prevalence and years lived with disability (YLDs) of T1DM and T2DM, and the burden of T2DM in YLDs attributable to high body mass index (HBMI), for 24 WE countries. RESULTS: In 2019, prevalence and YLDs estimates were higher for T1DM than T2DM among 10-24 years old adolescents in WE. However, T2DM incidence rates per 100,000 population were 3.5 times higher than T1DM. T2DM showed a greater increase in prevalence and YLDs than T1DM in the 30-year observation period in all WE countries. The highest prevalence rate of T1DM was in Finland (542.7 [402.9-681.0]), while the United Kingdom had the highest prevalence for T2DM (751.0 [501.2-1063.3]). Prevalence increased with age, while only minor differences were observed between sexes. In 2019, HBMI accounted for 28.8 (12.6-54.9) of the attributable YLD rates for T2DM in age group 20-24 years in WE. CONCLUSIONS: The findings show the substantial burden posed by DM among adolescents in WE. The study can help inform the development and implementation of appropriate infrastructure and healthcare frameworks for adolescent-centred diabetes care. It highlights the need for transition services, and adolescent-oriented education programs, as well as investments in data systems to improve the availability and quality of data for T1DM and T2DM in 10-24-year-olds. Finally, it can be used to guide policymakers towards prevention of obesity and broader policy actions on the social and commercial determinants of health across the life course. KEY MESSAGES: • Adolescent-oriented health system responses on transition services, data collection systems, education, and complications’ prevention are needed to achieve targets for NCDs within the 2030 UN SDGs. • T2DM should not only be considered as an adult-onset disease, implying a paradigm shift for paediatric DM services and a strengthening of interventions on social and commercial determinants of health.