Trends in Type 1 Diabetes Mortality and Disability-Adjusted Life-Years in 27 European Countries and the United Kingdom: 1990–2017

Abstract

Background: Type 1 diabetes mellitus (T1DM) is a prevalent condition with significant morbidity and financial implications. This study aims to compare the temporal trends in T1DM mortality and morbidity across 27 European Union (EU) countries and the United Kingdom between 1990 and 2017. Methods: The Global Burden of Disease Study database was used to extract T1DM age-standardized mortality rates (ASMR) and disability-adjusted life-years rates (DALYs) per 100,000 for 27 EU countries and the United Kingdom. Joinpoint regression analysis was used to interpret trends. Results: All countries, excluding males from the Czech Republic (+28.5%), had relative reductions in ASMR between 1990 and 2017. The largest relative reductions in ASMR between 1990 and 2017 were observed in Slovenia for both males and females (-75.9% and -87.9%, respectively). The smallest relative reductions in ASMR between 1990 and 2017 were seen in Malta for males (-5.9%) and Czech Republic for females (-12.5%). For all years from 1999 to 2017, males in all countries had higher T1DM ASMRs compared to females. Similarly, T1DM DALYs have decreased across all countries excluding males from the Czech Republic and Malta (+10.4% and +5.3%, respectively). The largest relative reductions in DALYs between 1990 and 2017 were observed in Poland for both males and females (-46.4% and -70.4%, respectively). The smallest relative reductions in DALYs were seen in Greece for both males and females (-4.1% and -17.0%, respectively). From all years from 2006 to 2017, males in all countries had higher T1DM DALYs compared to females. Joinpoint regression analysis demonstrated that over the time period covered by the most recent trends (2013/14–2017), small increases in T1DM ASMRs were observed in Malta, Germany, and Denmark, for males, and in the UK, Netherlands, Germany, and Denmark for females. Furthermore, the UK also observed increases in DALY rates for both males and females between 2013 and 2017 (estimated annual percentage increases: males +0.6%, females +0.5%). Discussion: We identified improvements in both the mortality and morbidity from T1DM in European Union Countries between 1990 and 2017. Both the incidence and prevalence of T1DM is known to be increasing, therefore the observed improvements in mortality and morbidity reflect continent wide improvements in disease management. Our data do suggest, however, that the improvements in mortality and DALYs appear to be plateauing in the UK over the time periods covered by the most recent trends.