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Dec. 8, 2021 — One in 10 adults worldwide currently have diabetes, and these numbers are only expected to increase over the coming decades, according to the new International Diabetes Federation’s Diabetes Atlas.

Increases have been greatest with adult-onset type 1 diabetes and in youths with type 2 diabetes.

The IDF Diabetes Atlas 10th edition was published online Monday.

Half of people who have diabetes, or about 240 million adults, are undiagnosed, and another 319 million have a type of prediabetes, says Atlas co-chair Dianna Magliano, PhD. More than 75% of all adults with diabetes now live in low- and middle-income countries. About 6.7 million deaths in 2021 can be linked to diabetes.

There are also more people with prediabetes, children with type 1 diabetes, and pregnancies affected by diabetes, she says.

“There is a strong need for effective intervention strategies and policies to stall the increase in the number of people developing diabetes across the world,” says Magliano, head of diabetes and population health at the Baker Heart and Diabetes Institute in Australia.

Increase in Deaths Among Those Younger Than 60

One-third of the 6.7 million diabetes-related deaths in 2021 have been in people younger than 60, says Elbert S. Huang, MD, a professor of medicine and public health sciences at the University of Chicago. This shows there’s more need for diabetes prevention programs worldwide.

Diabetes and COVID-19: Increased Risk

COVID-19 brings a higher risk for people with diabetes, says Gillian Booth, MD, a professor in the Department of Medicine at the Institute of Health Policy, Management, and Evaluation at the University of Toronto.

High blood sugar and high glycated hemoglobin (HbA1c) — a measure of long-term blood sugar control in diabetes — can be used to predict severe outcomes.

“Further research is needed to understand the interplay between COVID-19 and diabetes and how best to address the disproportionate burden of COVID-19 among people living with diabetes,” Booth says.

More Research Needed on Adult-Onset Type 1 Diabetes

Jessica Harding, PhD, an assistant professor at Emory University in Atlanta, also calls attention to the higher number of adults being diagnosed with type 1 diabetes.

“There is a growing recognition of the burden of adult-onset type 1 [diabetes],” she says, noting that past studies have focused mostly on children, and it can also be difficult to distinguish type 1 from type 2 in adults.

Countries with the highest incidence of type 1 diabetes in adults older than 20 were the East African nation of Eritrea, followed by Sweden, Ireland, and Finland.

While Nordic countries — Finland, Sweden, and Norway — are among the top in the world for the incidence of both childhood-onset (0-14 years) and adult-onset type 1, Eritrea isn’t even among the top 10 for childhood-onset type 1 diabetes, which makes this a bit of a mystery.

“There is a pressing need to improve the quality and quantity of information on adult-onset type 1 diabetes, particularly in those low and middle-income countries,” Harding says.

Type 2 Diabetes in Youth: A Call for Better Information

As has been reported previously, there has been a big increase in type 2 diabetes in youths, creating more need for education and prevention measures.

“The onset of advanced complications during the most productive time of life has significant impact on individuals, communities, and health economies,” says Andrea Luk, MD, an associate professor in the Department of Medicine and Therapeutics at the Chinese University of Hong Kong.

The Black population in the United States, as well as indigenous populations of the U.S. and Canada, along with Brazil and Mexico, reported the highest numbers of type 2 diabetes in youths. The lowest rates were reported in Europe.

Childhood obesity is not the only factor. Others include family history, inequalities, access to health care, and cultural practices, Luk says.

“Some populations that have a low prevalence of obesity, such as East Asians, reported higher incidence rates of youth-onset type 2 diabetes than populations with a greater burden of childhood obesity,” she says

The rate of type 2 diabetes is generally low in younger children but rises in puberty. The disease tends to affect more girls than boys in youth, but this reverses in adulthood. Youths with type 2 diabetes are at risk for more adverse effects as a result of not controlling their blood sugar and complications arising from this, such as heart and kidney diseases, Luk says.

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