More People With T1D Are Living Into Old Age

People with type 1 diabetes (T1D) appear to be living longer, according to a new report that found the global prevalence of the disease has increased significantly among people aged 65 and older.

The authors of the study—which was based on 3 decades of data—say the increased prevalence shows people with T1D have relatively normal life expectancies thanks to advances in the treatment of the disease. The report was published in The BMJ.¹

They said T1D was traditionally seen as a disease with the potential to have a “profound effect on life span.” As recently as 2015, a study in Scotland suggested that young adults with T1D could expect to live about a dozen fewer years than their peers without T1D.²

Yet, the authors said there has been significant advancement in the treatment and management of people with T1D, factors that anecdotally appear to have improved the ability of patients to live relatively normal-length lives. What has been lacking, however, is comprehensive data on the actual prevalence of the disease among older adults. It is important to have those data, they said, because such data could help highlight the need for targeted clinical guidelines for treating older people with T1D.

The investigators decided to analyze the Global Burden of Disease and Risk Factors Study 2019, which tracked the burden of dozens of diseases in 21 regions and 204 countries and territories between 1990 and 2019. They extracted data about patients with T1D who were aged 65 and older, along with mortality and disability-adjusted life-years (DALY) data.

Their analysis showed a sharp upward trend in the disease’s prevalence. In 1990, the global age-standardized prevalence of T1D in people 65 and older was 400 cases per 100,000 people (95% uncertainty interval [UI], 332-476 per 100,000). In 2019, the prevalence was 514 cases per 100,000 people (95% UI, 417-624).

Mortality, conversely, decreased over the same time span. In 1990, mortality was 4.74 deaths per 100,000 people (95% UI, 3.44-5.9), but in 2019 it fell to 3.54 deaths per 100,000 people (95% UI, 2.91-4.59). Similarly, DALYs decreased over the time span, with the biggest improvement seen among the oldest populations.

“We found that the prevalence of T1D substantially increased in every age subgroup among those aged ≥ 65 years,” the authors wrote. “...In recent years, with the increasing prevalence and accessibility of scientific technologies, an increasing number of older people are turning to technology to improve the management of their diabetes.”

The investigators found the highest prevalence of older people with the disease in higher-income regions, including North America, Australasia, and western Europe. Mortality dropped 13 times faster in high-income countries compared with low-income countries, they found.

Meanwhile, DALYs were highest in Sub-Saharan Africa, Oceania, and the Caribbean, they found. They said the unequal distribution of T1D-related DALYs narrowed over the 3 decades covered in the study, but they said it remained “substantial.” The authors said a high fasting plasma glucose level was the main factor in DALYs, according to the data.

Still, in the broader context, they said the data are promising. An accompanying opinion piece argues that their findings might be the rare case in which increasing prevalence of a disease in a particular population is actually a positive.³

“The increasing prevalence of T1D among people aged 65 and older that we found in our research shows that an increasing number of people with T1D are surviving to older age,” they wrote. “According to our findings, T1DM is no longer a severely life-shortening condition thanks to medical improvements over the past 3 decades.”

However, they also said the data make clear that there is an urgent need for management strategies for older people with T1D, and for the funding and resources necessary to train staff and provide care to this population.

References

1. Yang K, Yang X, Jin C, et al. Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study. BMJ. 2024;385:e078432. doi:10.1136/bmj-2023-078432

2. Livingstone SJ, Levin D, Looker HC, et al. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010. JAMA. 2015;313(1):37-44. doi:10.1001/jama.2014.16425

3. Zhang J, Li Y. Increasing prevalence of type 1 diabetes in older age may be a good sign. BMJ. 2024;385:q1322. doi:10.1136/bmj.q1322