Diabetes is a serious, chronic disease characterized by elevated blood glucose concentrations related to the effects of abnormal β-cell biology on insulin action. According to estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, diabetes was the eighth leading cause of death and disability combined in the world, with nearly 460 million people across every country and age group living with the disease in 2019. Diabetes represents a substantial burden to health-care systems, with estimates by the International Diabetes Federation (IDF) indicating that 537 million people worldwide had diabetes in 2021, resulting in health expenditures of US$966 billion globally, forecast to reach more than $1054 billion by 2045. The 2016 NCD Risk Factor Collaboration (NCD-RisC) Study projected that the probability of meeting global targets to halt the rising diabetes prevalence by 2025 was lower than 1% for women and even lower for men. Diabetes is also a major risk factor for ischaemic heart disease and stroke, which were estimated by GBD 2019 to be the first and second leading causes, respectively, of the global disease burden. Type 1 and type 2 diabetes are the most common forms of the disease and are diagnosed through well-established criteria. Type 1 diabetes often develops during childhood, while type 2 diabetes has a strong genetic component and a robust association with obesity and a sedentary lifestyle. Although prevention and management approaches differ between diabetes types, there are well-established strategies to reduce the disease burden, including limiting risk factors for type 2 diabetes, increasing access to treatment such as insulin, and enhancing the health-system infrastructure. However, social determinants of health have led to considerable disparities across populations in risk factor profiles, and are designed to capture both undiagnosed and diagnosed cases. Our study, as part of the larger GBD analytical enterprise, leverages the newest available data and methods. We apply and detail the updated GBD analytical and evidentiary framework to generate comprehensive, type-specific estimates of diabetes burden for all regions of the world, across the human lifespan, for males and females separately and combined. We also quantify the proportion of type 2 diabetes attributable to 16 selected risk factors concurrently to highlight the main drivers of diabetes. The continued global spread of diabetes presents a massive public health challenge. The location-specific and population-specific data we present on the likely trajectory of diabetes in the coming decades are crucial to inform policy makers and public health professionals as they prepare to address the impending threat to the communities they serve.

GBD 2021 Diabetes Collaborators, Dr Kanyin, Liane Ong, A Aali, N Rahnavard, E J Boyko, A Y Aravkin, S D Morrison, R Somayaji, R J D Sorensen, Y Wu, M Ghasemi Nour, N Morovatdar, G Pourali, A Sahebkar, S Tabatabaei, A Kolahi, A Ahmadi, S Sabour, M Ajami, F Ghadirian, A Haj-Mirzaian, E Jamshidi, R Mirfakhraie, F Montazeri, S Rahmani, P Raee, S Safi, M Taheri, H, E Mohammadi, P Shobeiri, M Shafie, E Taki, S Vahabi, S Momtazmanesh, D Contreras, R Abd-Rabu, A Seidu, T D Adane, K H Misgina, G D Demissie, M Ekholuenetale, M Rahimifard, S Akinyemi, E K Chowdhury, J A Y Mackie, P Vart, M Moradi Sarabi, F Al-akkad, A Badawi