Global Burden, Temporal Trends, Extrapolation Based on Past Trends, and Population Attributable Fractions of Risk Factors for Type 2 Diabetes Mellitus: An Ecological Study Based on the Global Burden of Disease Study 2021

ABSTRACT Background and Aims Amidst the rising global impact of type 2 diabetes mellitus (T2DM), long‐term extrapolations and attributable risk estimations are essential for strategic healthcare planning. This study aimed to investigate the T2DM burden among adults aged ≥ 25 years, extrapolate trends to 2040, and quantify the population attributable fractions (PAFs) of major risk factors. Methods We extracted the prevalence, incidence, mortality, and disability‐adjusted life years (DALYs) of T2DM from 1990 to 2021 using data from the GBD 2021 release. Joinpoint regression was used to analyze the trend in the burden of disease. Then, using the AAPC in the previous step, we extrapolated the burden indicators up to 2040. To determine the independent contribution of each risk factor to the disease burden, we calculated the adjusted PAF. Results All burden indicators and their extrapolations showed a significant increasing trend (p < 0.001). Globally, the prevalence of T2DM increased from 4.82% in 1990 to 10.60% in 2021. Similarly, incidence rose from 255.21 in 1990 to 463.10 per 100,000 in 2021. Mortality and DALYs rates increased from 24.35 to 34.42 per 100,000 and 945.70 to 1594.20 per 100,000, respectively, over the same period (all p < 0.001). Among the risk factors examined, based on adjusted PAF and its extrapolation, high body mass index (BMI) was the most important contributing factor (25.99% to 32.52%). Conclusions The results of this study indicate that the global burden of T2DM is projected to rise significantly, and high BMI, which is associated with multiple metabolic disorders, significantly increases the risk of T2DM. Accordingly, integrating and implementing comprehensive interventions at three levels of prevention (primary, secondary, and tertiary), with a special focus on controlling and reducing obesity and overweight, is essential to control and reduce the burden of diabetes.