An Italian study published in Scientific Reports, a Nature magazine, has detected a rapid increase in patients with type 2 diabetes in our country due to aging, preventable risk factors and the worsening of the socioeconomic context, as well as complications of the disease, especially neurological and kidneys. The implications underline the need to better analyze the burden of the disease on the Italian healthcare system, society and economy.
Diabetes is a public health problem and its rate of increase is alarming, with a projected 1.3 billion cases by 2050. The disease is associated with serious complications such as kidney failure, lower limb amputation, blindness and disease. cardiovascular, which compromise the functional capacity, autonomy and quality of life of individuals.
In particular the type 2 diabetes represents over 90% of diabetes cases worldwide. The main risk factors for the increase in the incidence and prevalence of the condition are the aging of the population, sedentary lifestyle, overweight and obesity, as well as socioeconomic contexts, including urbanization. In 2021, the estimated global prevalence of type 2 diabetes in the adult population was nearly 10% and is projected to rise to 11.3% by 2030 and 12.2% by 2045, without considering undiagnosed diabetes which it unconsciously affects one in two adults.
Rapid increase in risk factors for diabetes in Italy
In Italy the prevalence of type 2 diabetes is approximately 6.4%, higher in men than women. Although the mortality rate has decreased by more than 20% in all age groups in the last decade, sedentary lifestyle, overweight and obesity have reached alarming levels: in 2021, 33.7% of Italians were physically inactive, 34.2% of adults were overweight and 12.0% were obese, the authors noted.
Patients with type 2 diabetes are rapidly increasing in Italy due to aging, preventable risk factors and a worsening socioeconomic context. Metabolic disease and its consequences impose a heavy toll on healthcare systems and the economy, given costly management, difficulties in coping with daily life, and decreased patient/worker productivity.
Calculation of years lived with disability due to diabetes and its consequences
Considering the long life expectancy in Italy and a decreasing mortality rate due to type 2 diabetes, the objective of the study conducted by Cristiana Abbafatiof the Department of Legal and Economic Studies, La Sapienza University of Rome, and colleagues, was to calculate the years lived with disability (YLDs) for diabetes and its sequelae grouped into three categories: neuropathy, chronic kidney disease and no complications, taking into account sex, year and geographic location.
The data come from the Italian Association of Diabetologists database, the most comprehensive longitudinal source of national outpatient data, and this is the first attempt to measure YLDs from data that are not based on self-reported diabetes diagnoses. YLDs are obtained by multiplying the number of individuals living with a specific health condition by a disability burden that represents the amount of health loss associated with that particular condition.
«Considering the country’s extraordinary regional disparities and the high impact of the Great Recession on its overall social and economic contexts, Italy represents a particularly interesting context for measuring YLDs for type 2 diabetes and for improving intervention models for prevention, health care, work organization, and political agendas” the authors underlined.
The global economic crisis of 2008 hit Italy particularly hard due to the stagnant economy for some time, with a high structural unemployment rate. Due to the exorbitant public debt, fiscal policy was necessarily restrictive and required mandatory reforms in view of the Stability Pact signed to enter the European Union. The period of austerity lasted until 2018. As a result, access to healthcare became more difficult and unequal, and the socio-economic context significantly deteriorated.
Significant increase in neurological and renal complications
The results showed an increase in age-standardized rates of YLDs for type 2 diabetes and its consequences, especially neuropathy, with a stronger trend in the central macroregion of the country and among men, and that the year 2009 marked a structural change in the growth rate of YLDs.
Over the years there has been a consistent decline in the percentage of patients without diabetes complications, combined with an increase in patients suffering from chronic renal failure and neurological disorders, highlighting an increasing severity of the disease due to the increase in the percentage of patients with comorbidity. Together, neurological and renal complications represent a percentage of patients that corresponds to approximately half of those without complications, with results fully consistent with those present in the literature, in particular with those that have captured the global trends of complications of type diabetes 2 in high-income countries.
«Our results constitute an important contribution as they provide insights into an issue never evaluated in Italy» the researchers wrote. “The implications highlight the need to carry out more analyzes of the burden of disease, which better demonstrate the extent of the burden on the Italian healthcare system, society and economy.”
Given the high costs of managing type 2 diabetes and its consequences, the reduction in the ability to cope with daily life and the productivity of the patient/worker, these results underline the urgency of the preventive strategy in various contexts, a necessary condition to help contain the emerging epidemic of diabetes complications.
References
Abbafati C et al. Measures of type 2 diabetes burden in Italy assessed using the AMD dataset over a twelve-year span across the Great Recession. Sci Rep. 2024 Feb 28;14(1):4901.
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Tags: Type diabetes rapid growth Italy disease
