---
title: "Global burden and future trends of diabetes mellitus in adolescents (1990–2040): GBD 2023 analysis"
id: "plos-one-5-global-burdens-of-diabetes-mellitus-in-adolescents-from-1990-to-2023-and-future"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-5-global-burdens-of-diabetes-mellitus-in-adolescents-from-1990-to-2023-and-future"
content_type: "clinical_feed_article"
specialty: "Pediatrics"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475"
published_at: "2026-09-16T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Global burden and future trends of diabetes mellitus in adolescents (1990–2040): GBD 2023 analysis
## Provenance & Clinical Metadata
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- **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475)
- **Published At:** 2026-09-16T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This GBD 2023–based study quantified the global burden of **diabetes mellitus** in adolescents (ages 10–19) from 1990 to 2023 and projected trends through 2040 using ARIMA forecasting. - Key burden metrics were age-standardized incidence rate (**ASIR**), age-standardized prevalence rate (**ASPR**), age-standardized mortality rate (**ASMR**), and age-standardized disability-adjusted life year rate (**ASDR**). - From 1990 to 2023, incident cases, prevalent cases, and DALYs rose substantially; deaths increased only modestly. ASIR, ASPR, and ASDR rose steadily while ASMR remained low and showed a slight decline. - In 2023 an estimated 6.07 million adolescents were living with diabetes (ASPR: 458.07 per 100,000). The highest ASPR occurred in low-SDI regions (482.25 per 100,000), followed by high-SDI regions (442.81 per 100,000). - Low-SDI regions bore the largest DALY and mortality burdens. Health inequality was assessed with the slope index of inequality (SII) and the concentration index (CI) to compare absolute and relative disparities by SDI. - Sex and age patterns: by 2023 males exceeded females in incidence and prevalence; the increase in burden was driven primarily by adolescents aged 15–19 years. Authors note sex trends may partly reflect changing screening and diagnostic practices. - Forecasting with sex- and region-stratified **ARIMA** models (auto.arima(), AICc selection, ADF for differencing, Ljung-Box for residual checks) projects continued increases in ASIR, ASPR, and ASDR through 2040; ASMR expected to remain low and stable. - The findings highlight rising non-fatal morbidity despite stable mortality, substantial geographic heterogeneity, and continuing inequalities — underscoring need for age-, sex-, and region-specific public health strategies. - Data used are publicly available from the GBD 2023 via GHDx; no new primary data were generated in this analysis.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0358475) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#citedHeader) * 0 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475#discussedHeader) Open Access Peer-reviewed Research Article # Global burdens of diabetes mellitus in adolescents from 1990 to 2023 and future trend predictions: An analysis of the Global Burden of Disease study 2023 * Xinyi Qiu , Contributed equally to this work with: Xinyi Qiu, Limei Guan Roles Conceptualization, Data curation, Investigation, Methodology, Software, Visualization, Writing – original draft Affiliation College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), Fuzhou, Fujian, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-6254-7875 ](https://orcid.org/0000-0002-6254-7875 "ORCID Registry") ⨯ * Limei Guan , Contributed equally to this work with: Xinyi Qiu, Limei Guan Roles Data curation, Formal analysis, Writing – review & editing Affiliation College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), Fuzhou, Fujian, China ⨯ * Hui Liu Roles Conceptualization, Funding acquisition, Validation, Writing – review & editing * E-mail: liuhui304@163.com Affiliation College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), Fuzhou, Fujian, China ⨯ # Global burdens of diabetes mellitus in adolescents from 1990 to 2023 and future trend predictions: An analysis of the Global Burden of Disease study 2023 * Xinyi Qiu, * Limei Guan, * Hui Liu ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 16, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0358475) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0358475) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0358475) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0358475) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#sec005) * [Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#sec013) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#sec027) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#sec029) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#sec030) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0358475) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475) ## Abstract ### Background Adolescent diabetes mellitus (DM) constitutes a significant global public health challenge. This study seeks to quantify the burden of DM in adolescents aged 10–19 years from 1990 to 2023 and to forecast trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) through 2040. ### Methods Epidemiological data for DM among adolescents in 204 countries and territories were obtained from the Global Burden of Disease (GBD) 2023 database. The global burden was evaluated using age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR), stratified by region, sex, age, and Socio-demographic Index (SDI). Health inequality was assessed using the slope index of inequality (SII) and concentration index (CI). Future trends were forecast using an autoregressive integrated moving average (ARIMA) model with model-specific validation (AICc, Ljung-Box test). ### Results From 1990 to 2023, global adolescent DM burden increased substantially. ASIR, ASPR, and ASDR rose consistently, whereas ASMR remained relatively stable with a slight decline. In 2023, an estimated 6.07 million adolescents were living with DM (ASPR: 458.07 per 100,000). The highest ASPR was observed in low-SDI regions (482.25 per 100,000), followed by high-SDI regions (442.81 per 100,000). Low-SDI regions also carried the highest DALY and mortality burdens. Males progressively exceeded females in both incidence and prevalence by 2023, although this observed sex reversal may partly reflect changes in screening and diagnostic practices. The overall burden increase was primarily driven by adolescents aged 15–19 years. ARIMA forecasts indicate that ASIR, ASPR, and ASDR are projected to continue increasing through 2040, while ASMR is expected to remain low and stable. ### Conclusions The burden of adolescent DM increased considerably from 1990 to 2023, with marked heterogeneity by age, sex, and geography. The rising non-fatal burden (incidence, prevalence, DALYs) contrasts with stable mortality, suggesting improvements in acute care alongside growing morbidity. Persistent health disparities and projected increases underscore the need for age-, sex-, and region-specific public health strategies. ## Figures ![Fig 7](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g007) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g002) ![Fig 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g003) ![Fig 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g004) ![Fig 5](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g005) ![Fig 6](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g006) ![Fig 7](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g007) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g002) ![Fig 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0358475.g003) **Citation:** Qiu X, Guan L, Liu H (2026) Global burdens of diabetes mellitus in adolescents from 1990 to 2023 and future trend predictions: An analysis of the Global Burden of Disease study 2023. PLoS One 21(9): e0358475. https://doi.org/10.1371/journal.pone.0358475 **Editor:** Masoud Rahmati, Lorestan University, IRAN, ISLAMIC REPUBLIC OF **Received:** April 13, 2026; **Accepted:** September 1, 2026; **Published:** September 16, 2026 **Copyright:** © 2026 Qiu et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** The data underlying the results presented in this study are publicly available from the Global Burden of Disease (GBD) 2023 database via the Global Health Data Exchange (GHDx): . No new data were generated in this study. **Funding:** H.L. received funding from the Startup Fund for Scientific Research, Fujian Medical University, China (Grant No. 2021QH1196). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Diabetes mellitus (DM) is among the most common and swiftly increasing disorders globally [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.ref001),[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.ref002)]. Extended duration of diabetes mellitus can result in dysfunction and failure of various organs, particularly the eyes, kidneys, nerves, heart, and blood vessels. The latest data from the International Diabetes Federation (IDF) Diabetes Atlas (11th Edition, 2025) estimates that around 589 million adults aged 20–79 globally were living with diabetes in 2024, representing 11.1% of the global population in this age group, with nearly half undiagnosed. The frequency of diabetes mellitus escalates with age, peaking at 24.8% among adults aged 75–79 [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.ref003),[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.ref004)]. The incidence of diabetes mellitus is anticipated to reach 853 million by 2050, mostly due to aging demographics, increasing obesity prevalence, and lifestyle influences. Significantly, low- and middle-income nations are projected to bear 75% of this illness burden. Type 1 diabetes mellitus (T1DM) is the most common form of diabetes mellitus among adolescents, with its highest frequency occurring during this developmental stage and a mean age of diagnosis approximately around 12 years. Simultaneously, escalating rates of childhood obesity have resulted in a heightened incidence of type 2 diabetes mellitus (T2DM) among adolescents across multiple nations. T2DM is estimated to account for approximately 32% of DM cases within this demographic. Increasing researches indicate that early-onset DM correlates with a heightened risk of premature complications, significantly impacting patients’ quality of life and long-term health outcomes [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.ref005),[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.ref006)]. Research conducted by the Collaborative Group on Emerging Risk Factors indicates that life expectancy may decrease by around 3–4 years for every decade earlier in the beginning of DM, a trend that presents a major challenge to future public health systems [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.ref007)]. Despite comprehensive documentation of the effects of T1DM in individuals aged 10–24 years and T2DM in patients aged 15–39 years, a systematic analysis of the long-term trends of both diabetes types in the adolescent population remains insufficient, particularly concerning regional, gender, and socio-demographic index (SDI) levels. This study systematically analyzed the disparities in the disease burden of DM from 1990 to 2023 across various regions, genders, ages, and sociodemographic index subgroups within the adolescent population, utilizing core indicators such as disability-adjusted life years (DALYs), mortality, morbidity, and prevalence. Additionally, it conducted future disease burden predictions and assessments of health inequality to furnish a scientific foundation for disease prevention and the formulation of public health strategies for this demographic. ## Methods ### Data sources The data for this analysis were obtained from the 2023 GBD database, encompassing prevalence, incidence, DALYs, and mortality associated with diabetes mellitus in the adolescent population. The 2023 GBD database employs an integrative meta-regression methodology to address data constraints, producing standardized burden estimates for 371 diseases and injuries across 204 nations and regions, facilitating multi-tiered (global, regional, national) comparison research. This study quantified the disease burden of diabetes mellitus in adolescents by mortality rates, prevalence, death counts, and DALYs, stratifying the burden across 204 geographical regions by age and gender. ### SDI regional classification The SDI integrates three fundamental determinants: national per capita GDP, educational attainment of the population (aged 15 and older), and age-specific fertility rates for individuals under 25 years. The index is measured on a scale from 0 (little development) to 1 (maximum development). In this study, all nations and territories were categorized into five SDI quintiles (high, high-middle, middle, low-middle, and low) according to their 2019 reference vaff, adhering to the established GBD stratification structure. ### Estimated annual percentage changes (EAPCs) This study generated the EAPC by employing a time series regression model to evaluate the temporal trend of age-standardized rates (ASRs). This epidemiological methodology implements temporal age-standardized rate patterns via semi-logarithmic regression modeling: ![](https://journals.plos.org/plosone/article/file?type=thumbnail&id=10.1371/journal.pone.0358475.e001) In this equation, α denotes the intercept, β signifies the slope, and ε represents the stochastic error term. The EAPC was calculated using the subsequent formula: ![](https://journals.plos.org/plosone/article/file?type=thumbnail&id=10.1371/journal.pone.0358475.e002) The 95% confidence intervals (CI) represent model-derived variance estimates. Trend directionality is ascertained using interval analysis: persistent rises required EAPC and lower confidence interval limits above 0, whereas drops require EAPC and upper confidence interval limits falling below 0. ### Health inequality analysis Following the World Health Organization’s recommendations, the slope index of inequality (SII) and the Concentration Index (CI) were employed to evaluate both absolute and relative income-related disparities among countries. SII denotes the absolute disparity in illness burden between the highest and lowest SDI categories. A positive SII signifies a greater burden on high SDI countries, whereas a negative SII denotes a heavier load on low SDI countries. The CI is employed to evaluate the comparative discrepancy in the burden of DM between nations by fitting the Lorenz concentration curve using cumulative prevalence, incidence, DALYs, mortality, and cumulative population data. The CI is a numerical integration of the area beneath the curve, spanning from −1–1. A negative CI value signifies an increased concentration of DM burden in populations living in nations with lower SDI. ### Autoregressive integrated moving average (ARIMA) model To forecast the future burden of diabetes mellitus among adolescents from 2023 to 2040, we employed a sex-stratified and region-stratified autoregressive integrated moving average (ARIMA) framework. For each time series — defined by disease (diabetes), measure (incidence, prevalence, mortality, DALYs), region (global and five SDI regions), and sex (female, male, both) — we constructed individual ARIMA models using the following procedure. First, age-standardized rates for adolescents aged 10–19 years from 1990 to 2023 were extracted from the GBD 2023 database. Second, for each unique combination, the optimal model order (parameters p,d,q) was automatically selected using the auto.arima() function in R (version 4.4.1) with the **corrected Akaike Information Criterion (AICc)** as the selection criterion. The function performs stepwise searches across a constrained parameter space to identify the model that minimizes the AICc. Third, the augmented Dickey-Fuller (ADF) test was applied to determine the order of differencing (d) required to achieve stationarity. For all selected models, the Ljung-Box test was used to verify that residuals exhibited no significant autocorrelation (p > 0.05), confirming adequate model specification. Model fit was evaluated using three key statistics: **AIC** , **Bayesian Information Criterion (BIC)** , and **log-likelihood**. The forecast horizon was set to 2040 (17 years ahead, from 2023). Prediction intervals at 80% and 95% confidence levels were constructed based on the estimated forecast error variance. All model specifications (ARIMA orders) and goodness-of-fit statistics are summarized in [S1 Table](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.s001). This transparent, data-driven approach ensures that model selection is reproducible and that forecast uncertainty is explicitly communicated. ### Statistical analysis Statistical analyses were executed within the R (version 4.4.1). This investigation adhered to non-participatory research protocols with no direct engagement of human subjects or community populations. Dissemination strategies were expressly designed without incorporating participatory knowledge translation initiatives involving patient advocacy groups or community stakeholders. ## Results ### Global burden of DM in adolescents, 1990–2023 Between 1990 and 2023, the global prevalence of diabetes mellitus among adolescents escalated significantly. Incident cases, prevalent cases, and DALYs had significant increases during the study period, but deaths grew just somewhat. Consequently, ASIR, ASPR, and ASDR exhibited persistent rising trends, although the ASMR remained comparatively steady with a marginal decrease ([Fig 1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone-0358475-g001) and [S1 Table](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0358475#pone.0358475.s001)). [![thumbnail](https://journals.plos.org/plosone/article/figure/im
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