Monitoring and projection of type 2 diabetes in Sweden for targeted public health interventions

Abstract Background The prevalence of type 2 diabetes (T2D) has increased with notable socioeconomic differences. Since T2D is largely preventable, it is of public health concern to monitor and tailor relevant interventions. A register-based monitoring of T2D is explored to allow for efficient and systematic surveillance. Methods Individuals with T2D were identified through the Swedish National Diabetes Registry and the National Patient Registry. Information on demographics, health care and prescription drug costs, and productivity losses were retrieved from other national registries. Data were combined into a simulation model to project the future prevalence and costs of T2D taking the demographic development into consideration but assuming a continuation of today's risks. Results The age-standardized prevalence of T2D increased from 6 806 (95% CI: 6 786-6 826) in 2012-2015 to 7 464 (95% CI: 7 445-7 484) per 100 000 individuals in 2019-2022. In the latest period, the rate was 8 612 (95% CI: 8 582-8 642) per 100 000 men, compared to 6 329 (95% CI: 6 304-6 355) per 100 000 women. The rates were significantly higher in the low- and middle-education groups, compared to the high-education group where the prevalence were 14 679 (95% CI: 14 609-14 749), 8 030 (95% CI: 7 998-8061) and 4 115 (95% CI: 4 092-4 138) per 100 000 individuals, respectively. The system dynamics model projected an overall increase of the future prevalence equal to 8 900 per 100 000 for the year 2040, which corresponds to a prevalence of 10 450 per 100 000 men and 7 290 per 100 000 women. The societal costs of T2D are estimated to increase by 22%, from approximately SEK 4.9 bn in 2025 to SEK 5.8bn in 2040. For comparison, the corresponding costs for cancer are estimated to increase by 19%. Conclusions The projection confirms a continuous increase in prevalence and costs. As T2D is highly correlated to lifestyle factors, public health interventions are needed to reduce T2D with a focus on socioeconomic inequalities. Key messages • It is of public health significance to monitor the development of type 2 diabetes as the results can support health promotion and disease prevention. • Public health interventions need to target groups with low socioeconomic status to reduce inequalities.