Dynamics of diabetes prevalence, incidence and mortality in France: A nationwide study, 2013-2021

Aim: To estimate the time trends of treated diabetes incidence, prevalence and mortality in France from 2013 to 2019 and to compare with the Covid-19 pandemic period (2020-2021). Methods: Using the French National Health Data System, people with treated diabetes >= 45 years-old were identified based on their medications. Annual time trends over 2013-2019 were estimated using Poisson loglinear model controlled for age, year and region for prevalence (aPTT), incidence (aITT) and mortality (aMTT). Numbers of incident cases and deaths in 2020-2021 were estimated from these trends, and compared with those observed. Results: Over 2013-2019, incidence and mortality declined significantly in men, aITT=-0.61 % (-0.95;-0.26); aMTT=-0.52 % (-0.81;-0.22), leading to a stable prevalence, aPTT=0.18 % (-0.03;0.40). In women, the fall in incidence was more marked, aITT=-1.45 % (-1.95;-0.95), mortality was stable, aMTT=-0.19 % (-0.54;0.15), leading to a significant decrease in prevalence, aPTT=-0.31 % (-0.60;-0.02). Compared with people not treated for diabetes, the relative risk of mortality increased significantly in men over the 2013-2019 period, from 1.38 (1.37;1.39) to 1.42 (1.41;1.43), while the risk remained stable in women, from 1.45 (1.44;1.46) to 1.46 (1.45;1.47). In 2020, there were 7,458 and 4,404 additional deaths and 3,550 and 4,919 new cases in respectively men and women. In 2021, there were 11,576 and 6,371 additional deaths and 30,057 and 26,169 new cases in respectively men and women. Conclusion: This study reports a favorable dynamic of diabetes over 2013-2019 followed by a sharp increase in incidence and mortality in 2020 and 2021. Continued monitoring is necessary to identify long-term trend and potential indirect effect of the pandemic.