{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T18:03:43Z","timestamp":1789581823861,"version":"build-2803163510"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012597","name":"Scientific Startup Foundation for Doctors of Northwest A and F University","doi-asserted-by":"publisher","award":["2021QH1196"],"award-info":[{"award-number":["2021QH1196"]}],"id":[{"id":"10.13039\/501100012597","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescent diabetes mellitus (DM) constitutes a significant global public health challenge. This study seeks to quantify the burden of DM in adolescents aged 10\u201319 years from 1990 to 2023 and to forecast trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) through 2040.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201319 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358475","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:34:20Z","timestamp":1789580060000},"page":"e0358475","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6254-7875","authenticated-orcid":true,"given":"Xinyi","family":"Qiu","sequence":"first","affiliation":[{"name":"College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Children\u2019s Hospital (Fujian Branch of Shanghai Children\u2019s Medical Center)","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Guan","sequence":"additional","affiliation":[{"name":"College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Children\u2019s Hospital (Fujian Branch of Shanghai Children\u2019s Medical Center)","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Liu","sequence":"additional","affiliation":[{"name":"College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Children\u2019s Hospital (Fujian Branch of Shanghai Children\u2019s Medical Center)","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"pone.0358475.ref001","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/2047487319881021","article-title":"The global epidemics of diabetes in the 21st century: current situation and perspectives","volume":"26","author":"E Standl","year":"2019","journal-title":"Eur J Prev Cardiol"},{"issue":"6","key":"pone.0358475.ref002","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s11892-013-0433-5","article-title":"The emerging global epidemic of type 1 diabetes","volume":"13","author":"J Tuomilehto","year":"2013","journal-title":"Curr Diab Rep"},{"key":"pone.0358475.ref003","doi-asserted-by":"crossref","first-page":"112277","DOI":"10.1016\/j.diabres.2025.112277","article-title":"Global type 1 diabetes prevalence, incidence, and mortality estimates 2025: results from the International diabetes Federation Atlas, 11th Edition, and the T1D Index Version 3.0","volume":"225","author":"GD Ogle","year":"2025","journal-title":"Diabetes Res Clin Pract"},{"key":"pone.0358475.ref004","doi-asserted-by":"crossref","first-page":"108078","DOI":"10.1016\/j.diabres.2020.108078","article-title":"Diabetes and global ageing among 65-99-year-old adults: findings from the International Diabetes Federation Diabetes Atlas, 9th edition","volume":"162","author":"A Sinclair","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"issue":"6","key":"pone.0358475.ref005","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.pedhc.2024.07.005","article-title":"Changes in self-efficacy during COVID-19 among adolescents with type 1 diabetes mellitus: a qualitative study","volume":"38","author":"N Okonkwo","year":"2024","journal-title":"J Pediatr Health Care"},{"issue":"22","key":"pone.0358475.ref006","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1016\/j.jacc.2008.07.062","article-title":"Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2 diabetes mellitus","volume":"52","author":"LJ Rijzewijk","year":"2008","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"pone.0358475.ref007","doi-asserted-by":"crossref","first-page":"292","DOI":"10.7326\/0003-4819-155-5-201109060-00006","article-title":"Lifestyle factors and risk for new-onset diabetes: a population-based cohort study","volume":"155","author":"JP Reis","year":"2011","journal-title":"Ann Intern Med"},{"issue":"1","key":"pone.0358475.ref008","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s12916-025-03890-w","article-title":"Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021","volume":"23","author":"X Chen","year":"2025","journal-title":"BMC Med"},{"issue":"1","key":"pone.0358475.ref009","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1186\/s12916-018-1225-1","article-title":"Insulin translates unfavourable lifestyle into obesity","volume":"16","author":"H Kolb","year":"2018","journal-title":"BMC Med"},{"issue":"1","key":"pone.0358475.ref010","doi-asserted-by":"crossref","first-page":"27","DOI":"10.7570\/jomes24045","article-title":"Ultra-processed food consumption and obesity: a narrative review of their association and potential mechanisms","volume":"34","author":"J-S Shim","year":"2025","journal-title":"J Obes Metab Syndr"},{"issue":"2","key":"pone.0358475.ref011","first-page":"225","article-title":"Rapid rise in incidence of childhood type 1 diabetes in Greater Poland over a 20-year period (1998\u20132018)","volume":"61","author":"E Niechcia\u0142","year":"2024","journal-title":"Acta Diabetol"},{"issue":"9","key":"pone.0358475.ref012","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.2337\/dc16-1066","article-title":"Youth-onset type 2 diabetes consensus report: current status, challenges, and priorities","volume":"39","author":"KJ Nadeau","year":"2016","journal-title":"Diabetes Care"},{"issue":"12","key":"pone.0358475.ref013","doi-asserted-by":"crossref","first-page":"2648","DOI":"10.2337\/dci18-0052","article-title":"Evaluation and management of youth-onset type 2 diabetes: a position statement by the American Diabetes Association","volume":"41","author":"S Arslanian","year":"2018","journal-title":"Diabetes Care"},{"issue":"3","key":"pone.0358475.ref014","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1210\/er.2015-1137","article-title":"Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus","volume":"37","author":"A Kautzky-Willer","year":"2016","journal-title":"Endocr Rev"},{"key":"pone.0358475.ref015","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.physbeh.2017.08.016","article-title":"Gender differences in glucose homeostasis and diabetes","volume":"187","author":"F Mauvais-Jarvis","year":"2018","journal-title":"Physiol Behav"},{"issue":"10397","key":"pone.0358475.ref016","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021","volume":"402","author":"GBD 2021 Diabetes Collaborators","year":"2023","journal-title":"Lancet"},{"issue":"15","key":"pone.0358475.ref017","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1056\/NEJMoa1610187","article-title":"Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012","volume":"376","author":"EJ Mayer-Davis","year":"2017","journal-title":"N Engl J Med"},{"issue":"11","key":"pone.0358475.ref018","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.2337\/dc11-1723","article-title":"Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society)","volume":"34","author":"A Peters","year":"2011","journal-title":"Diabetes Care"},{"issue":"7","key":"pone.0358475.ref019","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/pedi.13408","article-title":"ISPAD clinical practice consensus guidelines 2022: diabetes in adolescence","volume":"23","author":"JW Gregory","year":"2022","journal-title":"Pediatr Diabetes"},{"issue":"6","key":"pone.0358475.ref020","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.2337\/dc12-2420","article-title":"Rapid rise in hypertension and nephropathy in youth with type 2 diabetes: the TODAY clinical trial","volume":"36","author":"TODAY Study Group","year":"2013","journal-title":"Diabetes Care"},{"issue":"8","key":"pone.0358475.ref021","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1001\/jama.2021.11165","article-title":"Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017","volume":"326","author":"JM Lawrence","year":"2021","journal-title":"JAMA"},{"issue":"5","key":"pone.0358475.ref022","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1056\/NEJMoa2100165","article-title":"Long-term complications in youth-onset type 2 diabetes","volume":"385","author":"TODAY Study Group","year":"2021","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0358475.ref023","article-title":"Hemoglobin A1c and type 2 diabetes incidence among adolescents with overweight and obesity","volume":"7","author":"FM Hoe","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"pone.0358475.ref024","doi-asserted-by":"crossref","first-page":"130","DOI":"10.2215\/CJN.04510422","article-title":"Continuous glucose monitoring to optimize management of diabetes in patients with advanced CKD","volume":"18","author":"RJ Galindo","year":"2023","journal-title":"Clin J Am Soc Nephrol"},{"key":"pone.0358475.ref025","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1146\/annurev-publhealth-090419-103005","article-title":"Sugar-sweetened beverage reduction policies: progress and promise","volume":"42","author":"J Krieger","year":"2021","journal-title":"Annu Rev Public Health"},{"issue":"2","key":"pone.0358475.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003015","article-title":"An evaluation of Chile\u2019s Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: a before-and-after study","volume":"17","author":"LS Taillie","year":"2020","journal-title":"PLoS Med"},{"issue":"10","key":"pone.0358475.ref027","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1007\/s00125-019-4939-5","article-title":"Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course","volume":"62","author":"AG Huebschmann","year":"2019","journal-title":"Diabetologia"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358475","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:34:27Z","timestamp":1789580067000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358475"}},"subtitle":[],"editor":[{"given":"Masoud","family":"Rahmati","sequence":"first","affiliation":[{"name":"Lorestan University","place":["IRAN, ISLAMIC REPUBLIC OF"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0358475","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}