title: The burden of diabetes and hyperglycemia in Brazil-past and present: findings from the Global Burden of Disease Study 2015.
abstract: BACKGROUND
  Diabetes, hyperglycemia, and their complications are a growing problem in Brazil. However, no comprehensive picture of this disease burden has yet been presented to date.
  
  
  METHODS
  We used Global Burden of Disease 2015 data to characterize diabetes prevalence, incidence and risk factors from 1990 to 2015 in Brazil. Additionally, we provide mortality, years of life lost prematurely (YLL), years of life lived with disability (YLD) and disability-adjusted life years (DALYs) lost due to diabetes, as well as similar data for chronic kidney disease (CKD) due to diabetes and, as an overall summary measure, for hyperglycemia, the latter expressed as high fasting plasma glucose (HFPG).
  
  
  RESULTS
  From 1990 to 2015 diabetes prevalence rose from around 3.6 to 6.1%, and YLLs, YLDs, and DALYs attributable to diabetes increased steadily. The crude diabetes death rate increased 90% while that of CKD due to diabetes more than doubled. In 2015, HFPG became Brazil's 4th leading cause of disability, responsible for 65% of CKD, for 7.0% of all disability and for the staggering annual loss of 4,049,510 DALYs. Diabetes DALYs increased by 118.6% during the period, increasing 42% due to growth in Brazil´s population, 72.1% due to population ageing, and 4.6% due to the change in the underlying, age-standardized rate of DALY due to diabetes. Main risk factors for diabetes were high body mass index; a series of dietary factors, most notably low intake of whole grains and of nuts and seeds, and high intake of processed meats; low physical activity and tobacco use, in that order.
  
  
  CONCLUSIONS
  Our study demonstrates that diabetes, CKD due to diabetes, and hyperglycemia produce a large and increasing burden in Brazil. These findings call for renewed efforts to control the joint epidemics of obesity and diabetes, and to develop strategies to deal with the ever-increasing burden resulting from these diseases.
authors.affiliation: Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS Brazil.
authors.forename: Bruce Bartholow
authors.identifier: 0000-0002-7491-2630
authors.initials: BB
authors.lastname: Duncan
authors.affiliation: Postgraduate Program in Epidemiology and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS Brazil.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
authors.affiliation: Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos, 2600 Sala 414, Porto Alegre, RS 90035-003 Brazil.
authors.lastname: Ewerton Cousin
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA.|Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Maziar
authors.initials: M
authors.lastname: Moradi-Lakeh
authors.affiliation: Programa de Pós Graduação em Ciências do Adulto, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brazil.
authors.forename: Valéria Maria de Azeredo
authors.initials: VMA
authors.lastname: Passos
authors.affiliation: Programa de Pós Graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brazil.
authors.forename: Elisabeth Barboza
authors.initials: EB
authors.lastname: França
authors.affiliation: Departamento de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Ministério da Saúde, Brasília, DF Brazil.
authors.forename: Fátima
authors.initials: F
authors.lastname: Marinho
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA USA.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
keywords: Cost of illness; Diabetes; Hyperglycemia; Morbidity; Mortality