Burden and trends of diabetes mellitus in Ethiopia: systematic analysis of the Global Burden of Disease Study 1990–2023

Aim: Diabetes mellitus is a growing non-communicable disease (NCD) imposing major health and economic burdens in Ethiopia. While prior national and subnational estimates have been published using Global Burden of Disease (GBD) 2019 data, this study provides novel, updated estimates reflecting newly delineated regional boundaries and recent socio-demographic shifts using GBD 2023 data. We aimed to estimate the national and subnational burden and trends of diabetes mellitus in Ethiopia from 1990 to 2023. Methods: This analysis is part of the GBD 2023 study, a collaborative effort between the Ethiopian Public Health Institute and the Institute for Health Metrics and Evaluation. Estimates were generated using standard GBD modeling tools [DisMod-MR 2.1 and Cause of Death Ensemble modeling (CODEm)] for incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and DALYs [with 95% uncertainty intervals (UI)] across Ethiopia’s regions and city administrations. Results: In 2023, Ethiopia’s age-standardized prevalence of all forms of diabetes mellitus (type 1 and type 2 combined) was 2,996.4 (95% UI: 2,704.8–3,269.5) cases per 100,000 population. Type 2 diabetes accounted for nearly 99% of cases. The Somali region had the lowest prevalence (2,243.1 per 100,000), about 45% lower than in Sidama (4,066.4 per 100,000), highlighting marked regional disparities. The age-standardized DALY rate was 1,124.2 per 100,000. While high fasting plasma glucose was the leading proximal risk factor, high body mass index ranked as the top upstream modifiable risk factor (264.1 DALYs per 100,000). Conclusions: This study highlights the substantial and unevenly distributed burden of diabetes mellitus in Ethiopia, driven predominantly by type 2 diabetes and modifiable metabolic risk factors. These findings call for tailored, region-specific strategies, such as targeted obesity prevention in high-prevalence urban centers and strengthened health system capacity in high-mortality pastoral regions to curb the future burden and align with global NCD targets.