Projecting the burden of type 2 diabetes in Spain to 2030: a microsimulation model

Background

Anticipating future trends in the burden of type 2 diabetes (T2D) is essential for planning effective public health strategies.

Methods

We developed a discrete-event transition microsimulation model based on a synthetic open cohort sourced from the ENRICA study, and the 2023 Spanish census as inputs to the Simulation of Synthetic Complex Data (simPop) model. From 2023 to 2030, individual life-course trajectories were simulated annually using strata-specific transition probabilities of T2D risk factors with or without developing T2D as predicted by the FINDRISC Score. All-cause and T2D-related mortality were obtained from the National Institute for Statistics (INE) and used as death probabilities. The model estimated T2D incidence, prevalence, mortality, years lived with disability (YLDs), and disability-adjusted life years (DALYs) up to 2030.

Results

A total of 8,304 [95%UI: 8,200, 8,406] incident cases of T2D per 100,000 individuals are estimated between 2023 and 2030. Projections indicate a sustained increase in T2D burden in Spain by 2030 compared to 2023 levels, with age-standardised prevalence increasing from 7.4% to 11.7% [11.6-11.8] (+4.2%), and YLD rising from 608.9 [605.5-612.4] to 882.5 [875.4-890.9] per 100,000 (+44.9%), resulting in DALY increasing from 882.0 [848.4-922.6] to 1,119.9 [1,085.3-1,167.4] per 100,000 (+27.4%). Age-standardised mortality rates are expected to decrease slightly from 21.4 [18.0-23.5] in 2024 to 20.3 [17.5-22.6] per 100,000 in 2030 (-3.2%). The increase is primarily driven by population ageing and adverse trends in key modifiable risk factors, including high BMI, and elevated blood pressure.

Conclusions

The burden of T2D in Spain is estimated to increase substantially by 2030 relative to current levels. Microsimulation models grounded in nationally representative cohorts and validated European frameworks provide robust, policy-relevant evidence to inform prevention strategies and long-term health system planning.

Key messages

• T2D burden in Spain is projected to rise markedly by 2030, driven by ageing and worsening risk factors, despite slight declines in mortality.

• Microsimulation using national data provides robust forecasts to guide targeted prevention and long-term health system planning.