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ABSTRACT Background and Aims The variation in the incidence of type 2 diabetes mellitus (T2DM) in different countries is associated with various factors. This study aimed to examine the factors linked to the difference in the incidence of T2DM based on Global Burden of Disease (GBD) data and using a multilevel model. Methods A two‐level longitudinal ecological study using GBD data examined annual observations nested within countries from 1990 to 2021. Level 1 predictors were high BMI, low physical activity (PA), and diet low in fiber (DLF), while Level 2 predictors included human development index (HDI) and current health expenditure (CHE) as a percentage of gross domestic product (GDP). The first model used fixed effects with a random country effect; the second added random slopes for time, high BMI, and low PA. Results The results of the first model showed that high BMI and time had a positive and significant association with the incidence of T2DM, but the association between low PA, DLF, HDI and CHE (% of GDP) with the disease was inverse. In the second model, in addition to high BMI and time, low PA and CHE (% of GDP) also had a positive and significant association, but the HDI association was negative and significant, and DLF did not show a statistically significant association. Conclusion The incidence of T2DM is linked to individual, lifestyle, and socioeconomic factors; thus, effective prevention requires programs that consider interactions between individual factors and broader structures.
Jaafari et al. (Wed,) studied this question.