Global and Super-Regional Burden of Lower-Extremity Peripheral Arterial Disease Attributable to High Fasting Plasma Glucose, 1990–2023, with Projections to 2050: An Analysis of the Global Burden of Disease Study 2023

Aims: To estimate, from the Global Burden of Disease Study 2023 (GBD 2023), how much lower-extremity peripheral arterial disease (LEAD) mortality and disability is due to high fasting plasma glucose (HFPG), 1990–2023; to separate drivers of the change in deaths; and to forecast mortality to 2050. Methods: HFPG-attributable deaths, DALYs and age-standardised rates (ASMR, ASDR) were obtained globally, for five Socio-demographic Index (SDI) quintiles and seven GBD super-regions, by sex and age. Trends were expressed as estimated annual percentage change (EAPC); Das Gupta decomposition apportioned the change in deaths to population growth, ageing and rate change; five statistical, machine-learning and deep-learning models, compared on a 2019–2023 hold-out, projected global ASMR to 2050. Results: Global ASMR and ASDR declined (EAPC −0.96% and −0.30% per year) while deaths rose by 12 132; population growth (+11 595) and ageing (+4 048) outweighed epidemiological improvement (−4 132). Rates increased in the three lowest SDI quintiles and in North Africa and the Middle East (4.78%/year), South Asia (2.91%) and Sub-Saharan Africa (2.52%), climbed sharply with age and were higher in men; by 2050 global ASMR is expected to be about 0.19 per 100 000 (range 0.15–0.20). Conclusions: Rates are improving worldwide, yet deaths keep rising because populations are larger and older, and rates are worsening in lower-SDI settings, where glycaemic control and limb care most need expanding.