Diabetes mortality decreased, with challenges in lower sociodemographic countries
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An analysis published in The Lancet Diabetes & Endocrinology showed global progress in decreasing diabetes mortality in those younger than 25 years, with less pronounced reductions in low and low-middle sociodemographic countries.
“Deaths due to acute complications of diabetes, such as diabetic ketoacidosis, hyperosmolar coma and severe hypoglycemia, as well as due to early manifestation of diabetic kidney disease and acute infections, can largely be avoided with adequately functioning basic health care, including ready access to insulin. This had mostly been accomplished in high-income countries,” Ewerton Cousin, PhD, postdoctoral scholar at the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, and colleagues wrote. “Direct monitoring or progress on this cause of death globally is currently not feasible because details on the type of diabetes and cause of death are frequently incomplete, which makes it difficult to track and reveal disparities in avoidable causes of death related to diabetes around the world.”
Researchers used Global Burden of Diseases, Injuries and Risk Factors Study (GBD) estimates from 2019 to calculate international diabetes mortality for those younger than 25 years in 1990 and 2019 with causes of death obtained through vital registration systems, verbal autopsies and other surveillance systems. For each location, researchers estimated death rates using the GBD Cause of Death Ensemble model and analyzed associations with age-standardized death rates per 100,000 population with the sociodemographic index (SDI) and a measure of universal health coverage.
There were 16,300 global deaths attributed to type 1 or type 2 diabetes in 2019 among individuals younger than 25 years, and 73.7% of these deaths were attributed to type 1 diabetes. Per 100,000 population, the age-standardized death rate was 0.5 with 15,900 deaths occurring in low to high-middle sociodemographic countries. However, among countries in the high SDI quintile, the age-standardized death rate was 0.13 per 100,000 population, 0.6 per 100,000 population in the low-middle SDI quintile and 0.71 per 100,000 population in the low SDI quintile.
Among the SDI quintiles, researchers noted variability in death rates caused by diabetes across all countries, which they said may be explained by the extent of universal health coverage.
Globally, the age-standardized death rates decreased by 17% for both type 1 and type 2 diabetes and decreased by 21% for only type 1 diabetes from 1990 to 2019. Countries in the low SDI quintile had the lowest decline in mortality for both type 1 and type 2 diabetes and for type 1 diabetes only (–13.6% for both).
“Diabetes mortality at ages younger than 25 years can serve as a readily available indicator for the surveillance of basic diabetes care and access to insulin around the world,” the researchers wrote.
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