Global Diabetes Mortality Remains a Sociodemographic Challenge

Although global progress has been made in decreasing mortality rates in patients younger than 25 years with diabetes, it remains an important challenge in low and low-middle sociodemographic index (SDI) countries.

New data show large disparities across countries, with age-standardized mortality of low and low-middle SDI countries showing approximately five times higher rates compared to high SDI countries.

“Our findings of low mortality rates at ages younger than 25 years in high SDI countries attests to the amenability of these deaths and supports the importance of access to diabetes medications and basic diabetes care,” wrote study author Ewerton Cousin, PhD, Institute for Health Metrics and Evaluation, University of Washington.

Diabetes has been identified by the United Nations and World Health Organization as one of the five priority non-communicable diseases (NCDs). The current study used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), a systematic collection of mortality data including estimates of mortality rates by age group and disease for countries across the world.

Investigators in the current study aimed to evaluate diabetes mortality in people ≤25 years and its trends using estimates from the GBD 2019. They restricted the country-specific analyses to those with a total population of 1 million or more in 2019.

They defined deaths occurring due to type 1 diabetes (T1D) and type 2 diabetes (T2D) and due to chronic kidney disease resulting from diabetes. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990 - 2019.

Further, the GBD used the Cause of Death Ensemble model to estimate death rates for each location. Investigators analyzed the association of age-standardized death rates per 100,000 population with the SDI and a measure of universal health coverage (UHC).

They further expressed SDI and stratified into quintiles to explore the difference in age-standardized death rates due to diabetes between countries and presented estimates using 95% uncertainty intervals (UI).

Data from 2019 show 16,300 (95% UI, 14,200 - 18,900) deaths were due to diabetes (T1D and T2D) in individuals younger than 25 years globally, with 15,900 (97.5%) occurring in low to high-middle SDI countries. Specifically, 73.7% of deaths were classified as due to T1D, with the remainder due to T2D.

A total of 415 individuals younger than 25 years died from diabetes in 2019 in high SDI countries compared to 4860 in low SDI countries and 5300 in the low-middle SDI countries. The age-standardized death rate in 2019 was 0.50 per 100,000 population.

Further, the rate was 0.13 per 100,000 population in the high SDI quintile, 0.60 per 100,000 population in the low-middle SDI quintile, and 0.71 per 100,000 population in the low SDI quintile. A large variability in rates across countries within SDI quintiles was noted to be partially explained by the extent of UHC (r² = .62).

Then, from 1990 - 2019, age-standardized death rates decreased by 17.0% (95% UI, -28.4 to -2.9) globally for all diabetes and by 21.0% (95% UI, -33.0 to -5.9) when considering only T1D. Data show the low SDI quintile had the lowest decline for all diabetes (-13.6%; 95% UI, -28.4 to 3.4) and for T1D (-13.6%; 95% UI, -29.3 to 8.9).

“Prevention of diabetes mortality can be improved with the prompt diagnosis and treatment of type 1 diabetes and with the provision of basic care and education to both people with all types of diabetes and their families,” Cousin concluded.

The study, “Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019,” was published in The Lancet Diabetes & Endocrinology.