Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019


Ewerton Cousin, Institute for Health Metrics and Evaluation
Bruce B. Duncan, Universidade Federal do Rio Grande do Sul
Caroline Stein, Universidade Federal do Rio Grande do Sul
Kanyin Liane Ong, Institute for Health Metrics and Evaluation
Theo Vos, Institute for Health Metrics and Evaluation
Cristiana Abbafati, Sapienza Università di Roma
Mohsen Abbasi-Kangevari, Shahid Beheshti University of Medical Sciences
Michael Abdelmasseh, Marshall University
Amir Abdoli, Jahrom University of Medical Sciences
Rami Abd-Rabu, Mayo Clinic
Hassan Abolhassani, Research Center for Immunodeficiencies
Eman Abu-Gharbieh, University of Sharjah
Manfred Mario Kokou Accrombessi, London School of Hygiene & Tropical Medicine
Qorinah Estiningtyas Sakilah Adnani, Universitas Padjadjaran
Muhammad Sohail Afzal, University of Management and Technology Lahore
Gina Agarwal, McMaster University
Krishna K. Agrawaal, Tribhuvan University
Marcela Agudelo-Botero, Universidad Nacional Autónoma de México
Bright Opoku Ahinkorah, University of Technology Sydney
Sajjad Ahmad, Shahid Beheshti University of Medical Sciences
Tauseef Ahmad, Southeast University
Keivan Ahmadi, Lincoln Medical School
Sepideh Ahmadi, Shahid Beheshti University of Medical Sciences
Ali Ahmadi, Shahid Beheshti University of Medical Sciences
Ali Ahmed, Monash University Malaysia
Yusra Ahmed Salih, Sulaimani Polytechnic University
Wuraola Akande-Sholabi, University of Ibadan
Tayyaba Akram, Universiti Sains Malaysia
Hanadi A. Al Hamad, Hamad Medical Corporation

Publication Name

The Lancet Diabetes and Endocrinology


Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings: In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation: Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation.

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This publication may be available as open access





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Funding Sponsor

National Institutes of Health



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