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

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

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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Cousin, Ewerton, Duncan, Bruce B. and Stein, Caroline , GBD 2019 Diabetes Mortality Collaborators (2022) Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019. The Lancet Diabetes and Endocrinology, 10 (3), 177-192. (doi:10.1016/S2213-8587(21)00349-1).

Record type: Article

Abstract

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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Accepted/In Press date: 7 February 2022
e-pub ahead of print date: 21 February 2022
Published date: March 2022
Additional Information: Funding Information: J L Baker reports non-financial support as an unpaid speaker at Novo Nordisk symposiums (outside the submitted work). S Bhaskar reports institutional support from NSW Health Pathology (Australia), grants or contracts from the New South Wales (NSW) Ministry of Health NSW Brain Clot Bank (2019–22) in Australia, and paid or unpaid leadership or fiduciary roles in board, society, committee, or advocacy groups with the Rotary Club of Sydney (NSW, Australia) as a board director and chair of the Youth Committee and with the International Rotary Fellowship of Healthcare Professionals as board director (all outside the submitted work). I Y Elgendy acknowledges grants from Caladrius Biosciences, outside the submitted work. D Flood reports grants or contracts from US National Institutes of Health (NIH) funding comparative health systems research on diabetes indicators (grant P30-DK09292); unpaid leadership or fiduciary roles in board, society, committee, or advocacy groups with Maya Health Alliance as lead diabetes physician for this non-governmental clinical organisation in Guatemala, conducting unpaid advocacy on behalf of people with diabetes; and stock or stock options as co-founder and 1% co-owner of GlucoSalud, a diabetes social business in Guatemala (all outside the submitted work). N Ghith reports support for the present manuscript via a grant from the Novo Nordisk Foundation (NNF16OC0021856). N E Ismail reports an unpaid leadership or fiduciary role in board, society, committee, or advocacy group, with the Malaysian Academy of Pharmacy as a council member (outside the submitted work). K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India (outside the submitted work). U O Mueller reports a grant from the US National Institute of Aging to the University of Washington, granted as a subaward to the Center for Population and Health, and paid or unpaid leadership or fiduciary roles in board, society, committee, or advocacy group with the Center for Population and Health as the chairman (all outside the submitted work). M P Schlaich reports grants or contracts from Boehringer Ingelheim in support for an investigator-initiated study with SGLT-2 inhibitors in patients with diabetes (outside the submitted work). J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, FocusForward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, Practice Point communications, the NIH, and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings or travel from OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, when travelling to OMERACT meetings; participation on a data safety monitoring board or an advisory board as a member of the US Food and Drug Administration Arthritis Advisory Committee; paid or unpaid leadership or fiduciary roles in board, society, committee, or advocacy groups with OMERACT as a member of the steering committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a chair member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as director and editor; stock or stock options in TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, and Charlotte's Web Holdings and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals (all outside the submitted work). M Tonelli reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AstraZeneca (outside the submitted work). R Uddin reports grants from Deakin University (Geelong, VIC, Australia) through an Alfred Deakin Postdoctoral Research Fellowship and support for attending meetings or travel from the Deakin University Institute for Physical Activity and Nutrition (all outside the submitted work). S Zadey reports unpaid leadership or fiduciary roles in other board, society, committee, or advocacy groups with the Association for Socially Applicable Research as the co-founding director. Funding Information: This study is funded by the Bill & Melinda Gates Foundation. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University (Kuwait City, Kuwait), and the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia (Kuala Lumpur, Malaysia), for the approval and support to participate in this research project. T Astell-Burt was supported by a National Health and Medical Research Council (NHMRC; Australia) Boosting Dementia Research Leader Fellowship (1140317). D A Bennett is supported by the UK National Institute of Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR, or the UK Department of Health and Social Care. B Duncan and M I Schmidt were supported in part by the Brazilian National Council for Scientific and Technological Development (research fellowship), and the Institute for Health Technology Assessment (465518/2014-1). E Cousin acknowledges the Coordination for Improvement of Higher Education Personnel (Brazil). X Feng was supported by an NHMRC Career Development Fellowship (1148792). E Fernandes and M Freitas acknowledge support from Fundação para a Ciência e Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior through national funds, and Programa Operacional Competitividade e Internacionalização (POCI-01-0145-FEDER-029241). V K Gupta and V B Gupta acknowledge funding support from the NHMRC (Australia). S Haque is grateful to the Jazan University (Jazan, Saudi Arabia), for providing the access to the Saudi Digital Library for this research study. B-F Hwang acknowledges partial support by China Medical University (Taichung, Taiwan; CMU109-MF-63). S M S Islam acknowledges funding from the National Heart Foundation of Australia and NHMRC Emerging Leadership Fellowship. M Jakovljevic acknowledges partial funding through grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. O John is a recipient of the University International Postgraduate Award scholarship from the University of New South Wales (Sydney, NSW, Australia). M N Khan acknowledges the support of the Jatiya Kabi Kazi Nazrul Islam University (Mymensingh, Bangladesh). Y J Kim was supported by Research Management Centre, Xiamen University Malaysia (Sepang, Malaysia; XMUMRF/C6/ITCM-004). B Lacey acknowledges support from the UK Biobank, University of Oxford (Oxford, UK). G Lucchetti acknowledges support from the Brazilian National Council for Scientific and Technological Development through a Research Productivity Fellowship (level 1D). L G Mantovani acknowledges support from the Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica. M Molokhia is supported by the NIHR Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust and King's College London (London, UK). O O Odukoya was supported by the Fogarty International Center of the NIH under award number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. N Senthil Kumar acknowledges the Department of Biotechnology (New Delhi, India) for the Advanced State Biotech Hub. S Xu was supported by grants from National Natural Science Foundation of China (grant number 82070464) and Anhui Provincial Key Research and Development Program (grant number 202104j07020051). X Xu is supported by the Heart Foundation Post-doctoral Fellowship funded by the Heart Foundation of Australia, and Scientia Program at the University of New South Wales. S B Zaman received a scholarship from the Australian Government Research Training Program in support of his academic career. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Funding Information: This study is funded by the Bill & Melinda Gates Foundation. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University (Kuwait City, Kuwait), and the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia (Kuala Lumpur, Malaysia), for the approval and support to participate in this research project. T Astell-Burt was supported by a National Health and Medical Research Council (NHMRC; Australia) Boosting Dementia Research Leader Fellowship (1140317). D A Bennett is supported by the UK National Institute of Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR, or the UK Department of Health and Social Care. B Duncan and M I Schmidt were supported in part by the Brazilian National Council for Scientific and Technological Development (research fellowship), and the Institute for Health Technology Assessment (465518/2014-1). E Cousin acknowledges the Coordination for Improvement of Higher Education Personnel (Brazil). X Feng was supported by an NHMRC Career Development Fellowship (1148792). E Fernandes and M Freitas acknowledge support from Fundação para a Ciência e Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior through national funds, and Programa Operacional Competitividade e Internacionalização (POCI-01-0145-FEDER-029241). V K Gupta and V B Gupta acknowledge funding support from the NHMRC (Australia). S Haque is grateful to the Jazan University (Jazan, Saudi Arabia), for providing the access to the Saudi Digital Library for this research study. B-F Hwang acknowledges partial support by China Medical University (Taichung, Taiwan; CMU109-MF-63). S M S Islam acknowledges funding from the National Heart Foundation of Australia and NHMRC Emerging Leadership Fellowship. M Jakovljevic acknowledges partial funding through grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. O John is a recipient of the University International Postgraduate Award scholarship from the University of New South Wales (Sydney, NSW, Australia). M N Khan acknowledges the support of the Jatiya Kabi Kazi Nazrul Islam University (Mymensingh, Bangladesh). Y J Kim was supported by Research Management Centre, Xiamen University Malaysia (Sepang, Malaysia; XMUMRF/C6/ITCM-004). B Lacey acknowledges support from the UK Biobank, University of Oxford (Oxford, UK). G Lucchetti acknowledges support from the Brazilian National Council for Scientific and Technological Development through a Research Productivity Fellowship (level 1D). L G Mantovani acknowledges support from the Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica. M Molokhia is supported by the NIHR Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust and King's College London (London, UK). O O Odukoya was supported by the Fogarty International Center of the NIH under award number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. N Senthil Kumar acknowledges the Department of Biotechnology (New Delhi, India) for the Advanced State Biotech Hub. S Xu was supported by grants from National Natural Science Foundation of China (grant number 82070464) and Anhui Provincial Key Research and Development Program (grant number 202104j07020051). X Xu is supported by the Heart Foundation Post-doctoral Fellowship funded by the Heart Foundation of Australia, and Scientia Program at the University of New South Wales. S B Zaman received a scholarship from the Australian Government Research Training Program in support of his academic career. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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Local EPrints ID: 471835
URI: http://eprints.soton.ac.uk/id/eprint/471835
ISSN: 2213-8587
PURE UUID: 1330b3f4-40ac-4a2e-9500-2fc95c7a6fb6

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Date deposited: 21 Nov 2022 17:54
Last modified: 06 Jan 2023 11:59

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Contributors

Author: Ewerton Cousin
Author: Bruce B. Duncan
Author: Caroline Stein
Author: Kanyin Liane Ong
Author: Theo Vos
Author: Cristiana Abbafati
Author: Mohsen Abbasi-Kangevari
Author: Michael Abdelmasseh
Author: Amir Abdoli
Author: Rami Abd-Rabu
Author: Hassan Abolhassani
Author: Eman Abu-Gharbieh
Author: Manfred Mario Kokou Accrombessi
Author: Qorinah Estiningtyas Sakilah Adnani
Author: Muhammad Sohail Afzal
Author: Gina Agarwal
Author: Krishna K. Agrawaal
Author: Marcela Agudelo-Botero
Author: Bright Opoku Ahinkorah
Author: Sajjad Ahmad
Author: Tauseef Ahmad
Author: Keivan Ahmadi
Author: Sepideh Ahmadi
Author: Ali Ahmadi
Author: Ali Ahmed
Author: Yusra Ahmed Salih
Author: Wuraola Akande-Sholabi
Author: Tayyaba Akram
Author: Hanadi Al Hamad
Author: Ziyad Al-Aly
Author: Jacqueline Elizabeth Alcalde-Rabanal
Author: Vahid Alipour
Author: Syed Mohamed Aljunid
Author: Rajaa M. Al-Raddadi
Author: Nelson Alvis-Guzman
Author: Saeed Amini
Author: Robert Ancuceanu
Author: Tudorel Andrei
Author: Catalina Liliana Andrei
Author: Ranjit Mohan Anjana
Author: Adnan Ansar
Author: Ippazio Cosimo Antonazzo
Author: Benny Antony
Author: Anayochukwu Edward Anyasodor
Author: Jalal Arabloo
Author: Damian Arizmendi
Author: Wei Chen Lee
Author: Ming Chieh Li
Author: Stephen S. Lim
Author: Md Mosfequr Rahman
Corporate Author: GBD 2019 Diabetes Mortality Collaborators

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