Global Diabetes Mortality: Disparities, Rankings & WHO Efforts

Introduction: The Global Burden of Diabetes

In 2012, 1.5 million lives were lost to diabetes globally. It ranked eighth among the causes of death across both sexes and fifth among women (WHO, 2016). Higher-than-optimal glucose levels — even those that fall below the diabetes diagnostic threshold — are one of the major causes of morbidity and mortality. The diagnostic criterion for diabetes is a fasting plasma glucose level of ≥ 7.0 mmol/L, a threshold chosen because of micro-vascular complications such as diabetic retinopathy. The likelihood of developing a macro-vascular disease such as stroke or heart attack begins to increase even before this threshold is reached (Bellamy, Casas, Hingorani & Williams, 2009).

To comprehend the impact blood glucose levels can have on mortality, one must view blood-glucose-related mortality as a risk factor. The total number of lives lost to high blood glucose in 2012 has been estimated at approximately 3.7 million. This figure includes the 1.5 million deaths directly attributable to diabetes. The remaining 2.2 million deaths are derived from various complications — such as chronic kidney disease, tuberculosis, and cardiovascular diseases — associated with blood glucose levels that are higher than optimal (WHO, 2016).

Countries Faring Better or Worse

Mortality rates due to high blood glucose levels vary greatly across WHO regions. The highest rates are found in the African, South-East Asia, and Eastern Mediterranean regions (WHO, 2016). Rates also vary by gender: the WHO South-East Asia and European regions record higher mortality rates for women than for men. Between 2000 and 2012, premature deaths attributable to high blood glucose increased for both men and women in all regions, with the exception of women living in the WHO European Region (WHO, 2016).

The rise in deaths due to high blood glucose was most pronounced in the WHO Western Pacific Region. In that region, the combined number of mortalities due to high blood glucose rose from 490,000 to 944,000 over the period (WHO, 2016). It is estimated that the WHO Western Pacific and South-East Asia regions together account for nearly half of the world's diabetes cases. Globally, the number of people with diabetes has increased significantly since 1980, when 108 million people were affected; that number has since nearly quadrupled. The WHO Eastern Mediterranean Region has recorded the highest increase and now has a diabetes prevalence of 13.7%, the highest in the world (WHO, 2016).

How the U.S. Ranks Globally

Diabetes remains one of the leading causes of death in the United States, currently ranking seventh. In 2010, 69,071 death certificates directly listed diabetes as the underlying cause of death, while a total of 234,051 death certificates listed it as either a contributing or an underlying cause (ADA, n.d.). It is estimated that approximately 208,000 Americans under the age of 20 have been diagnosed with diabetes, representing about 0.25% of the U.S. population (ADA, n.d.).

Data from 2008–2009 estimated the annual incidence of diagnosed diabetes among youth at 19,436 cases for type 1 diabetes and 5,089 cases for type 2 diabetes. Research suggests that more deaths may be caused by diabetes than are officially reported. Studies have revealed that between 35% and 40% of individuals with diabetes who had passed away had death certificates indicating that diabetes was a contributing cause, while only around 10% to 15% of such certificates listed diabetes as the underlying cause (ADA, n.d.).