Abstract
BackgroundThe global epidemic of diabetes mellitus continues to grow and affects developed and developing countries alike. Intensive glycemic control is thought to modify the risks for vascular complications, hence the risks for diabetes-related death. We investigated the trend of diabetic vascular complication-related deaths between 2000 and 2016 in the global diabetes landscape.MethodsWe collected 17 years of death certificates data from 108 countries in the World Health Organization mortality database between 2000 and 2016, with coding for diabetic complications. Crude and age-standardized proportions and rates were calculated. Trend analysis was done with annual average percentage change (AAPC) of rates computed by joinpoint regression.ResultsFrom 2000 through 2016, 7,108,145 deaths of diabetes were reported in the 108 countries. Among them, 26.8% (1,904,787 cases) were attributed to vascular complications in damaged organs, including the kidneys (1,355,085 cases, 71.1%), peripheral circulatory (515,293 cases, 27.1%), nerves (28,697 cases, 1.5%) and eyes (5751 cases, 0.3%). Overall, the age-standardized proportion of vascular complication-related mortality was 267.8 [95% confidence interval (95% CI), 267.5–268.1] cases per 1000 deaths and the rate was 53.6 (95% CI 53.5–53.7) cases per 100,000 person-years. Throughout the 17-year period, the overall age-standardized proportions of deaths attributable to vascular complications had increased 37.9%, while the overall age-standardized mortality rates related to vascular complications had increased 30.8% (AAPC = 1.9% [1.4–2.4%, p < 0.05]). These increases were predominantly driven by a 159.8% increase in the rate (AAPC = 2.7% [1.2–4.3%, p < 0.05]) from renal complications. Trends in the rates and AAPC of deaths varied by type of diabetes and of complications, as well as by countries, regions and domestic income.ConclusionDiabetic vascular complication-related deaths had increased substantially during 2000–2016, mainly driven by the increased mortality of renal complications.
Highlights
The global epidemic of diabetes mellitus continues to grow and affects developed and developing countries alike
Throughout the 17-year period, the overall age-standardized proportions of deaths attributable to vascular complications had increased 37.9%, while the overall age-standardized mortality rates related to vascular complications had increased 30.8% (AAPC = 1.9% [1.4–2.4%, p < 0.05])
Between 2000 and 2016, a total of 7,108,145 diabetes-related deaths were reported in the 108 selected countries, including 1,904,787 cases (26.8%) that were attributed to vascular complications
Summary
The global epidemic of diabetes mellitus continues to grow and affects developed and developing countries alike. Intensive glycemic control is thought to modify the risks for vascular complications, the risks for diabetes-related death. Intensive glycemic control has been shown to be beneficial for the management of microvascular complications of diabetes [2, 3]. Diabetes has been implicated in all-cause mortality, especially in deaths related to cardiovascular and cerebral vascular disease. In 2016, an estimated 1.6 million deaths were directly caused by diabetes. Given that clinical guidelines and recommendations regarding some of these factors have been considerably modified during the past two decades, diabetes-related deaths from microvascular complications might have changed due to tight glycemic control. Understanding the mortality trends of vascular complication-related events will help evaluate the current clinical hypoglycemic treatments and guide future diabetes management
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