Diabetes, why we need to look beyond mortality

28 February 2022

According to World Health Organization estimates, 41 million annual deaths were due to non-communicable diseases (NCDs) in 2021. This accounted for more than 71% of all deaths globally. While diabetes itself only accounts for a small proportion of all NCD deaths, this hides its impact on other NCDs. Several preventable and non preventable risk factors are commonly associated with NCDs. Diabetes is a significant risk factor for several NCDs including cardiovascular diseases (CVD) such as coronary heart disease and heart failures, and certain types of cancer.

 Currently, one in ten people worldwide live with diabetes and this number is expected to grow to 643 million people by 2030 and to 783 million by 2045 unless more attention is placed on prevention and screening. The 45% expected increase in diabetes prevalence over the next 25 years will inevitably increase the burden and mortality linked to CVD and cancer.

The close link between diabetes and CVD is best demonstrated by the fact that it is the most prevalent cause of morbidity and mortality in patients living with diabetes[i]. Global figures show that CVD affects about one third of all persons living with type 2 diabetes and accounts for half of its deaths[ii]. Studies have shown that an increase in HbA1c levels by one mmol/mol increases the risk of CVD by a staggering 11%[iii]. Gestational diabetes mellitus is also associated with long-term adverse consequences in the offspring and is an important risk factor for both type 2 diabetes and CVD[v]. A strong link has also been demonstrated between diabetes and certain types of cancer. One in five persons living with cancer also lives with diabetes. Type 1 diabetes has proven to considerably increase the risk of cervical and stomach cancer, while type 2 diabetes increases liver, pancreatic, bowel, womb, breast, and bladder cancer.

CVD is the leading cause of death among NCDs worldwide, with 17.9 million deaths annually followed by cancer (9.3 million) and diabetes (1.5 million deaths). As a major risk factor for other NCDs with high mortality rates, it is urgent to start looking beyond mortality when measuring the impact of diabetes on individuals and health systems, and adapting health policies accordingly. . Lowering the diabetes incidence will help reduce overall mortality, including those for CVD and cancer.

Tackling NCDs requires a holistic approach, with a core focus on prevention and screening. Early detection greatly increases the chance of survival, reduces complications and lowers the costs of health interventions. An integrated care model which is defined by the WHO as “A concept bringing together inputs, delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion” can contribute to strengthening health systems, providing better quality care, and greatly enhancing the quality of life of people living with more than one condition.

[i] Leon, B. M., & Maddox, T. M. (2015). Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World journal of diabetes, 6(13), 1246.
[ii] Einarson, T. R., Acs, A., Ludwig, C., & Panton, U. H. (2018). Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovascular diabetology, 17(1), 1-19.
[iii] Burgess, S., Malik, R., Liu, B., Mason, A. M., Georgakis, M. K., Dichgans, M., & Gill, D. (2021). Dose–response relationship between genetically proxied average blood glucose levels and incident coronary heart disease in individuals without diabetes mellitus. Diabetologia, 64(4), 845-849.
[iv] Lu, J., Wang, C., Shen, Y., Chen, L., Zhang, L., Cai, J., … & Zhou, J. (2021). Time in range in relation to all-cause and cardiovascular mortality in patients with type 2 diabetes: a prospective cohort study. Diabetes Care, 44(2), 549-555.5
[v] Paulo, M. S., Abdo, N. M., Bettencourt-Silva, R., & Al-Rifai, R. H. (2021). Gestational Diabetes Mellitus in Europe: A Systematic Review and Meta-Analysis of Prevalence Studies. Frontiers in endocrinology, 12.