Global view of the amenable mortality from diabetes in the young and burden of diabetes and hyperglycemia in adults in the Americas

Contexto: As doenças crônicas não transmissíveis (DCNT) são responsáveis por mais de 60% da carga global de doenças avaliada em 2017. O custo das DCNTs são escalantes e poderão prejudicar o desenvolvimento econômico das nações. A Organização Mundial da Saúde lidera um esforço internacional para o controle e prevenção dessas doenças atualmente referido como Agenda 5x5 para DCNTs. Entre as principais 4 DCNTs, o diabetes é a única doença que apresentou aumento nas taxas padronizadas por idade nas últimas décadas, motivo de preocupação global. Digno de nota também, a mortalidade por diabetes em jovens é próxima de zero em países de alta renda com bons programas de atendimento, mas o panorama global não é conhecido. Dessa forma, um indicador da mortalidade por diabetes nesta faixa etária poderia demonstrar os graus de sucesso da implementação de cuidados básicos de saúde para diabetes e também monitorar os níveis de mudanças. A carga de diabetes em muitos países das Américas é muito alta quando comparada à carga global, embora até agora pouco tenha sido explorado para estampar as diferenças entre regiões e países. O objetivo desta tese é apresentar uma métrica para mortalidade por diabetes nos jovens no mundo; e descrever a carga de diabetes nas Américas em adultos. Métodos: Foram utilizadas estimativas do Global Burden of Disease 2017. Para este estudo, mortes por diabetes foram consideradas quando o código CID10 reportado foi entre E10 e E14 e P70.2. Para as medidas não fatais, diabetes foi definido a partir de exame laboratorial de glicemia de jejum >7 mmol/L (126 mg/dL), ou uso de medicamento para diabetes. Hiperglicemia foi definida como resultado de glicemia de jejum maior que 4,8-5,4 mmol/L (86-97 mg/dL). Foram considerados indivíduos jovens aqueles menores de 25 anos de idade, e adultos aqueles com 25 anos ou mais. Foram apresentadas estimativas para mortalidade, prevalência, incidência, anos de vida perdidos (YLLs – years of life lost), anos de vida vividos com incapacidade (YLDs – years lived with disabilitty), e a soma dos dois últimos, anos de vida perdidos ajustados por incapacidade (DALYs – disability adjusted life years). Além disso, analisamos a correlação entre as taxas por idade padronizada e o Índice Sócio Demográfico (SDI – socio-demographic index) Resultados: A taxa de mortalidade por idade padronizada devido ao diabetes em indivíduos menores de 25 anos diminuiu 20% entre 1990 e 2017, sendo 0,36 (Intervalo de Incerteza [II] I95%:0,33 – 0,38) mortes /100.000 em 2017. Os países de médio-baixo e baixo SDI apresentaram as maiores taxas, 0,48 (II95%:0,44 – 0,53) /100.000 e 0,44(II95%: 0,41 – 0,49) /100.000. Essas taxas contrastam com as encontradas nos países de alto SDI, 0,11 (II95%:0,11 – 0,12) /100.000. Há notável variação mesmo entre países de SDI semelhante. As Américas apresentaram uma maior carga de diabetes do que a média mundial. Em 2017 a taxa de DALYs padronizada por idade nas Américas foi de 51,0 (II95%: 49,1 – 53,0)/100.000, um aumento de 17% em relação a 1990. As taxas de DALYs por idade padronizadas na América Latina Central (98,4 /100.000; 94,2 – 102,7) e no Caribe (74,9 /100.000; 70,3 – 79,8) foram notadamente maiores que nas demais regiões. Essas regiões também apresentaram altas prevalências de diabetes e altas frações atribuíveis na população para obesidade e alimentação inadequada. Conclusão: As estimativas da mortalidade por diabetes abaixo de 25 anos, supostamente decorrentes de complicações agudas do diabetes, foram cerca de quatro vezes mais altas em países de baixo/médio SDI comparativamente aos de alto SDI, sugerindo que essa métrica seja um bom indicador para monitorar os cuidados básicos para o diabetes. A carga de diabetes nas Américas é maior que a carga global, especialmente na América Latina Central e no Caribe.Background: The noncommunicable diseases (NCDs), accounted for more than 60% of the global disease burden in 2017. The costs of NCDs are high, and could spoil the economic development of nations. The World Health Organization leads an international effort to control and prevent these diseases currently referred as the 5x5 Agenda for NCDs. Of the 4 major NCDs, diabetes is the only one that shows increasing in the age-standardized deaths and DALYs rates in recent decades, cause of global concern. Noteworthy also, diabetes mortality in young people is close to zero in high-income countries with good health care programs, but the global picture is unknow. Thus, an indicator of diabetes mortality in this age group can demonstrate the degree of success of implementing basic health care for diabetes and also monitor levels of change. The burden of diabetes in many countries of the Americas are very high compared to the global average, however, to date, little effort has been done for highlight the differences between regions and countries. The purpose of this dissertation is to present a metric of diabetes mortality in young people worldwide; and describes the burden of diabetes in the Americas in adults. Methods: Was used estimates from the Global Burden of Disease (GBD) 2017. For this study, diabetes deaths were defined when the ICD10 code reported was between E10 and E14 and P70.2. For nonfatal measures, diabetes was defined as fasting blood glucose≥ 7 mmol / L (126 mg / dL), or use of diabetes medication. Hyperglycemia, referred as High Fasting Plasma Glucose, was defined as a result of fasting glucose greater than 4.8-5.4 mmol / L (86-97 mg / dL). We considered young people those under 25 years old, and adults those aged 25 years or older. We presented estimates for deaths, prevalence, incidence, years of life lost (YLLs), years lived with disabilities (YLDs), and the sum of the last two, disability adjusted life years (DALYs). In addition, we analyzed a correlation between age-standardized rates and the Socio-Demographic Index (SDI). Results: The age-standardized mortality rate due to diabetes in young decreased by 20% between 1990 and 2017, being 0.36 (Uncertainty Interval [UI] I95%: 0.33 - 0.38) deaths / 100,000 in 2017. The low-middle and low SDI countries had the highest age-standardized mortality rates, 0.48 (UI95%: 0.44 - 0.53) / 100,000 and 0.44 (UI95%: 0.41 - 0.49) / 100,000 respectively. These rates contrast with those found in the high SDI countries, 0.11 (UI95%: 0.11 - 0.12) / 100,000. Was found a notably variation between countries with similar SDI. The Americas had a greater burden of diabetes than the world average. In 2017, the age-standardized DALYs rate in the Americas was 51.0 (UI95%: 49.1 - 53.0) / 100,000, an increase of 17% from 1990. The age-standardized DALYs rates in Central Latin America (98.4 / 100,000; 94.2 - 102.7) and the Caribbean (74.9 / 100,000; 70.3 - 79.8) were notably higher than in other regions. These regions also showed high diabetes prevalence, and high population attributable fractions for obesity and poor diet. Conclusion: The diabetes mortality in young, mostly due to acute diabetes complications, were about 4 times higher in the low and low-middle SDI countries, compared to the high SDI countries, suggesting that this metric is a good indicator for monitoring the basic care of diabetes. The burden of diabetes in the Americas is greater than globally, especially in Central Latin America and the Caribbean

Burden of diabetes and hyperglycaemia in adults in the Americas, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background High prevalence of diabetes has been reported in the Americas, but no comprehensive analysis of diabetes burden and related factors for the region is available. We aimed to describe the burden of type 1 and type 2 diabetes and that of hyperglycaemia in the Americas from 1990 to 2019. Methods We used estimates from GBD 2019 to evaluate the burden of diabetes in adults aged 20 years or older and high fasting plasma glucose in adults aged 25 years or older in the 39 countries and territories of the six regions in the Americas from 1990 to 2019. The main source to estimate the mortality attributable to diabetes and to chronic kidney disease due to diabetes was vital registration. Mortality due to overall diabetes (ie, diabetes and diabetes due to chronic kidney disease) was estimated using the Cause of Death Ensemble model. Years of life lost (YLLs) were calculated as the number of deaths multiplied by standard life expectancy at the age that the death occurred, years lived with disability (YLDs) were estimated based on the prevalence and severity of complications of diabetes. Disability-adjusted life-years (DALYs) were estimated as a sum of YLDs and YLLs. We assessed the association of diabetes burden with the level of development of a country (according to the Socio-demographic Index), health-care access and quality (estimated with the Healthcare Access and Quality Index), and diabetes prevalence. We also calculated the population attributable fraction (PAF) of diabetes burden due to each of its risk factors. We report the 95% uncertainty intervals for all estimates. Findings In 2019, an estimated total of 409 000 (95% uncertainty interval 373 000–443 000) adults aged 20 years or older in the Americas died from diabetes, which represented 5·9% of all deaths. Diabetes was responsible for 2266 (1930–2649) crude DALYs per 100 000 adults in the Americas, and high fasting plasma glucose for 4401 DALYs (3685–5265) per 100 000 adults, with large variation across regions. DALYs were mostly due to type 2 diabetes and distribution was heterogeneous, being highest in central Latin America and the Caribbean and lowest in high-income North America and southern Latin America. Between 1990 and 2019, age-standardised DALYs due to type 2 diabetes increased 27·4% (22·0–32·5). This increase was particularly high in Andean Latin America and high-income North America. Burden for both type 1 and type 2 diabetes across countries increased with higher diabetes prevalence and decreased with greater Socio-demographic and Healthcare Access and Quality Indices. Main risk factors for the burden were high BMI, with a PAF of 63·2% and dietary risks, with a PAF of 27·5%. The fraction of burden due to disability has increased since 1990 and now represents nearly half of the overall burden in 2019. Interpretation The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding. To confront the rising burden, population-based interventions aimed to reduce type 2 diabetes risk and strengthening health systems to provide effective and cost-efficient care for those affected are mandatory.Bill & Melinda Gates FoundationpublishedVersio

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 (r(2)=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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout.Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function.Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, –1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, –1·1 to 3·5). KD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function.Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Epidemiology and burden of chronic respiratory diseases in Brazil from 1990 to 2017 : analysis for the Global Burden of Disease 2017 Study

Introduction: In Brazil, little is known about the trends of chronic respiratory diseases, which was estimated as the third leading cause of deaths in 2017 worldwide. Methods: We analyzed Global Burden of Disease (GBD) 2017 estimates for prevalence, incidence, mortality, disability-adjusted life years (DALY), a summary measure of years of life lost (YLLs) and years lived with disability (YLDs), and risk factors attributable to chronic respiratory diseases in Brazil from 1990 to 2017. Results: The overall estimates have decreased for all ages and both sexes, and for age-standardized rates. For age-adjusted prevalence, there was a 21% reduction, and nearly 16% reduction for incidence. There was a 42% reduction in mortality for both sexes, though the rate of deaths for men was 30% greater than the rate in women. The increase in the number of DALY was essentially due to the population growth and population ageing. We observed a 34% increase in the absolute number of DALY in Brazil over the study period. The majority of the DALY rates were due to Chronic Obstructive Pulmonary Disease (COPD). For all ages and both sexes, smoking was the main attributable risk factor. Conclusion: In Brazil, although mortality, prevalence and incidence for chronic respiratory diseases have decreased over the years, attention should be taken to the DALYs increase. Smoking remained as the main risk factor, despite the significant decrease of tobacco use, reinforcing the need for maintenance of policies and programs directed at its cessation.Introdução: No Brasil, pouco se sabe sobre as tendências das doenças respiratórias crônicas, que foram estimadas como a terceira principal causa de mortes em 2017 em todo o mundo. Métodos: Analisamos as estimativas do Global Burden of Disease (GBD) 2017 para prevalência, incidência, mortalidade, anos de vida ajustados por incapacidade (DALY), uma medida resumida de anos de vida perdidos (YLL) e anos vividos com deficiência (YLD), e fatores de risco atribuíveis a doenças respiratórias crônicas no Brasil, de 1990 a 2017. Resultados: As estimativas gerais diminuíram para todas as idades e ambos os sexos, assim como para as taxas padronizadas por idade. Para a prevalência ajustada pela idade, houve uma redução de 21% e, aproximadamente, 16% para a incidência. Houve uma redução de 42% na mortalidade para ambos os sexos, embora a taxa de mortes para homens tenha sido 30% maior do que a taxa para mulheres. O aumento no número de DALY deveu-se ao crescimento e envelhecimento da população. Observamos um aumento de 34% no número absoluto de DALYs no Brasil durante o período do estudo. A maioria das taxas de DALY foi devido a Doença Pulmonar Obstrutiva Crônica (DPOC). Para todas as idades e ambos os sexos, tabagismo foi o principal fator de risco atribuível. Conclusão: No Brasil, embora a mortalidade, a prevalência e a incidência de doenças respiratórias crônicas tenham diminuído ao longo dos anos, maior atenção deve ser dada ao aumento dos DALYs. O tabagismo permaneceu como principal fator de risco, apesar da redução significativa do seu uso, reforçando a necessidade de manutenção de políticas e programas direcionados à sua cessação

Exposure to and burden of major non-communicable disease risk factors in Brazil and its states, 1990-2019 : the Global Burden of Disease Study

Introduction: Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil. Our objective was to describe trends (1990 to 2019) in prevalence and attributable burden of five modifiable risk factors and related metabolic risk factors in Brazil and its states. Methods: In Global Burden of Disease 2019 analyses, we described trends in prevalence of modifiable risk factors and their metabolic mediators as percentage change in Summary Exposure Value (SEV). We estimated deaths and disabilityadjusted life years (DALYs) attributable to the risk factors. Results: Age-adjusted exposures to alcohol [41.0%, Uncertainty Interval (UI): 24.2 – 63.4], red meat (61.2%, UI: 42.4–92.3), low physical activity (3.9%, UI: -5–17.5) and ambient particulate matter pollution (3.3%, UI: -48.9–128.0) have worsened. Those for smoking (-51.4%, UI: -54.7– - 47.8), diet low in fruits (-28.1%, UI: -39.1– -18.7) and vegetables (-19.6%, UI: -32.7 – -8.7), and household air pollution (-85.3%, UI: -92.9– -74.3) have improved. All mediating metabolic risk factors, except high blood pressure (0.7%, UI: -6.9–8.3), have worsened: BMI (110.2%, UI: 78.6–161.7), hyperglycemia (15.1%, UI: 9.3–21.2), kidney dysfunction (12.0%, UI: 8.4–17.2), and high LDL-c (11.8%, UI: 6.9–17.2). Conclusions: A variable pattern of progress and failure in controlling modifiable risk factors has been accompanied by major worsening in most metabolic risk factors. The mixed success in public health measures to control modifiable risk factors for NCDs, when gauged by the related trends in metabolic risk factors, alert to the need for stronger actions to control NCDs in the future

Premature mortality due to four main non-communicable diseases and suicide in Brazil and its states from 1990 to 2019 : a global burden of disease study

Introduction: The goal of reducing the burden of non-communicable diseases (NCDs) requires close monitoring. Our objective is to characterize the decline of premature NCD mortality in Brazil based on Global Burden of Diseases (GBD) Study 2019 estimates. Methods: We used GBD 2019 data to estimate death rates of the four main NCDs – cardiovascular diseases, neoplasms, diabetes, and chronic respiratory diseases. We estimated the unconditional probability of death between ages 30 to 69, as recommended by the World Health Organization, as well as premature crude- and age-standardized death rates and disability-adjusted life years (DALYs) lost for these conditions. We also estimated trends in suicide (self-harm) death rates. Results: From 2010 to 2019, the age-standardized unconditional probability of premature death declined -1.4%/year (UI: -1.7%;-1.0%) . Age-standardized death rates declined -1.5%/ year (UI: -1.9%; -1.2%), and crude death rates -0.6%/year (UI: (-1.0%; -0.2%). Level of development correlated strongly with the rate of decline, with greatest declines occurring in the Southeast, Center West and South regions. Age-standardized mortality from selfharm declined, most notably in the elderly. Conclusions: Premature mortality due to the main NCDs has declined from 1990 in Brazil, although at a diminishing rate over time. The unconditional probability of death and the age-standardized mortality rate produced similar estimates of decline for the four main NCDs, and mirror well decline in mortality from all NCDs. Declines, especially more recent ones, fall short of the international goals. Strategic public health actions are needed. The challenge to implement them will be great, considering the political and economic instability currently faced by Brazil

The burden of low back pain in Brazil : estimates from the Global Burden of Disease 2017 Study

Background: The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study. Methods: We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period. Results: The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality. Conclusions: Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.Telemedicin

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\u27s Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations