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.publishedVersio

Characterization of Wood-based Industrial Biorefinery Lignosulfonates and Supercritical Water Hydrolysis Lignin

Understanding the properties of any particular biorefinery or pulping residue lignin is crucial when choosing the right lignin for the right end use. In this paper, three different residual lignin types [supercritical water hydrolysis lignin (SCWH), ammonium lignosulfonate (A-LS), and sodium lignosulfonate (S-LS)] were evaluated for their chemical structure, thermal properties and water vapor adsorption behavior. SCWH lignin was found to have a high amount of phenolic hydroxyl groups and the highest amount of beta-O-4 linkages. Combined with a low ash content, it shows potential to be used for conversion into aromatic or platform chemicals. A-LS and S-LS had more aliphatic hydroxyl groups, aliphatic double bonds and C=O structures. All lignins had available C-3/C-5 positions, which can increase reactivity towards adhesive precursors. The glass transition temperature (T-g) data indicated that the SCWH and S-LS lignin types can be suitable for production of carbon fibers. Lignosulfonates exhibited considerable higher water vapor adsorption as compared to the SCWH lignin. In conclusion, this study demonstrated that the SCWH differed greatly from the lignosulfonates in purity, chemical structure, thermal stability and water sorption behavior. SCWH lignin showed great potential as raw material for aromatic compounds, carbon fibers, adhesives or polymers. Lignosulfonates are less suited for conversion into chemicals or carbon fibers, but due to the high amount of aliphatic hydroxyl groups, they can potentially be modified or used as adhesives, dispersants, or reinforcement material in polymers. For most value-adding applications, energy-intensive purification of the lignosulfonates would be required.Open access funding provided by Linnaeus University. Venla Hemmila and Stergios Adamopoulos would like to thank the Knowledge Foundation for the financial support (project titled "New environment-friendly board materials", 2015-2019). Arantxa Eceiza thanks the Basque Government (IT776-16) and SgiKer General Services of the University of the Basque Countr