Diabetes is one of the major causes of premature illness and death in most countries. Cardiovascular disease, resulting from damage to large blood vessels, causes the death of 50% or more of people with diabetes depending on the population. Damage to small blood vessels (microvascular disease) can affect many parts of the body (see What is Diabetes? ). Due to different methods of assessing the presence of these complications it is difficult to make comparisons between different populations. However, it is clear that they are very common, with at least one complication present in a large proportion of people (50% or more in some studies) at the time of diagnosis. Figure 2.6 shows the range of percentages of people with diabetes who have complications, based on the studies that were summarized in the Diabetes Atlas, third edition 1 .
Diabetes complications are frequently the cause of death in people with diabetes. Estimating the mortality burden has been challenging because more than a third of countries of the world do not have any data on diabetes-related mortality and also because existing routine health statistics have been shown to underestimate mortality from diabetes 2 . To provide a more realistic estimate of mortality, a modelling approach has been used to estimate the number of deaths attributable to diabetes in the year 2010.
Close to four million deaths in the 20-79 age group may be attributable to diabetes in 2010, accounting for 6.8% of global all-cause mortality in this age group. This estimated number of premature deaths is similar in magnitude to deaths in this age group from several infectious diseases. The highest number of deaths due to diabetes is expected to occur in countries with large populations as they have the largest numbers of people with diabetes—India, China, United States of America and the Russian Federation. More women than men are expected to die from diabetes-related deaths, and diabetes makes for a higher proportion of deaths in women than in men, reaching up to a quarter of all deaths in middle-aged women in some regions (see Regional Overview ). In most age groups women with diabetes, compared to those without, have a higher relative risk of death than men with diabetes. It is this that accounts for diabetes making a proportionately greater contribution to female mortality.
The number of deaths attributable to diabetes in 2010 shows a 5.5% increase over the estimates for the year 2007 1 . This increase is largely due to a 29% increase in the number of deaths due to diabetes in the NAC Region, a 12% increase in the SEA Region and an 11% increase in the WP Region. These increases can be explained by a rise in diabetes prevalence in some highly populated countries in each region, particularly in women.
While there has been a documented decline in the morbidity and mortality of a few chronic non-communicable diseases in some countries 3 , no such decline has been reported for diabetes. Although some high-income countries have documented an improved survival of persons with diabetes, the increased prevalence is most likely due to a rise in incidence rather than improved survival 4 .
Accurate estimates of mortality attributable to diabetes are difficult to obtain with currently available data, and any attempt will be based on a set of assumptions. The mortality estimates in this report should be interpreted with caution. However, they are probably more realistic than estimates derived from routine sources of health statistics which systematically underestimate the burden of mortality due to diabetes, largely because diabetes is often omitted on death certificates as contributing to death. A substantial proportion of these premature deaths are potentially preventable through public health action directed at primary prevention of diabetes in the population and improvement of care for all people with diabetes 5 .
The background paper, Mortality Attributable to Diabetes, and country by country estimates on which this summary is based are available in the Downloads  section.
Map 2.5 Number of deaths attributable to diabetes (20-79 years), 2010
1: International Diabetes Federation. The Diabetes Atlas. Third Edition. Brussels: International Diabetes Federation; 2006.
3: Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 1999; 353 (9164): 1547-1557.
4: Colagiuri S, Borch-Johnsen K, Glümer C, et al. There really is an epidemic of type 2 diabetes. Diabetologia 2005; 48 (8): 1459-1463.
5: World Health Organization. Preventing chronic diseases: a vital investment. Geneva: World Health Organization; 2005. http://www.who.int/chp/chronic_disease_report/contents/en/index.html