Jie Shen
In 2012 there were 1.5 million deaths worldwide directly caused by diabetes. It was the eighth leading cause of death among both sexes and the fifth leading cause of death in women in 2012. Blood glucose levels that are higherthan-optimal, even if below the diagnostic threshold for diabetes, are a major source of mortality and morbidity. The diagnostic criterion for diabetes is fasting plasma glucose ≥ 7.0 mmol/L – a diagnostic point selected on the basis of micro-vascular complications such as diabetic retinopathy. The risk of macro-vascular disease, such as heart attack or stroke, however, starts increasing well before this diagnostic point. To better understand the full impact of blood glucose levels on mortality therefore requires a look at mortality related to blood glucose as a risk factor. The total burden of deaths from high blood glucose1 in 2012 has been estimated to amount to 3.7 million. This number includes 1.5 million diabetes deaths, and an additional 2.2 million deaths from cardiovascular diseases, chronic kidney disease, and tuberculosis related to higher-than-optimal blood glucose. Its magnitude highlights that high blood glucose causes a large burden of mortality beyond those deaths directly caused by diabetes. The largest number of deaths resulting from high blood glucose occur in upper-middle income countries (1.5 million) and the lowest number in low-income countries (0.3 million). After the age of 50, middle-income countries have the highest proportion of deaths attributed to high blood glucose, for both men and women.
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