Experts report rise in diabetes deaths amid 'obesity pandemic'

Mortality in RUSSIA from diabetes increased by 14.4% in 2023, to 48,469 people (2.7% of the total number of deaths), according to the annual report of Rosstat. Among the mass diseases that caused more than 1% of deaths last year, this is the most significant increase.

The increase in deaths from diabetes occurred against the backdrop of a 7.1% decrease in overall mortality in 2023, to 1.764 million people, which is largely due to a sharp decrease in the number of deaths from covid-19 (by almost 90%) after the end of the pandemic. The largest number of Russians - 46.2% (814 thousand) - died last year from diseases of the circulatory system (mortality from this cause decreased by 2.1%), the second most common cause of death (16%, or 284 thousand people) - from malignant neoplasms (mortality increased by 2.7%).

The number of deaths from diabetes increased by 26% in 2020, the year the pandemic began, and reached a peak of 51,800 deaths, but then declined for two years. Experts explain the current growth by a combination of factors, including the delayed effects of the CORONAVIRUS, an increase in the number of people with obesity, which contributes to the development of diabetes, an increase in the detection of this disease and its inclusion in the causes of death.

Diabetes is a chronic metabolic disorder that is based on a deficiency in the formation of one's own insulin and an increase in the level of glucose in the blood. The disease is divided into two main types:

• Type I diabetes (or insulin-dependent) - in this case the body does not produce enough insulin;
• Type II diabetes (non-insulin-dependent) - in this case, the cells and tissues of the body become insensitive to insulin with a sufficient content of the hormone.

The majority of patients with diabetes suffer from type II. According to online statistics from the National Medical Research Center of Endocrinology of the Ministry of HEALTH, among 5.277 million patients registered with insulin-independent diabetes, 4.857 million people.

In early 2024 , Deputy Prime Minister Tatyana Golikova reported that in 2023, medical preventive examinations helped identify 1.8 times more patients with diabetes than in 2022. “These are not frightening figures for healthcare, but, on the contrary, positive,” Golikova noted, pointing to an increase in the efficiency of identifying patients.

The risk of a fatal outcome from COVID-19 in patients with diabetes was certainly higher, notes Natalia Mokrysheva, DIRECTOR of the National Medical Research Center of Endocrinology of the Ministry of Health, Corresponding Member of the Russian Academy of Sciences, explaining the surge in deaths from the disease during the pandemic. According to her, this is influenced by both factors directly related to diabetes, such as high blood glucose levels, and the presence of complications and concomitant diseases. For example, obesity in a patient is accompanied by chronic inflammation - and the risk of an unfavorable outcome with an additional viral load in these patients increases significantly, the specialist points out.

Even at the height of the pandemic, the Deputy Prime Minister in charge of the issue, Tatyana Golikova, spoke about registering deaths of people who had recovered from the coronavirus but then died from other diseases, primarily chronic ones, since the infection had a negative impact on their health .

The current increase in mortality from diabetes may also be partly related to the pandemic, experts admit. The "tails" of COVID-19 may indeed have an impact on the increase in mortality, says Ilya Barsukov, chief specialist in endocrinology at Medsi Group. "Since the spread of COVID-19 was a new phenomenon, it is not entirely clear to what extent the consequences of the disease will continue to make themselves felt," he says. "It is known that COVID-19 influenced the development of vascular diseases, and diabetes also affects small vessels." Elvira Gustova, president of the Moscow Diabetes Association of Patients with Diabetes Mellitus (MDA), also points to the influence of the long-term consequences of COVID-19 among the possible causes, emphasizing that there are currently no problems with the provision of patients with sugar-lowering drugs.

During the COVID-19 period, severe forms of diabetes mellitus could have arisen, since the level of its primary detection was limited then, and this factor could have worsened the prognosis of the course of the disease, which could also have influenced the increase in the number of deaths, notes Larisa Popovich, Director of the Institute of Health Economics at the National Research University Higher School of Economics.

Among the factors that could have affected the increase in mortality, she also pointed out the gradual increase in the proportion of the elderly population, which is also characterized by higher rates of diabetes. In addition, the prevalence of obesity in the population has been growing in recent years, which entails serious changes in the risk of developing diabetes, Popovich adds: “The increase in obesity in general has become very noticeable in recent years. This means that the incidence of diabetes will also increase. This, of course, will be accompanied by a gradual increase in the number of deaths.”

Director of the National Medical Research Center of Endocrinology of the Ministry of Health Natalya Mokrysheva also emphasizes that the number of patients with type II diabetes is increasing in proportion to the increase in the prevalence of obesity as the main factor provoking diabetes. In her opinion, we can talk about a non-infectious obesity pandemic. In 2022, more than 419 thousand new cases of obesity were identified in Russia, according to Rosstat data, which is collected every two years. In 2020, doctors made 372 thousand such diagnoses, in 2021 - 383 thousand.

Barsukov from Medsi also draws attention to the fact that “diabetes has become better treated in recent years and even decades, and the life expectancy of a person diagnosed with diabetes is increasing.” “We have more and more diabetics, and if their number grows, then the number of people dying from diabetes also grows,” Barsukov adds.

Another factor, according to Popovich, is stress, which has a negative impact on the prognosis of the disease and can increase mortality from diabetes. “Mortality from any disease is usually due to a whole set of factors, and it cannot always be explained in a simple way,” she concludes.

According to Rosstat, before the pandemic surge, the mortality rate from diabetes was consistently growing and jumped more than fourfold between 2011 and 2019. Health Ministry experts warned ten years ago that mortality from diabetes would grow. They made their forecast counting on a more accurate accounting of the underlying causes of death and an increase in the life expectancy of diabetics.

In general, the increase in mortality rates in recent years may be associated with a change in the rules for coding the death of patients with diabetes, says the HEAD of the Moscow Diabetes Association of Diabetes Patients, Gustova. During this period, diabetes began to be more often named as the main cause of death, rather than complications from the disease, she notes.

But even now doctors and pathologists may not list diabetes as the main cause of death, indicating it as a concomitant disease, Popovich emphasizes, and the main cause will be complications of diabetes, such as a heart attack or stroke . This shifts the real picture of the danger of diabetes, Popovich, head of the Institute of Health Economics at the National Research University Higher School of Economics, is sure.

Barsukov from Medsi noted that about two years ago, a transition to a new system for classifying causes of death was announced, according to which cause-and-effect relationships are established to a greater extent. Thus, if a person died of a heart attack or stroke and was also ill with diabetes, then, according to the updated classification, it is necessary to establish whether diabetes specifically was the cause of death or not, the expert explains. According to Barsukov, when using the new system, it is necessary to conduct explanatory work with pathologists so that specialists adhere to one order of establishing causes of death.

The National Medical Research Center of Endocrinology of the Ministry of Health keeps records of patients with diabetes in the diaregistry. The center is currently working to improve the system of recording people who died both with diabetes (for example, due to myocardial infarction) and directly as a result of diabetes (for example, due to ketoacidotic coma), said the center's director Natalia Mokrysheva. According to her, such records may lead to a change in the structure of patient mortality, taking into account a detailed analysis of the causes.

"The growth of diabetes prevalence and the severity of complications is a challenge for the entire healthcare system," says Mokrysheva. In this regard, she notes, the key task is to form an effective system for the prevention and early detection of diabetes, as well as to ensure the most effective screening of complications in the case of an already developed disease.

In 2023, a new federal project "Fight against diabetes" was launched. The previous similar project on diabetes was implemented from 1996 to 2012.

The project includes five areas, including: equipping medical institutions with equipment for detecting diabetes and monitoring patients' condition; training and advanced training of health workers providing assistance to diabetics; providing children with type 1 diabetes with continuous glucose monitoring systems.

For 2024–2026, the federal budget has allocated approximately 9.9 million rubles annually for the program.