Towards an understanding of the high death rate among young people with diabetes in Ukraine

Aims Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics s ince the late 1980s. The reasons for this increase, and the situation facin g patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on the ir death certificate. Methods Interviews with surviving relatives or neighbours, combining elemen ts of verbal autopsy and confidential enquiry. For those who had lived in t he city of Lviv a random sample was taken. For those in rural areas a purpo sive sample was used to ensure coverage of more and less remote areas. Results Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified f rom their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypogly caemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is o fficially available free of charge, most had retained supplies for use in a n emergency. More than half had, at some time, purchased supplies. The larg e number of deaths from renal failure reflects the effective absence of ren al replacement therapy for patients with diabetes. Conclusions Individuals with diabetes in Ukraine face profound challenges i nvolving access to necessary care. Their needs require significantly more a ttention from policy makers.