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      Excess Mortality among Persons with Type 2 Diabetes.

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          Abstract

          The excess risks of death from any cause and death from cardiovascular causes among persons with type 2 diabetes and various levels of glycemic control and renal complications are unknown. In this registry-based study, we assessed these risks according to glycemic control and renal complications among persons with type 2 diabetes.

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          The Danish National Diabetes Register: trends in incidence, prevalence and mortality.

          , B Carstensen, P Ottosen … (2008)
          The aim of the study was to describe trends in the incidence rate, prevalence and mortality rate for diabetes in Denmark. Healthcare registers at the National Board of Health were used to compile a register of diabetic patients in the Danish population (5.4 million people). Age- and sex-specific prevalence, incidence rates, mortality rates and standardised mortality ratios relative to the non-diabetic part of the population were calculated. The register contains records for about 360,000 persons with diabetes; 230,000 were alive at 1 January 2007, corresponding to an overall prevalence of 4.2%. The prevalence increased by 6% per year. In 2004 the incidence rates were 1.8 per 100,000 at age 40 years and 10.0 per 100,000 at age 70 years. The incidence rate increased 5% per year before 2004 and then stabilised. The mortality rate in the diabetic population decreased 4% per year, compared with 2% per year in the non-diabetic part of the population. The mortality rate decreased 40% during the first 3 years after inclusion in the register. The standardised mortality ratio decreased with age, from 4.0 at age 50 years to 2.5 at age 70 years and just under 2 at age 85 years, identically for men and women. The standardised mortality ratio decreased 1% per calendar year. The lifetime risk of diabetes was 30%. The prevalence of diabetes in Denmark rose in 1995-2006, but the mortality rate in diabetic patients decreased faster than that of the non-diabetic population. The mortality rate decreased markedly just after inclusion in the register. Incidence rates have shown a tendency to decrease during the last few years, but this finding should be viewed with caution.
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            Mortality trends in men and women with diabetes, 1971 to 2000.

            Edward Gregg, Qiuping Gu, Yiling J Cheng … (2007)
            Whether mortality rates among diabetic adults or excess mortality associated with diabetes in the United States has declined in recent decades is not known. To examine whether all-cause and cardiovascular disease mortality rates have declined among the U.S. population with and without self-reported diabetes. Comparison of 3 consecutive, nationally representative cohorts. Population-based health surveys (National Health and Nutrition Examination Surveys I, II, and III) with mortality follow-up assessment. Survey participants age 35 to 74 years with and without diabetes. Diabetes was determined by self-report for each survey (1971-1975, 1976-1980, and 1988-1994), and mortality rates were determined through 1986, 1992, and 2000 for the 3 surveys, respectively. Among diabetic men, the all-cause mortality rate decreased by 18.2 annual deaths per 1000 persons (from 42.6 to 24.4 annual deaths per 1000 persons; P = 0.03) between 1971 to 1986 and 1988 to 2000, accompanying decreases in the nondiabetic population. Trends for cardiovascular disease mortality paralleled those of all-cause mortality, with 26.4 annual deaths per 1000 persons in 1971 to 1986 and 12.8 annual deaths per 1000 persons in 1988 to 2000 (P = 0.06). Among women with diabetes, however, neither all-cause nor cardiovascular disease mortality declined between 1971 to 1986 and 1988 to 2000, and the all-cause mortality rate difference between diabetic and nondiabetic women more than doubled (from a difference of 8.3 to 18.2 annual deaths per 1000 persons). The difference in all-cause mortality rates by sex among people with diabetes in 1971 to 1986 were essentially eliminated in 1988 to 2000. Diabetes was assessed by self-report, and statistical power to examine the factors explaining mortality trends was limited. Progress in reducing mortality rates among persons with diabetes has been limited to men. Diabetes continues to greatly increase the risk for death, particularly among women.
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              Trends in Death Rates Among U.S. Adults With and Without Diabetes Between 1997 and 2006

              Edward Gregg, Yiling J Cheng, Sharon H. Saydah … (2012)
              OBJECTIVE To determine whether all-cause and cardiovascular disease (CVD) death rates declined between 1997 and 2006, a period of continued advances in treatment approaches and risk factor control, among U.S. adults with and without diabetes. RESEARCH DESIGN AND METHODS We compared 3-year death rates of four consecutive nationally representative samples (1997–1998, 1999–2000, 2001–2002, and 2003–2004) of U.S. adults aged 18 years and older using data from the National Health Interview Surveys linked to National Death Index. RESULTS Among diabetic adults, the CVD death rate declined by 40% (95% CI 23–54) and all-cause mortality declined by 23% (10–35) between the earliest and latest samples. There was no difference in the rates of decline in mortality between diabetic men and women. The excess CVD mortality rate associated with diabetes (i.e., compared with nondiabetic adults) decreased by 60% (from 5.8 to 2.3 CVD deaths per 1,000) while the excess all-cause mortality rate declined by 44% (from 10.8 to 6.1 deaths per 1,000). CONCLUSIONS Death rates among both U.S. men and women with diabetes declined substantially between 1997 and 2006, reducing the absolute difference between adults with and without diabetes. These encouraging findings, however, suggest that diabetes prevalence is likely to rise in the future if diabetes incidence is not curtailed.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): N. Engl. J. Med.
                Title: The New England journal of medicine
                ISSN (Electronic): 1533-4406
                ISSN (Print): 0028-4793
                Publication date (Electronic): Oct 29 2015
                Volume: 373
                Issue: 18
                Affiliations
                [1 ] From the Department of Molecular and Clinical Medicine, University of Gothenburg (M.T., A.R., S.G., M.L.), Center of Registers in Region Västra Götaland (A.-M.S.), Statistiska Konsultgruppen (A.P.), and Nordic School of Public Health (H.W.), Gothenburg, and the Department of Medicine, NU Hospital Group, Trollhättan and Uddevalla (M.T., S.D., M.L.) - all in Sweden; Saint Luke's Mid America Heart Institute (M.K.) and Children's Mercy Hospital (M.C.), University of Missouri-Kansas City School of Medicine, Kansas City; and the University of Kansas School of Medicine, Kansas City (M.C.).
                Article
                DOI: 10.1056/NEJMoa1504347
                PubMed ID: 26510021
                SO-VID: 248048b4-56e3-4230-b36f-a44d1d540eec
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