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Diabetes and Death

 Diabetes and Death

  • Compared to nondiabetics, people with diabetes have a higher risk of death from a variety of causes: cardiovascular disease (CVD) 132%; all-cause 80%; cancer 25%; other causes 73%.1
  • A 50-year-old with diabetes dies, on average, 6 years earlier than a counterpart without diabetes, with about 40% of the difference in survival attributable to excess nonvascular deaths including 10% from cancer.2
  • The risk of death is increased with increasing duration of diabetes; after 15 years, the risk is increased 9-fold among those with diabetes alone and 30-fold among those with diabetes and heart disease.
  • CVD is the most common cause of death among diabetic subjects accounting for 75% of all fatalities in people with diabetes.3 4 84% of CVD diabetes-related deaths occur in low and middle income countries. The countries of the former Soviet Union have the largest CVD diabetes-related mortality rate of any region. 5
  • End Stage Renal Disease (ESRD) is another important cause of death among diabetic subjects.3 Diabetes increases the risk of end-stage renal disease 6-fold.6
  • Native Americans have the highest rate of diabetes in the US. Early-onset type 2 diabetes (<22 years of age) was associated with a 5-fold increase in the incidence of ESRD compared to those with older age onset (22-55 years of age). The longer duration of diabetes by middle age in individuals diagnosed at a younger age largely accounts for this. Compared with nondiabetic participants, the death rate was 3.0 times as high in individuals with youth-onset diabetes and 1.4 times as high in individuals with older-onset diabetes.7 
  • Favorable lifestyle factors can potentially achieve substantial reductions in premature mortality among people with diabetes underscoring the importance of optimizing lifestyle behaviors in people with diabetes.8
  • An integrated diabetes management program in Germany carried out by physicians and promoting adherence to treatment goals and self-management has shown impressive results.  After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program, compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.9 
  • Compared with people without diabetes, Indians with diabetes have double the CVD mortality, and 3-fold higher kidney and all-cause mortality.5

Sources 

1. Seshasai SR, Kaptoge S, Thompson A, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. Mar 3 2011;364(9):829-841.

2. Seshasai SR, Kaptoge S, Thompson A, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. Mar 3 2011;364(9):829-841.

3. Mohan V, Shanthirani CS, Deepa M, Deepa R, Unnikrishnan RI, Datta M. Mortality rates due to diabetes in a selected urban south Indian population–the Chennai Urban Population Study [CUPS--16]. J Assoc Physicians India. Feb 2006;54:113-117.

4. International Diabetes Federation. Diabetes and CVD Disease: A Time to Act. 2001. Brussels  2001.

5. Danaei G, Lawes CM, Vander Hoorn S, Murray CJ, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet. Nov 11 2006;368(9548):1651-1659.

6. Hoffmann F, Haastert B, Koch M, Giani G, Glaeske G, Icks A. The effect of diabetes on incidence and mortality in end-stage renal disease in Germany. Nephrol Dial Transplant. May 2011;26(5):1634-1640.

7. Pavkov M E, Sievers ML, Knowler WC, Bennett PH, Nelson RG. An explanation for the increase in heart disease mortality rates in diabetic Pima Indians: effect of renal replacement therapy. Diabetes Care. May 2004;27(5):1132-1136.

8. Nothlings U, Ford ES, Kroger J, Boeing H. Lifestyle factors and mortality among adults with diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study*. J Diabetes. Jun 2010;2(2):112-117.

9. Stock S., Drabik A, Buscher G, et al. German diabetes management programs improve quality of care and curb costs. Health Aff (Millwood). Dec 2010;29(12):2197-2205.

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