Diabetes-related mortality 'grossly underestimated' in Germany

Official estimates of excess diabetes-related deaths in Germany that were gathered from information from death certificates “grossly underestimated” the prevalence of diabetes mortality, study data show.

“Along with increasing diabetes prevalence, population aging and diabetes complications, evidence on the burden of diabetes mortality is an important component for adequate public health decisions,” Esther Jacobs, MSc, of the Leibniz Center for Diabetes Research at Heinrich-Heine University, Dusseldorf, told Endocrine Today. “For the first time, we were able to estimate the absolute number of excess deaths and the population attributable fraction associated with diabetes at a national level in Germany.” Jacobs and colleagues reviewed data from 64.9 million people enrolled in the German national health care system in 2010. The researchers estimated the prevalence of diabetes deaths using the mortality rate ratio from the Danish National Diabetes Register because Germany did not have nationwide information on deaths related to the disease, and because Denmark, which Jacobs said has one of Europe’s most accurate registers, has a standard of living similar to that of Germany. Jacobs and colleagues calculated the absolute number of excess diabetes deaths as the number of deaths attributable to diabetes, less the number of deaths attributable to diabetes with a mortality equal to that of the general population, according to the study.

Diabetes caused 174,627 excess deaths in 2010, the researchers reported, with 137,950 attributable to type 2 diabetes. More than one-fifth of all deaths nationwide were due to diabetes (21%), according to Jacobs and colleagues; type 2 diabetes was responsible for 16%.

There were more excess deaths in men (n = 92,924) than in women (n = 81,703). Most of these deaths occurred in groups aged 70 to 79 and 80 to 89 years (34% each), the researchers wrote.

The study was limited by its reliance on routine health care claims, and because it did not account for people who died, moved out of the country or switched to private insurance, Jacobs and colleagues wrote.

“In conclusion, we have estimated, for the first time in our knowledge, the absolute number of excess deaths for people with diabetes and type 2 diabetes in Germany,” the researchers wrote. “The method can be applied to other countries without national diabetes registries to determine the national burden of mortality attributable to diabetes.” – by Andy Polhamus

Disclosures: Jacobs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.