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All-cause mortality risk doubles for adults with type 2 diabetes
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German adults with type 2 diabetes are twice as likely to die of any cause vs. those without the disease, with the excess risk at least as high for those with undiagnosed as with diagnosed diabetes, according to an analysis of registry data.
In an analysis of follow-up data from participants in the 1998 German National Health Interview and Examination Survey (GNHIES), the researchers also found that the excess risk for death in association with type 2 diabetes is higher among younger vs. older adults regardless of sex, and higher for men vs. women with undiagnosed type 2 diabetes.
Christa Scheidt-Nave, MD, MPH, of the department of epidemiology and health monitoring at the Robert Koch Institute in Berlin, and colleagues analyzed data from 6,550 participants in GNHIES, a population-based survey conducted by the Robert Koch Institute from 1997 to 1999. The survey included a computer-assisted personal interview, an assessment of current medications and an exam with laboratory analysis. Follow-up occurred between 2008 and 2011. Researchers calculated age-specific mortality rates for participants without type 2 diabetes (n = 5,975; mean age, 44 years; 50.75% women) and for those with diagnosed (n = 330; mean age, 62 years; 52.72% women) and undiagnosed type 2 diabetes (n = 245; mean age, 60 years; 44.72% women). Mortality RRs comparing age-specific mortality rates of participants with and without type 2 diabetes were calculated and stratified by sex. Researchers also calculated years of life lost due to diagnosed diabetes in Germany in 2010, comparing the official number of deaths in Germany in 2010 with the number of deaths expected in the absence of excess mortality from diabetes.
During a median follow-up time of 12 years, deaths included 73 participants with undiagnosed type 2 diabetes, 103 participants with diagnosed type 2 diabetes and 425 participants without type 2 diabetes.
Researchers found that mortality rate increased with age regardless of diabetes status, whereas mortality RRs were higher among younger vs. older participants with type 2 diabetes.
Among participants aged at least 45 years, age- and sex-standardized overall mortality was twofold higher among those with undiagnosed type 2 diabetes and 70% higher among those with diagnosed diabetes compared with those without the disease, although researchers noted that CIs were overlapping.
In sex-stratified analyses, age-specific mortality RRs were generally higher for younger vs. older participants with diabetes, according to researchers. Age-standardized, overall mortality RRs from age 45 years were similar among women with both diagnosed and undiagnosed type 2 diabetes; however, in men, RR for all-cause mortality was higher among those with undiagnosed vs. diagnosed type 2 diabetes (mortality RR, 2.06 vs. 1.7).
Researchers estimated that there were 334,500 years of life lost due to diagnosed diabetes in 2010 (164,600 years for women and 169,900 years for men), accounting for about 2% of overall years of life lost due to death from any cause.
“Our estimates provide a baseline for surveillance of diabetes epidemiology and quality of care,” the researchers wrote. “In addition to the lifetime lost, the amount and quality of lifetime spent with the disease should also be considered in future analyses. This becomes all the more important as several countries report declining [mortality] RR in association with diabetes, suggesting improved survival into old age and hence a potential increase in years spent in disability.”
According to Scheidt-Nave, population-based surveillance of excess mortality in association with type 2 diabetes must factor in differences according to sex, age and undiagnosed vs. diagnosed diabetes.
“Younger persons with type 2 diabetes, in particular men with undiagnosed diabetes, need specific attention in secondary prevention,” Scheidt-Nave told Endocrine Today. – by Regina Schaffer
For more information:
Christa Scheidt-Nave, MD, MPH, can be reached at the Robert Koch Institute, Nordufer 20, 13353 Berlin; email: scheidt-navec@rki.de.
Disclosure: One of the study authors reports receiving grants from the Federal Ministry of Health.
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