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Endocrine, CV causes drive excess mortality in type 2 diabetes in Sweden
Among Swedish patients with new-onset type 2 diabetes, most excess mortality was related to cardiovascular or diabetes-related causes, study data showed.
“Improved survival among patients with diabetes has been reported from several studies in Western countries including Sweden,” Tobias Andersson, of Närhälsan Norrmalm Health Centre, Skövde, and colleagues wrote. “Population-based prospective data is limited about causes of death and long-term changes in mortality among patients with clinically diagnosed new-onset type 2 diabetes compared to the background population.”
The researchers conducted a prospective cohort study of patients from Skaraborg County in southwestern Sweden. All patients with new-onset type 2 diabetes added to the Skaraborg Diabetes Register between 1991 and 2004 were included. Andersson and colleagues used Poisson models to calculate adjusted excess mortality and changes in excess mortality over time. They also evaluated the cumulative incidences of cause-specific mortality using competing risk regression.
The overall excess mortality rate among patients with new-onset type 2 diabetes was 47% compared with controls (HR = 1.47; 95% CI, 1.39-1.57), the researchers wrote. There were 4,364 deaths among 7,461 patients over the course of 24 years of follow-up (90,529 person-years; 48.2 deaths per 1,000 person-years; 95% CI, 46.8-49.7). In controls, Andersson and colleagues reported 18,541 deaths in 37,271 patients in 479,428 person-years (38.7 per 1,000 person-years; 95% CI, 38.1-39.2).
Among patients who were diagnosed in 1991, the adjusted mortality HR was 1.47 (P < .0001); this fell by 2% per increasing calendar year of diagnosis until 2004. Andersson and colleagues attributed this decrease to earlier disease detection caused by lowered thresholds for diabetes diagnosis and intensified diagnostic activities, as well as more vigorous risk factor treatment during the study.
Most excess mortality was attributed to endocrine (crude subdistributional HR = 5.06) or cardiovascular (HR = 1.22) causes (both P < .001).
“As excess mortality was mainly attributed to increased risk of death by cardiovascular disease and diabetes, diagnosis of type 2 diabetes at an early stage of disease prior to development of cardiovascular complications and aggressive treatment of cardiovascular risk factors seem important to further close the gap of excess mortality, especially among younger patients who had highest excess mortality,” the researchers wrote. – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.