Diabetes linked to lower life expectancy in UK
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Adults with diabetes in the United Kingdom live fewer years on average than people without diabetes and 100 days for each year an HbA1c above 7.5%, according to study data.
“This is pooled national data for England looking at the way having type 1 and type 2 diabetes does influence life expectancy,” Adrian Heald, MD, consultant physician in diabetes and endocrinology at Leighton and Macclesfield hospitals, and lecturer at the University of Manchester, told Healio. “We’re very keen on preventing complications and all of the work to prevent premature death. But it is still happening, and that’s what we wanted to highlight.”
Heald and colleagues presented the findings at the European Association for the Study of Diabetes virtual meeting.
The researchers’ model included data from the National Diabetes Audit published in 2015 and 2016. Statistics included the mortality rates for people with type 1 and type 2 diabetes in five age groups and each sex in relation to the general population. Information from the Office for National Statistics was gathered from 2015 to 2017 with the actual mortality rates and projected life expectancy of the general population for each age year and sex.
The model applied mortality rates for each age group and sex to calculate future life expectancy. Lost life-years were calculated through the difference between life expectancy for people with type 1 and type 2 diabetes in each age group and sex, as well as the life expectancy for the equivalent population without diabetes.
According to the model, an “average” adult with type 1 diabetes (mean age, 32.8 years) was estimated to live an additional 32.6 years vs. an additional 40.2 years for age-matched people without diabetes. An “average” adult with type 2 diabetes (mean age, 65.4 years) was estimated to live an additional 18.6 years while those without type 2 diabetes were expected to live an additional 20.3 years.
Researchers estimated that an HbA1c of greater than 58 mmol/mol (7.5%) would result in the loss of about 100 life-days each year. According to the National Diabetes Audit, 70% of people with type 1 diabetes and 33% of people with type 2 diabetes had an HbA1c of 58 mmol/mol or higher.
“If we can incentivize people to bring their HbA1c to target, then there are advantages down the road for them later in life,” Heald said. “It’s not always easy to achieve that target, but any step toward that target is going to be a good thing in terms of improving life expectancy and reducing the number of life-days lost for each year spent as a high, above target HbA1c.”
Women with type 1 diabetes had an average of 8.5 lost life-years vs. 7 lost life-years for men with type 1 diabetes. In the type 2 diabetes population, women also had a higher amount of lost life-years (2 years) vs. men (1.4 years).
“It’s not that the women are living shorter lives than the men,” Heald said. “It’s just that they are losing the benefit that normally comes with being a woman. In the general population, without diabetes, women live longer than men. What happens with diabetes is it takes away that biological advantage.”
Researchers are planning to do further research on diabetes mortality by working with 550 general practices in the Royal College of General Practitioners database and applying the data at a local level.
“We have permission to analyze the practice-level data to look, in more detail, at how the variation between practices in how good they are in managing diabetes in relation to HbA1c, may relate to mortality over a 5-year period,” Heald said.
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Stedman M, et al. Estimating life years lost to diabetes: Outcomes from analysis of National Diabetes Audit and Office of National Statistics Data England. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 21-25, 2020 (virtual meeting).
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