Poor care leads to 24 000 premature deaths from diabetes in England each yearBMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d8081 (Published 13 December 2011) Cite this as: BMJ 2011;343:d8081
Around 24 000 people in England with diabetes are dying each year from complications that could be avoided with better management, the first national audit of diabetes mortality has shown.
The mortality audit linked information on 1.42 million people with diabetes included in the 2007-8 national diabetes audit with data from their death certificates. The annual diabetes audit collects data from general practices on numbers of people recorded on diabetes registers, their complication rates, and measures of care.
From its inception the diabetes audit team at the NHS Information Centre had planned to include mortality among its outcomes, but this is the first time it has been able to do so. Tracking death certificate data showed that 49 282 of the people in the 2007-8 audit died in the follow-up period from 1 November 2008 to 31 October 2009.
The audit included 68% of the 2.1 million people in England estimated on the basis of national Quality and Outcomes Framework (QOF) data to have diabetes, so the audit group estimated that a total of 70 000 to 75 000 people with diabetes die each year.
The figures showed that the risk of premature death for patients with type 1 diabetes was 2.6 times that in the general population and that the risk for people with type 2 diabetes was 1.6 times the general rate.
Just over 16 000 more people died among those included in the audit than would have been expected if their mortality risk were the same as the general population. Extrapolating this to include patients not in the audit gave a total of about 24 000 excess deaths each year in England occurring in people with diagnosed diabetes.
Bob Young, a consultant diabetologist in Salford who was the audit’s lead clinician and is also clinical lead for the NHS Information Centre’s national diabetes information service, said, “For the first time we have a reliable measure of the huge impact of diabetes on early deaths. Many of these early deaths could be prevented.”
He added, “I hope the audit findings will begin to raise awareness of the health burden that diabetes represents. It often gets a bit overlooked because the consequences of diabetes, including excess mortality, appear in such an insidious way. Deaths due to diabetes are not recognised in the same way as deaths due to heart attack or cancer. The whole health system needs to wake up to the fact that diabetes is not a trivial disease.”
The audit showed that excess mortality was much greater in young and middle aged adults with diabetes. In young women aged 15-34 with type 1 diabetes, mortality was around nine times that in people without diabetes; mortality in men in this age group was four times that in people without diabetes. For type 2 diabetes, death rates were approximately six and 3.6 times as high, respectively. In people over 85 years all these ratios had dropped to less than two.
“Evidence based preventive care should be delivered more comprehensively and effectively to reduce the life lost due to diabetes,” Dr Young recommended. He said, “It’s quite striking that the relative impact on mortality is so much greater in people of working age and younger as opposed to older people.” He said that this may relate to previous findings from the diabetes audit showing that young people with diabetes are more likely than older people to receive all components of recommended diabetes care and to achieve treatment targets.
Poor management of diabetes, including not receiving basic healthcare checks, leading an unhealthy lifestyle, and not taking drugs appropriately, can increase the risk of death from causes such as critically high or low blood sugar concentrations, heart failure, or kidney failure.
“Good diabetes care greatly reduces the risk of heart failure or kidney failure, while good diabetes education can help people with diabetes to reduce their risk of dangerously high or low blood sugar,” Dr Young said. “The mortality audit is a wake-up call of the need to provide better services for young people with diabetes.”
The results also indicated a strong link between deprivation and increased mortality. Death rates in people with type 1 diabetes ranged from a low of 1852 per 100 000 in London to a high of 2351 per 100 000 in the north east strategic health authority. The death rate in people with type 2 diabetes ranged from 1246 per 100 000 in London to 1668 per 100 000 in the north east.
The audit group estimates that in cases where diabetes contributed to the death it is mentioned as such in only about half of death certificates. Diabetes should be recorded more comprehensively as a contributory factor on the certificates, it said.
Cite this as: BMJ 2011;343:d8081
The audit results are at www.ic.nhs.uk/nda.