Audit finds 24 000 excess deaths among people with diabetes in England and Wales

BMJ 2012; 345 doi: (Published 10 December 2012) Cite this as: BMJ 2012;345:e8406
  1. Zosia Kmietowicz
  1. 1BMJ

An audit of nearly two million people with diabetes in England and Wales has found that in 2010-11 about 45 000 of them had heart failure, 17 700 (65%) more than the number that would be expected in the general population (27 300).1

However, the risk of heart failure varied widely across England and Wales. After standardisation to minimise differences in local populations, such as age and sex, the risk of heart failure in patients with diabetes in Havering was 27% more than the general population, while in Kensington and Chelsea it was 164% higher.

The national diabetes audit of diabetes related complications and mortality has quantified the risks of cardiovascular complications among people with diabetes for the first time. It included 85% of people with diabetes in England and 54% in Wales—just under two million people whose complications were recorded between 1 April 2010 and 31 March 2011. It was carried out by the NHS Health and Social Care Information Centre in partnership with the charity Diabetes UK.

It found that 14 500 people with diabetes had a heart attack in 2010-11, 48% more than the 9800 expected cases. There were also an excess of 3600 strokes among people with diabetes (25% more than expected) and 5800 more cases of people needing renal replacement therapy (114% more than expected).

In 2010-11 around 3000 people with diabetes needed a minor amputation, which was 331% more than the 700 cases expected, while major amputations were 210% more common than expected (1700 cases, rather than the 600 expected).

Overall, people with diabetes were found to have a 40% higher risk of death than the general population in 2011, with the highest risk among women and patients with type 1 diabetes.

But again the risk of death varied widely, with a low of 6% in the Heart of Birmingham Teaching Primary Care Trust area and a high of 91% in Greenwich. The audit estimated that there were 22 200 excess deaths in England and 1900 in Wales among people with diabetes.

Barbara Young, chief executive of Diabetes UK, said that too many people with diabetes were dying from the complications of stroke, heart disease, and kidney disease. Altogether 80% of the £10bn (€12.4bn; $16bn) that the NHS spends on diabetes goes on treating complications. Young called on the government and NHS to prioritise care of people with diabetes to reduce premature deaths in the UK.

She added, “The finding that people with diabetes are almost 50% more likely to have a heart attack is shocking, and this is one of the main reasons many thousands of people with the condition are dying before their time.

“It is a tragedy that a large proportion of these thousands of extra heart attacks could have been prevented simply through better education, treatment, and care. We hope this report spurs the NHS into action to improve the current situation where fewer than half of people with diabetes meet the recommended cholesterol levels and a significant minority are not even having it measured.”

The charity said that at the moment just 41% of people with diabetes were meeting the recommended cholesterol levels and that 10% were not getting the annual cholesterol check recommended by the National Institute for Health and Clinical Excellence. Many people with the condition also had high blood pressure and blood glucose levels, which also increased their risk of heart disease.

Young added, “We want everyone with diabetes to get their cholesterol, blood pressure, and blood glucose checked once a year and for this to be the start of a process of supporting the person to achieve healthy levels of these. Unless this happens, people with diabetes will continue to be at much greater risk of heart attacks.”


Cite this as: BMJ 2012;345:e8406