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Excess mortality associated with diabetes is falling, study shows

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f4118 (Published 25 June 2013) Cite this as: BMJ 2013;346:f4118
  1. Susan Mayor
  1. 1London

The excess mortality associated with having diabetes has fallen over the past decade, shows a study that compared death rates in adults with the condition and those without.1

The researchers compared annual age and sex adjusted mortality rates of adults with and without diabetes by using a population based healthcare database for Ontario, Canada, and the UK Health Improvement Database (THIN) between 1996 and 2009.

Their results showed that the increased risk of mortality associated with diabetes in adults in Ontario fell from 1.9 (95% confidence interval 1.86 to 1.94) in 1996 to 1.51 (1.48 to 1.54) in 2009. Over the same period in the United Kingdom it fell from 2.14 (1.97 to 2.32) to 1.65 (1.57 to 1.72).

The excess risk of mortality in people with diabetes fell in all age groups over the time period: by 25-40% in those aged 20-64 and by 50-65% in people aged over 64.

The study’s authors, led by Marcus Lind of the Sahlgrenska Academy at the University of Gothenburg, Sweden, said, “Our findings indicate that for diabetic patients as a group the excess risk of mortality is lower today.

“Although caution should be exercised in identifying a trend shift in the prognosis of patients with diabetes, more aggressive treatment during recent decades may be applicable to the present results.”

The researchers noted that practice guidelines for the management of diabetes have emphasised the need for aggressive control of blood pressure, lipid concentrations, and hyperglycaemia. “As a consequence, patients with diabetes now receive more intensive care and are taking substantially more medication,” they suggested.

But they cautioned that the reduction in mortality might be partly explained by earlier detection of diabetes and shorter duration of the disease, as guidelines have encouraged more screening of groups of people at high risk of having the condition. The prevalence of diabetes rose considerably during the study period in both settings, in Ontario from 5.4% in 1996 to 11.4% in 2009 and in the UK from 3.2% to 5.9%, indicating better detection.

Notes

Cite this as: BMJ 2013;346:f4118

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