Advertisement

Mortality trends and cause of death in patients with new-onset type 2 diabetes and controls: A 24-year follow-up prospective cohort study

Published:February 05, 2018DOI:https://doi.org/10.1016/j.diabres.2018.01.038

      Highlights

      • Reduced excess mortality over time among patients with new-onset type 2 diabetes.
      • Poisson and competing risk regression survival modeling with matched controls.
      • Excess mortality mainly attributed to cardiovascular and endocrinological disease.
      • Doubled excess mortality among young patients < 55 years at time of diagnosis.

      Abstract

      Aims

      Our aim was to assess causes of death and temporal changes in excess mortality among patients with new-onset type 2 diabetes in Skaraborg, Sweden.

      Methods

      Patients from the Skaraborg Diabetes Register with prospectively registered new-onset type 2 diabetes 1991–2004 were included. Five individual controls matched for sex, age, geographical area and calendar year of study entry were selected using population records. Causes of deaths until 31 December 2014 were retrieved from the Cause of Death Register. Adjusted excess mortality among patients and temporal changes of excess mortality were calculated using Poisson models. Cumulative incidences of cause-specific mortality were calculated by competing risk regression.

      Results

      During 24 years of follow-up 4364 deaths occurred among 7461 patients in 90,529 person-years (48.2/1000 person-years, 95% CI 46.8–49.7), and 18,541 deaths in 479,428 person-years among 37,271 controls (38.7/1000 person-years, 38.1–39.2). The overall adjusted mortality hazard ratio was 1.47 (p < .0001) among patients diagnosed at study start 1991 and decreased by 2% (p < .0001) per increase in calendar year of diagnosis until 2004. Excess mortality was mainly attributed to endocrine and cardiovascular cause of death with crude subdistributional hazard ratios of 5.06 (p < .001) and 1.22 (p < .001).

      Conclusions

      Excess mortality for patients with new-onset type 2 diabetes was mainly attributed to deaths related to diabetes and the cardiovascular system, and decreased with increasing year of diagnosis 1991–2004. Possible explanations could be temporal trends of earlier diagnosis due to lowered diagnostic thresholds and intensified diagnostic activities, as well as improved treatment.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Guariguata L.
        • Whiting D.R.
        • Hambleton I.
        • Beagley J.
        • Linnenkamp U.
        • Shaw J.E.
        Global estimates of diabetes prevalence for 2013 and projections for 2035.
        Diabetes Res Clin Pract. 2014; 103: 137-149
        • Jansson S.P.
        • Fall K.
        • Brus O.
        • Magnuson A.
        • Wandell P.
        • Ostgren C.J.
        • et al.
        Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden.
        Diabet Med. 2015; 32: 1319-1328
        • NCD Risk Factor Collaboration
        Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.
        Lancet. 2016; 387: 1513-1530
        • Gregg E.W.
        • Gu Q.
        • Cheng Y.J.
        • Narayan K.M.
        • Cowie C.C.
        Mortality trends in men and women with diabetes, 1971 to 2000.
        Ann Intern Med. 2007; 147: 149-155
        • Dale A.C.
        • Vatten L.J.
        • Nilsen T.I.
        • Midthjell K.
        • Wiseth R.
        Secular decline in mortality from coronary heart disease in adults with diabetes mellitus: cohort study.
        BMJ. 2008; 337: a236
        • Gaede P.
        • Oellgaard J.
        • Carstensen B.
        • Rossing P.
        • Lund-Andersen H.
        • Parving H.H.
        • et al.
        Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial.
        Diabetologia. 2016; 59: 2298-2307
        • Hansen M.B.
        • Jensen M.L.
        • Carstensen B.
        Causes of death among diabetic patients in Denmark.
        Diabetologia. 2012; 55: 294-302
        • Lind M.
        • Garcia-Rodriguez L.A.
        • Booth G.L.
        • Cea-Soriano L.
        • Shah B.R.
        • Ekeroth G.
        • et al.
        Mortality trends in patients with and without diabetes in Ontario, Canada and the UK from 1996 to 2009: a population-based study.
        Diabetologia. 2013; 56: 2601-2608
        • Tancredi M.
        • Rosengren A.
        • Svensson A.M.
        • Kosiborod M.
        • Pivodic A.
        • Gudbjornsdottir S.
        • et al.
        Excess Mortality among Persons with Type 2 Diabetes.
        N Engl J Med. 2015; 373: 1720-1732
        • Jansson S.P.
        • Andersson D.K.
        • Svardsudd K.
        Mortality trends in subjects with and without diabetes during 33 years of follow-up.
        Diabetes Care. 2010; 33: 551-556
        • Gregg E.W.
        • Cheng Y.J.
        • Saydah S.
        • Cowie C.
        • Garfield S.
        • Geiss L.
        • et al.
        Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey.
        Diabetes Care. 2012; 35: 1252-1257
        • Harding J.L.
        • Shaw J.E.
        • Peeters A.
        • Davidson S.
        • Magliano D.J.
        Age-specific trends from 2000–2011 in all-cause and cause-specific mortality in type 1 and type 2 diabetes: a cohort study of more than one million people.
        Diabetes Care. 2016; 39: 1018-1026
        • Barnett K.N.
        • Ogston S.A.
        • McMurdo M.E.
        • Morris A.D.
        • Evans J.M.
        A 12-year follow-up study of all-cause and cardiovascular mortality among 10,532 people newly diagnosed with Type 2 diabetes in Tayside.
        Scotland Diabet Med. 2010; 27: 1124-1129
        • Gulliford M.C.
        • Charlton J.
        Is relative mortality of type 2 diabetes mellitus decreasing?.
        Am J Epidemiol. 2009; 169: 455-461
        • Berger B.
        • Stenstrom G.
        • Chang Y.F.
        • Sundkvist G.
        The prevalence of diabetes in a Swedish population of 280,411 inhabitants. A report from the Skaraborg Diabetes Registry.
        Diabetes Care. 1998; 21: 546-548
        • Albertsson-Wikland K.
        • Martensson A.
        • Savendahl L.
        • Niklasson A.
        • Bang P.
        • Dahlgren J.
        • et al.
        Mortality is not increased in recombinant human growth hormone-treated patients when adjusting for birth characteristics.
        J Clin Endocrinol Metab. 2016; 101: 2149-2159
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
      1. Cleves M, Gould WW, Marchenko YV. An introduction to survival analysis using stata. 3rd ed. Stata Press: College Station, TX; 2016.

        • Charlton J.
        • Latinovic R.
        • Gulliford M.C.
        Explaining the decline in early mortality in men and women with type 2 diabetes: a population-based cohort study.
        Diabetes Care. 2008; 31: 1761-1766
        • Ludvigsson J.F.
        • Otterblad-Olausson P.
        • Pettersson B.U.
        • Ekbom A.
        The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research.
        Eur J Epidemiol. 2009; 24: 659-667
        • Alberti K.G.
        • Zimmet P.Z.
        Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
        Diabet Med. 1998; 15: 539-553
        • Harding J.L.
        • Shaw J.E.
        • Peeters A.
        • Guiver T.
        • Davidson S.
        • Magliano D.J.
        Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997–2010.
        Diabetes Care. 2014; 37: 2579-2586
        • Eliasson M.
        • Talback M.
        • Rosen M.
        Improved survival in both men and women with diabetes between 1980 and 2004–a cohort study in Sweden.
        Cardiovasc Diabetol. 2008; 7: 32
        • Carstensen B.
        • Kristensen J.K.
        • Ottosen P.
        • Borch-Johnsen K.
        The danish national diabetes register: trends in incidence, prevalence and mortality.
        Diabetologia. 2008; 51: 2187-2196
        • Feldman A.L.
        • Griffin S.J.
        • Fhärm E.
        • Norberg M.
        • Wennberg P.
        • Weinehall L.
        • et al.
        Screening for type 2 diabetes: do screen-detected cases fare better?.
        Diabetologia. 2017; 60: 2200-2209
      2. Nationella Diabetesregistret. Årsrapport 2016, <https://www.ndr.nu/pdfs/Arsrapport_NDR_2016.pdf>; 2017 [accessed 26 October 2017].

        • Rawshani A.
        • Rawshani A.
        • Franzen S.
        • Eliasson B.
        • Svensson A.M.
        • Miftaraj M.
        • et al.
        Mortality and cardiovascular disease in type 1 and type 2 diabetes.
        N Engl J Med. 2017; 376: 1407-1418
        • Read S.H.
        • Kerssens J.J.
        • McAllister D.A.
        • Colhoun H.M.
        • Fischbacher C.M.
        • Lindsay R.S.
        • et al.
        Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013.
        Diabetologia. 2016; 59: 2106-2113