[Diabetes-talk] FW: Death rates decrease from Diabetes

[Mike Freeman]

Methinks the message below puts the medical panicking about diabetes currently in vogue in proper perspective. Long live skepticism!

 

Mike

 

 

From: acb-diabetics-bounces at acb.org [mailto:acb-diabetics-bounces at acb.org] On Behalf Of Nancy Matulis
Sent: Friday, June 21, 2013 11:46 AM
To: acb-diabetics at acb.org
Subject: [acb-diabetics] Death rates decrease from Diabetes

 

According to a population-based study of 2 cohorts in the United Kingdom and in Canada, the overall excess mortality risk from having diabetes vs not having this disease has dropped by about half since the mid-1990s.

The collaborative work by researchers in Sweden, the United Kingdom, and Canada is published online June 20 inDiabetologia.

In 2009 compared with 1996, the excess risk for mortality in patients with diabetes vs patients without diabetes decreased from 90% to 51% in the province of Ontario, Canada and from 114% to 65% in a representative sample of patients seen in primary care in the United Kingdom.

"About 14 years ago, the excess mortality associated with diabetes was often quoted as a 2-fold increased risk; now it has gone down to about 50%," lead author Lorraine Lipscombe, MD, from Women’s College Hospital and the University of Toronto, in Ontario, told Medscape Medical News.

For clinicians, "it's good news," she noted. "This is evidence that we are doing a better job of taking care of diabetes," and "we can counsel patients that we are better able to manage them and keep them healthy for a longer period."

How Does Diabetes Affect Survival in a Modern Cohort?

Dr. Lipscombe and colleagues say that a recent review of prospective studies suggested that diabetes was linked with an approximate 80% increased risk for mortality, but many of the data came from before 2000. Newer research hinted that this rate was much lower now.

To investigate this, she and her colleagues set out to look at contemporary rates of mortality and examine changes over time. They used 2 databases, one of around 10 million Ontario residents covered by a provincial healthcare plan and the other covering more than 3 million patients seen in primary-care practices in the United Kingdom who are part of  <http://www.thin-uk.com/> The Health Improvement Network (THIN).

>From 1996 to 2009, the prevalence of diabetes in adults aged 20 and older increased from 5.4% to 11.4% in Ontario and from 3.2% to 5.9% in the United Kingdom (THIN population).

"The reasons for this discrepancy [between the 2 cohorts] are unclear but may be related to differences in factors known to influence the incidence of diabetes, such as screening programs, ethnicity, eating habits, or physical-activity patterns," the authors write, adding that further research is needed.

Dr. Lipscombe explained that they included diagnoses of both type 1 and type 2 diabetes, but they were unable to differentiate between the 2.

The excess risk for mortality in patients with diabetes vs patients without diabetes fell over time for all age groups during the study period: it was approximately 25% to 40% lower in those below the age of 64 years and 50% to 65% lower in those aged over 64 years.

Adjusted Mortality Rate Ratios for Adults With vs Without Diabetes in 1996


Age (y)

Ontario database

THIN UK database


20 – 44

1.98

2.30


45 – 64

2.48

2.60


65 – 74

1.45

1.46


> 75

1.63

1.75


Total

1.90

2.14

 

Adjusted Mortality Rate Ratios for Adults With vs Without Diabetes in 2009


Age (y)

Ontario database

THIN UK database


20 – 44

1.70

1.79


45 – 64

1.94

2.23


65 – 74

1.16

1.24


> 75

1.23

1.25


Total

1.51

1.65

By 2009, the excess risk for mortality in patients with diabetes compared to their age-matched peers without diabetes was 70% to 79% higher in 20- to 44-year-olds, about double in 45- to 64-year-olds, and 15% to 25% greater in those aged 65 and older.

The oldest individuals were more likely to have other comorbidities, which may explain why, compared with younger people, they had a lower rate of mortality related to diabetes, Dr. Lipscombe suggested.

The decline in deaths related to diabetes was similar in men and women.

UKPDS Likely Influenced the Better Outcomes


"We're much more aggressive with glucose control, blood-pressure control, and lipid treatment, so that has probably led to healthier populations," she speculated. "We're [also] screening more often and detecting diabetes at an earlier stage."The overall narrowing in the mortality gap may reflect changes in practice guidelines that followed the 1998 United Kingdom Prospective Diabetes Study (UKPDS), which showed that intensive management of type 2 diabetes led to better outcomes, Dr. Lipscombe said.

This study was supported by the National Diabetes Surveillance System funding from Ontario's Ministry of Health and Long-Term Care and an unrestricted grant from AstraZeneca and Novo Nordisk Scandinavia. Dr. Lipscombe was supported by the Canadian Diabetes Association/Canadian Institute of Health Research (CDA/CIHR) Clinician Scientist Award and currently receives support from a CIHR New Investigator Award. Disclosures for the coauthors are listed in the article.

 

Nancy Matulis

ACB Maine Secretary

Sent from my iPad

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