[Nfbmo] good news for diabetics
debbiewunder at centurytel.net
Sun Jun 23 13:34:34 UTC 2013
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
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
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
THIN UK database
20 - 44
45 - 64
65 - 74
Adjusted Mortality Rate Ratios for Adults With vs Without Diabetes in 2009
THIN UK database
20 - 44
45 - 64
65 - 74
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.
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