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Diabetes mortality risks have decreased

Nov. 14, 2013

By Patricia Nicholson

It has been well established that having diabetes increases the risk of dying, compared to not having the condition. This is in large part because diabetes increases the risk for cardiovascular issues, including heart attack and stroke. It is also a leading cause of kidney disease.

However, new research suggests that things have improved significantly for people with diabetes in recent years. Data on Ontario diabetes patients show that their excess mortality risk has almost been cut in half since 1996.

“There have been so many advances in diabetes treatment, and we’ve seen a lowering of complication rates,” says Dr. Lorraine Lipscombe, a scientist at Women’s College Research Institute and lead author of a recent study of diabetes mortality in Ontario and the U.K. “So we wanted to know, can we tell our patients that now, having diabetes today is not as bad as having it 15 years ago?”

To find out, Dr. Lipscombe and her research colleagues used information from healthcare databases to look at diabetes mortality in Ontario and the U.K.

“We compared the mortality rate of people living with and without diabetes in 1996 and every year thereafter up until 2009,” she says. “In Ontario we saw in 1996 the increased risk of mortality associated with diabetes was about two-fold, and then in 2009 it’s about 1.5-fold. So it’s come down by almost 50 per cent. So that’s good news, and it tells us that we’re correct: all the advances we’ve seen in the care of diabetes, and what we’ve learned about lowering the risk of complications and early detection of the disease, have now translated into lower mortality rates.”

The decrease in excess risk of dying was similar in the U.K. data.

Along with the good news about mortality risks, there was also further confirmation of the bad news about diabetes: its prevalence has risen sharply in Ontario. In 1996, 5.4 per cent of Ontarians over age 20 had diabetes. By 2009, this had grown to 11.4 per cent – higher than one in every 10 adults.

The study, which was published in the medical journal Diabetologia, also looked at different age groups. Diabetes-related mortality risk became lower in every age group over the study period, but there were differences between age groups. The highest mortality risk associated with diabetes in Ontario in 2009 was in people ages 20 to 45, who had a five times higher risk of dying than people the same age without diabetes. This was a much higher increased risk than was found in those aged 65 to 74 (70-80 per cent increased risk) or those 75 and over (10-20 per cent increased risk).

“When you’re comparing death rates in people with and without diabetes, diabetes is contributing far more to the relative increase in death for people in that (younger) age group,” says Dr. Lipscombe, although she notes that the actual number of deaths in young people was very low: almost 90 per cent of deaths occurred in people ages 65 and over, despite the lower risk associated with diabetes.  “This suggests that people are dying from many more different reasons when they’re older, so diabetes may not be contributing as much.”

It’s likely that the drop in excess mortality in people with diabetes is related to advances in care – particularly addressing cardiovascular risks in diabetes patients. The most common cause of death worldwide is cardiovascular events – such as heart attack and stroke – and risks are even higher in people with diabetes.

“We’ve learned a lot about what we can do to lower the risk of cardiovascular disease in people with diabetes,” Dr. Lipscombe says. Current blood sugar control guidelines are more aggressive than they were 15 years ago, there are more medications for controlling blood sugar, and diabetes treatment now also focuses on other factors such as blood pressure, cholesterol, and eliminating smoking.

“All of those things are contributing to a lower risk of cardiovascular events which is probably translating into a lower risk of death,” says Dr. Lipscombe.

She adds that people are also more likely to be screened for diabetes now, compared to 1996. That means it’s being diagnosed at an earlier stage more often, which has likely contributed to better overall health in the population of people with diabetes.

The good news for people with diabetes is that if they manage it well, they are likely to be able to live a normal, healthy life. Good diabetes management often includes medication as well as lifestyle changes such as stopping smoking, keeping fit and maintaining a healthy weight.

However, there are still health risks associated with the condition.

“I don’t think we’ll ever be able to fully eliminate the gap between people with and without diabetes, and we may never be able to fully control complication rates in people with diabetes. There are too many factors that go into whether or not a person’s diabetes is well managed,” Dr. Lipscombe says.

For that reason, and given the rising rates of diabetes in Ontario, it’s imperative that we look at ways to prevent diabetes before it happens.

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  • A publication of:
  • Women's College Hospital