Mortality in individuals with Type 2 diabetes and heart disease in a unique New Zealand population.
OBJECTIVE
To determine rate and predictors of mortality in patients with Type 2 diabetes living in a population with a large proportion of Maori and Pacific peoples who were admitted to hospital with myocardial infarction (MI) or congestive cardiac failure (CCF).


METHODS
The study population included 4193 individuals with Type 2 diabetes who lived in South Auckland and who participated in a primary care audit between 1994 and 1999. We studied a subgroup of 319 patients who subsequently had a hospital admission for MI or CCF between 1999 and 2001. We examined their demographics, drug treatment, vascular risk factors and mortality up to 2003.


RESULTS
Following discharge, the prescription of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, aspirin and statins had all increased significantly. Vascular risk factors including total cholesterol, high-density lipoprotein (HDL) cholesterol, systolic blood pressure and glycated haemoglobin (HbA(1c)) improved significantly. Nevertheless, mortality remained high with individuals admitted because of an MI 7.2-fold more likely to die early and those with a CCF admission 5.9-fold more likely to die early than other individuals with Type 2 diabetes. Maori patients have an 80% excess mortality.


CONCLUSIONS
Patients with past admission for MI and/or CCF remain at exceptionally high risk of death for at least 4 years after hospital admission, even with improvements in management of cardiovascular risk factors. Maori individuals are at particular risk.
Kerr
G D
GD
Faculty of Medicine and Health Sciences, University of Auckland, New Zealand. gilliandkerr@hotmail.com
Gamble
G D
GD
Doughty
R N
RN
Simmons
D
D
Baker
J
J
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000208:ethnology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000208:ethnology