Long-term cardiovascular and non-cardiovascular mortality in women and men with type 1 and type 2 diabetes mellitus: a 30-year follow-up in Switzerland.
BACKGROUND
While studies from other countries have shown an excess mortality in diabetic individuals when compared with the general population, comparable long-term data is not available for Switzerland.


OBJECTIVE
To assess gender-specific cardiovascular and non-cardiovascular mortality of patients with type 1 and type 2 diabetes compared with the general Swiss population between 1974 and 2005.


METHODS
533 patients (225 type 1, 308 type 2 diabetes, 52.2% men) were followed for 30 years (10349 person-years).


RESULTS
Diabetic patients had an increased all-cause mortality compared with the general population (SMR [95% CI] 3.8 [3.5-4.3]). Standardised mortality ratio (SMR) was higher for type 1 compared with type 2 diabetic patients (4.5 [3.8-5.3] vs 3.5 [3.1-4.0], p = 0.032). For cardiovascular and non-cardiovascular deaths SMRs were 5.6 (95% CI 4.8-6.6) and 2.7 (2.3-3.1) and did not differ according to type of diabetes. SMRs for all-cause and cardiovascular mortality were significantly higher in women compared with men in type 1 (p <0.05 and p <0.01) and type 2 diabetes (p <0.001 and p <0.01). In both types of diabetes, SMRs significantly decreased during the last two decades (p for trend 0.004 and 0.002).


CONCLUSIONS
Patients with type 1 and type 2 diabetes had an increased long-term mortality compared with the general Swiss population. Excess mortality was higher in type 1 compared with type 2 diabetes and in women compared with men for both types of diabetes, but steadily decreased over the last two decades.
Division of Endocrinology, Diabetes and Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
Sabin
S
Allemann
Christoph
C
Saner
Marcel
M
Zwahlen
Emanuel R
ER
Christ
Peter
P
Diem
Christoph
C
Stettler
D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D013557:Switzerland / Q000453:epidemiology