title: All-cause mortality risk among a national sample of individuals with diabetes.
abstract: OBJECTIVE
  Little is known about the relative contributions of modifiable risk factors to overall diabetes mortality. The purpose of the current study is to 1) assess the association between modifiable risk factors and all-cause mortality among a nationally representative sample of individuals with diabetes and 2) determine the population-attributable risk percent (PAR%) for these factors.
  
  
  METHODS
  We analyzed data from a nationally representative sample of 1,507 adults over the age of 17 years with a self-reported diagnosis of diabetes from the Third National Health and Nutrition Examination Survey (NHANES III) mortality study. Our main outcome measures were all-cause mortality and PAR%. We used the Cox proportional hazard analysis to determine hazard ratios (HRs) for known diabetes risks and calculated PAR%.
  
  
  RESULTS
  Among adults with diabetes, the HRs for all-cause mortality were significant for individuals who had an A1C≥8% (HR 1.65, 95% CI 1.11-2.45) or reported no regular physical activity (1.58, 1.24-2.02) or current tobacco use (1.77, 1.15-2.73). The population-attributable risk was 15.3% for A1C value≥8%, 16.4% for no regular physical activity, and 7.5% for current tobacco use.
  
  
  CONCLUSIONS
  Health systems may consider prioritizing care to include smoking cessation, increasing physical activity, and moderate glycemic control among patients with diabetes. This study suggests that focusing on these areas may result in significant reductions in mortality in individuals with diabetes.
authors.affiliation: General Medicine Service, VA Puget Sound Health Care System, Seattle, Washington, USA. karin.nelson@va.gov
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Thomas
authors.initials: T
authors.lastname: Koepsell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin