Excess Mortality among Persons with Type 2 Diabetes.
BACKGROUND
The excess risks of death from any cause and death from cardiovascular causes among persons with type 2 diabetes and various levels of glycemic control and renal complications are unknown. In this registry-based study, we assessed these risks according to glycemic control and renal complications among persons with type 2 diabetes.


METHODS
We included patients with type 2 diabetes who were registered in the Swedish National Diabetes Register on or after January 1, 1998. For each patient, five controls were randomly selected from the general population and matched according to age, sex, and county. All the participants were followed until December 31, 2011, in the Swedish Registry for Cause-Specific Mortality.


RESULTS
The mean follow-up was 4.6 years in the diabetes group and 4.8 years in the control group. Overall, 77,117 of 435,369 patients with diabetes (17.7%) died, as compared with 306,097 of 2,117,483 controls (14.5%) (adjusted hazard ratio, 1.15; 95% confidence interval [CI], 1.14 to 1.16). The rate of cardiovascular death was 7.9% among patients versus 6.1% among controls (adjusted hazard ratio, 1.14; 95% CI, 1.13 to 1.15). The excess risks of death from any cause and cardiovascular death increased with younger age, worse glycemic control, and greater severity of renal complications. As compared with controls, the hazard ratio for death from any cause among patients younger than 55 years of age who had a glycated hemoglobin level of 6.9% or less (≤52 mmol per mole of nonglycated hemoglobin) was 1.92 (95% CI, 1.75 to 2.11); the corresponding hazard ratio among patients older than 75 years of age or older was 0.95 (95% CI, 0.94 to 0.96). Among patients with normoalbuminuria, the hazard ratio for death among those younger than 55 years of age with a glycated hemoglobin level of 6.9% or less, as compared with controls, was 1.60 (95% CI, 1.40 to 1.82); the corresponding hazard ratio among patients older than 75 years of age or older was 0.76 (95% CI, 0.75 to 0.78), and patients 65 to 75 years of age also had a significantly lower risk of death (hazard ratio, 0.87; 95% CI, 0.84 to 0.91).


CONCLUSIONS
Mortality among persons with type 2 diabetes, as compared with that in the general population, varied greatly, from substantial excess risks in large patient groups to lower risks of death depending on age, glycemic control, and renal complications. (Funded by the Swedish government and others.).
From the Department of Molecular and Clinical Medicine, University of Gothenburg (M.T., A.R., S.G., M.L.), Center of Registers in Region Västra Götaland (A.-M.S.), Statistiska Konsultgruppen (A.P.), and Nordic School of Public Health (H.W.), Gothenburg, and the Department of Medicine, NU Hospital Group, Trollhättan and Uddevalla (M.T., S.D., M.L.) - all in Sweden; Saint Luke's Mid America Heart Institute (M.K.) and Children's Mercy Hospital (M.C.), University of Missouri-Kansas City School of Medicine, Kansas City; and the University of Kansas School of Medicine, Kansas City (M.C.).
Mauro
M
Tancredi
Annika
A
Rosengren
Ann-Marie
AM
Svensson
Mikhail
M
Kosiborod
Aldina
A
Pivodic
Soffia
S
Gudbjörnsdottir
Hans
H
Wedel
Mark
M
Clements
Sofia
S
Dahlqvist
Marcus
M
Lind
D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D013548:Sweden / Q000453:epidemiology
D001786:Blood Glucose; D008078:Cholesterol, LDL