title: Mortality in patients with diabetes mellitus and Addison's disease: a nationwide, matched, observational cohort study.
abstract: OBJECTIVE
  Our hypothesis was that patients with diabetes mellitus obtain an additional risk of death if they develop Addison's disease (AD).
  
  
  METHODS
  Nationwide, matched, observational cohort study cross-referencing the Swedish National Diabetes Register with Inpatient, Cancer and Cause of Death Registers in patients with diabetes (type 1 and 2) and AD and matched controls with diabetes. Clinical characteristics at baseline, overall, and cause-specific mortality were assessed. The relative risk of death was assessed using a Cox proportional hazards regression model.
  
  
  RESULTS
  Between January 1996 and December 2012, 226 patients with diabetes and AD were identified and matched with 1129 controls with diabetes. Median (interquartile range) follow-up was 5.9 (2.7-8.6) years. When patients with diabetes were diagnosed with AD, they had an increased frequency of diabetes complications, but both medical history of cancer and coronary heart disease did not differ compared with controls. Sixty-four of the 226 patients with diabetes and AD (28%) died, while 112 of the 1129 controls (10%) died. The estimated relative risk increase (hazard ratio) in overall mortality in the diabetes and AD group was 3.89 (95% confidence interval 2.84-5.32) compared with controls with diabetes. The most common cause of death was cardiovascular in both groups, but patients with diabetes and AD showed an increased death rate from diabetes complications, infectious diseases and unknown causes.
  
  
  CONCLUSIONS
  Patients with the rare combination of diabetes and AD showed a markedly increased mortality and died more frequently from infections and unknown causes than patients with diabetes alone. Improved strategy for the management of this combination of metabolic disorders is needed.
authors.affiliation: Department of Internal Medicine and Clinical NutritionInstitute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden dimitrios.chantzichristos@gu.se.|Department of Endocrinology-Diabetes-MetabolismSahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Chantzichristos
authors.affiliation: Department of MedicineNational Diabetes Register, Centre of Registers, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Persson
authors.affiliation: Department of Internal Medicine and Clinical NutritionInstitute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Endocrinology-Diabetes-MetabolismSahlgrenska University Hospital, Gothenburg, Sweden.|Department of MedicineNational Diabetes Register, Centre of Registers, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Eliasson
authors.affiliation: Department of MedicineNational Diabetes Register, Centre of Registers, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Mervete
authors.initials: M
authors.lastname: Miftaraj
authors.affiliation: Department of MedicineNational Diabetes Register, Centre of Registers, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Franzén
authors.affiliation: Department of Internal Medicine and Clinical NutritionInstitute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Endocrinology-Diabetes-MetabolismSahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ragnhildur
authors.initials: R
authors.lastname: Bergthorsdottir
authors.affiliation: Department of Internal Medicine and Clinical NutritionInstitute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Endocrinology-Diabetes-MetabolismSahlgrenska University Hospital, Gothenburg, Sweden.|Department of MedicineNational Diabetes Register, Centre of Registers, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdottir
authors.affiliation: Department of MedicineNational Diabetes Register, Centre of Registers, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.affiliation: Department of Internal Medicine and Clinical NutritionInstitute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Endocrinology-Diabetes-MetabolismSahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
mesh_terms: D000224:Addison Disease / Q000401:mortality*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D016016:Proportional Hazards Models