How do people die of diabetes
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Summary
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These studies suggest that people die of diabetes primarily due to cardiovascular diseases, cancers, infections, and renal complications, with varying risks based on age, glycemic control, and other health factors.
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Understanding Mortality in Diabetes: Causes and Trends
Introduction to Diabetes-Related Mortality
Diabetes significantly impacts global mortality rates, contributing to a substantial number of deaths annually. In 2019, diabetes was estimated to be responsible for 4.2 million deaths among adults aged 20-79 years, accounting for 11.3% of global deaths in this age group. This article explores the primary causes of death among individuals with diabetes and the trends observed over recent decades.
Cardiovascular Disease and Diabetes
Vascular Complications as Leading Cause
Cardiovascular disease (CVD) is the leading cause of death among individuals with diabetes. Studies have shown that people with diabetes have a significantly higher risk of dying from vascular causes compared to those without diabetes. For instance, the hazard ratio for death from vascular causes in people with diabetes is 2.32, indicating more than double the risk compared to non-diabetics. This elevated risk is consistent across various age groups and is exacerbated by poor glycemic control and renal complications.
Decline in Cardiovascular Mortality
Despite the high risk, there has been a notable decline in deaths from cardiovascular causes among people with diabetes. In the USA, from 1988-94 to 2010-15, death rates from vascular causes decreased by 32% every 10 years among adults with diabetes. This decline is attributed to improved management of diabetes and its complications, including better control of blood pressure, cholesterol, and blood glucose levels.
Cancer and Diabetes
Increased Cancer Risk
Diabetes is also associated with an increased risk of death from several types of cancer. Individuals with diabetes have a moderately higher risk of dying from cancers of the liver, pancreas, ovary, colorectum, lung, bladder, and breast. The overall hazard ratio for death from cancer in people with diabetes is 1.25, indicating a 25% higher risk compared to those without diabetes.
Stable Cancer Mortality Rates
While the risk of cancer is higher, the mortality rates from cancer among people with diabetes have remained relatively stable over time. The proportion of deaths due to cancer has not seen significant changes, ranging from 16% to 20% over the past few decades.
Non-Vascular, Non-Cancer Causes
Diverse Causes of Death
Aside from vascular diseases and cancer, diabetes is linked to a variety of other causes of death. These include infections, renal disease, liver disease, pneumonia, mental disorders, and chronic obstructive pulmonary disease (COPD) . In Japan, a survey of 45,708 diabetic patients revealed that infections were the second most common cause of death, accounting for 17% of deaths, followed by vascular diseases at 14.9%.
Increasing Proportion of Non-Vascular, Non-Cancer Deaths
The proportion of deaths from non-vascular, non-cancer causes has increased over time. In the USA, the proportion of total deaths from these causes among adults with diabetes rose from 33.5% in 1988-94 to 46.5% in 2010-15. This shift highlights the need for comprehensive management strategies that address a wide range of health issues in diabetic patients.
Impact of Glycemic Control and Renal Complications
Importance of Glycemic Control
Poor glycemic control is a significant factor contributing to the reduced lifespan of individuals with diabetes. Patients with worse glycemic control have a higher risk of death from any cause, particularly from cardiovascular diseases and renal complications. Effective management of blood glucose levels is crucial in reducing mortality risk.
Renal Complications
Renal complications, including nephropathy, are common among diabetic patients and significantly increase the risk of death. In Japan, diabetic nephropathy was a major cause of death, particularly among patients with poor glycemic control. The management of renal health is therefore a critical component of diabetes care.
Conclusion
Diabetes is a major contributor to global mortality, with cardiovascular disease being the leading cause of death among diabetic patients. While there have been significant improvements in reducing cardiovascular mortality, the risk of death from cancer and other non-vascular causes remains high. Effective management of glycemic control and renal complications is essential in reducing the overall mortality risk in individuals with diabetes. Continued efforts in prevention, early detection, and comprehensive care are vital to improving the life expectancy and quality of life for people with diabetes.
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