Mortality risk in diabetes
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All-Cause Mortality Risk in Diabetes
People with diabetes face a higher risk of death from all causes compared to those without diabetes. This increased risk is seen in both type 1 and type 2 diabetes, and is influenced by factors such as age at diagnosis, glycemic control, presence of complications, and socioeconomic status 1234+4 MORE. For example, individuals with type 2 diabetes have a 15% higher risk of death from any cause compared to the general population, with the risk being especially high in younger patients and those with poor glycemic control or kidney complications . Similarly, people with type 1 diabetes diagnosed at a younger age have a much higher risk of early death, losing up to 17.7 years of life for women and 14.2 years for men if diagnosed before age 10 .
Cardiovascular Mortality and Diabetes
Cardiovascular disease is a leading cause of death in people with diabetes. Both type 1 and type 2 diabetes significantly increase the risk of dying from heart disease, stroke, and related conditions 1234+3 MORE. For instance, the risk of cardiovascular death is about twice as high in people with diabetes compared to those without, and this risk is even greater in women and those diagnosed at a younger age 35. Good control of blood sugar, blood pressure, cholesterol, and not smoking can reduce this risk to levels similar to the general population, except for heart failure, which remains higher .
Non-Cardiovascular Mortality Risks
Diabetes also raises the risk of death from non-cardiovascular causes, including kidney disease, chronic lower respiratory diseases, and infections like influenza and pneumonia 134. However, the link between diabetes and cancer or Alzheimer’s disease mortality is less clear, with some studies finding no significant association .
Key Risk Factors for Mortality in Diabetes
Several factors increase the risk of death in people with diabetes:
- Older age and male sex: Older individuals and men have higher mortality risk 1235.
- Low income and living alone: Socioeconomic disadvantage and social isolation are linked to higher mortality, especially in younger, low-income men 18.
- Longer duration of diabetes: The longer someone has diabetes, the higher their risk 15.
- Poor glycemic control: Higher HbA1c levels are strongly linked to increased mortality, especially in women 269.
- Kidney disease and albuminuria: Renal complications are major predictors of death 126.
- Smoking: Smoking is a strong independent risk factor for death in diabetes 16.
- Macrovascular and microvascular complications: Heart and blood vessel diseases, as well as kidney and nerve damage, increase risk 135.
- High neutrophil-lymphocyte ratio (NLR): Elevated NLR, a marker of inflammation, is associated with higher all-cause and cardiovascular mortality .
Impact of Intensive Management and Lifestyle
Intensive management of blood sugar and other risk factors can lower mortality in people with diabetes. For example, those with type 1 diabetes who received intensive therapy had mortality rates similar to the general population, while those with conventional therapy had higher rates . Adopting healthy lifestyle behaviors also reduces mortality risk, especially for those living alone .
Trends in Mortality Over Time
Recent decades have seen a decline in mortality and cardiovascular events among people with diabetes, though the reduction in fatal outcomes is smaller for those with type 2 diabetes compared to the general population . This suggests that while care has improved, there is still a gap to close, especially for certain high-risk groups.
Conclusion
Diabetes significantly increases the risk of death from both cardiovascular and non-cardiovascular causes. The risk is highest in those with early-onset disease, poor glycemic control, kidney complications, and social or economic disadvantages. However, intensive management of risk factors and healthy lifestyle choices can greatly reduce this risk, highlighting the importance of comprehensive diabetes care and support.
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Most relevant research papers on this topic
Risk Factors for Mortality Among Patients With Diabetes
Older age, male sex, smoking, and renal disease are significant predictors of mortality in people with diabetes, while socioeconomic circumstance is an important independent predictor of health.
Excess Mortality among Persons with Type 2 Diabetes.
Type 2 diabetes mortality rates vary greatly, with higher risks in younger patients, worse glycemic control, and greater renal complications, while lower risks are found in older patients and those with better glycemic control.
Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study.
Age at onset of type 1 diabetes is an important determinant of survival and cardiovascular outcomes, with higher excess risk in women.
Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes
Patients with type 2 diabetes who have all five risk factors within target ranges have little or no excess risk of death, myocardial infarction, or stroke compared to the general population.
Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
In Sweden from 1998 to 2014, mortality and cardiovascular disease incidence declined substantially among individuals with diabetes, with fatal outcomes declining less among those with type 2 diabetes than controls.
Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population
Overall mortality in type 1 diabetes patients in the DCCT/EDIC study cohort was similar to the general population, but higher in the conventional therapy group, with mortality increasing significantly with increasing HbA1c levels.
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