What causes death in diabetes
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Causes of Death in Diabetes
Overview of Diabetes-Related Mortality
Diabetes significantly increases the risk of death from various causes, including cardiovascular diseases, cancers, and other nonvascular conditions. Research indicates that individuals with diabetes have a higher mortality rate compared to those without the condition, with diabetes contributing to a substantial number of premature deaths globally .
Cardiovascular Diseases
Increased Risk of Cardiovascular Death
Cardiovascular diseases are a leading cause of death among individuals with diabetes. Studies show that diabetes doubles the risk of cardiovascular mortality, with hazard ratios ranging from 2.03 to 2.32 for cardiovascular deaths in diabetic individuals compared to non-diabetic individuals . This elevated risk is consistent across different populations and is influenced by factors such as age, glycemic control, and the presence of renal complications.
Decline in Cardiovascular Mortality
Despite the high risk, there has been a notable decline in cardiovascular mortality among diabetic patients over recent decades. This decline is attributed to improved management of cardiovascular risk factors and better medical care . However, cardiovascular diseases remain a significant cause of death, particularly in younger diabetic patients and those with poor glycemic control .
Cancer
Association with Various Cancers
Diabetes is moderately associated with an increased risk of death from several types of cancer, including liver, pancreas, ovary, colorectum, lung, bladder, and breast cancers . The hazard ratios for cancer mortality in diabetic individuals range from 1.25 to 1.68, indicating a significant but moderate increase in risk compared to non-diabetic individuals .
Stable Cancer Mortality Rates
While the proportion of deaths due to cardiovascular diseases has declined, the proportion of cancer-related deaths among diabetic individuals has remained relatively stable over time, ranging from 16% to 20% . This stability suggests that while diabetes increases cancer risk, advancements in cancer treatment and early detection may be mitigating some of the excess mortality.
Nonvascular, Noncancer Causes
Diverse Causes of Death
Diabetes is also associated with an increased risk of death from various nonvascular, noncancer causes. These include renal disease, liver disease, infections (such as pneumonia), mental disorders, digestive diseases, and chronic obstructive pulmonary disease (COPD) . The hazard ratios for these causes range from 1.50 to 1.89, indicating a significant increase in mortality risk .
Trends in Nonvascular Mortality
The proportion of deaths from nonvascular, noncancer causes has increased over time, reflecting a diversification of diabetes-related mortality. This shift is partly due to the decline in cardiovascular mortality, which has led to a relative increase in the importance of other causes of death . For instance, deaths from infections and liver disease have shown an upward trend, particularly in older diabetic patients.
Impact of Glycemic Control and Renal Complications
Importance of Glycemic Control
Poor glycemic control is a critical factor influencing mortality in diabetic patients. Individuals with higher glycated hemoglobin levels have a significantly increased risk of death from all causes, including cardiovascular diseases and infections . Effective glycemic control can mitigate some of these risks, highlighting the importance of regular monitoring and management of blood glucose levels.
Role of Renal Complications
Renal complications, such as nephropathy, are common in diabetic patients and significantly contribute to increased mortality. The presence of renal disease exacerbates the risk of death from cardiovascular causes and infections, underscoring the need for comprehensive management of renal health in diabetic individuals .
Conclusion
Diabetes is associated with a heightened risk of death from a variety of causes, including cardiovascular diseases, cancers, and other nonvascular conditions. While improvements in medical care have led to a decline in cardiovascular mortality, the overall mortality burden remains high due to the persistent risks associated with poor glycemic control and renal complications. Effective management of diabetes and its complications is crucial to reducing the excess mortality risk in this population.
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