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 Ismail2021Tancredi2015Gregg2018.

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 Ismail2021Tancredi2015Gregg2018. 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 Pearson-Stuttard2021Nakamura2017. However, cardiovascular diseases remain a significant cause of death, particularly in younger diabetic patients and those with poor glycemic control Gregg2018Nakamura2017.

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 Ismail2021Tancredi2015. 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 Ismail2021Tancredi2015.

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% Pearson-Stuttard2021Nakamura2017. 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) Ismail2021Tancredi2015Rodriguez2019. The hazard ratios for these causes range from 1.50 to 1.89, indicating a significant increase in mortality risk Ismail2021Tancredi2015.

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 Pearson-Stuttard2021Nakamura2017. 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 Gregg2018Saeedi2020. 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 Gregg2018Saeedi2020.

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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Most relevant research papers on this topic

Association of risk factors with type 2 diabetes: A systematic review

This review identifies key risk factors for type 2 diabetes and their interactions, providing recommendations for better diagnosis and prognosis.

Systematic Review

2021·

273citations

·L. Ismail et al.

Computational and Structural Biotechnology Journal·

DOI

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis

Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes.

Meta-AnalysisVery Rigorous Journal

2016·

340citations

·J. Baena-Díez et al.

Diabetes Care·

DOI

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.

Rigorous Journal

2015·

506citations

·Mauro Tancredi et al.

The New England journal of medicine·

DOI

Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data.

Decreasing rates of vascular disease mortality are leading to a diversification of diabetes-related mortality, impacting clinical management, prevention, and disease monitoring.

Rigorous Journal

2018·

377citations

·E. Gregg et al.

Lancet·

DOI

Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records

Decreasing vascular death rates has led to a shift from vascular diseases to cancers as the leading contributor to diabetes-related death in individuals with diabetes.

2021·

268citations

·J. Pearson-Stuttard et al.

The Lancet. Diabetes & Endocrinology·

DOI

Causes of death in Japanese patients with diabetes based on the results of a survey of 45,708 cases during 2001–2010: Report of the Committee on Causes of Death in Diabetes Mellitus

Malignant neoplasia is the most common cause of death in Japanese patients with diabetes, followed by infections and vascular diseases.

Cross-Sectional StudyRigorous Journal

2017·

120citations

·J. Nakamura et al.

Journal of Diabetes Investigation·

DOI

Diabetes-attributable mortality in the United States from 2003 to 2016 using a multiple-cause-of-death approach.

Using a multiple-cause-of-death approach, we can better understand diabetes' contribution to mortality in the United States.

2019·

39citations

·F. Rodriguez et al.

Diabetes research and clinical practice·

DOI

Cause-specific mortality in type 2 diabetes. The Verona Diabetes Study.

Early detection and treatment of type 2 diabetes is crucial, as the highest mortality rates are for diabetes and liver cirrhosis, with lower risks for cardiovascular diseases in Italian patients.

Cohort Study

1999·

393citations

·R. Marco et al.

Diabetes care·

DOI

Diabetes and Cause-Specific Mortality in Mexico City

In Mexico, where obesity is common and glycemic control is poor, diabetes accounts for one third of all deaths between 35 and 74 years of age, with the largest risks from renal, cardiac, infection, and vascular diseases.

Cohort StudyRigorous Journal

2016·

246citations

·J. Alegre-Díaz et al.

The New England journal of medicine·

DOI

Mortality attributable to diabetes in 20-79 years old adults, 2019 estimates: results from the International Diabetes Federation Diabetes Atlas, 9th edition.

Diabetes contributes to one in nine deaths among adults aged 20-79 years, with a higher impact in middle-income countries.

2020·

616citations

·Pouya Saeedi et al.

Diabetes research and clinical practice·

DOI

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