Age-standardized mortality rates (ASMR) for all causes, cardiovascular disease (CVD), and diabetes have decreased over the last decade while cancer ASMRs remain unchanged in type 1 and type 2 diabetes, according to data published in Diabetes Care.

Data regarding the effects of diabetes on other causes of death have revealed increased, unchanged, or reduced mortality rates for complications of diabetes.  However, many studies do not distinguish between type 1 and type 2 diabetes, and few have analyzed the age-specific trends in mortality. In the current study, researchers sought to analyze changes of all-cause and cause-specific mortality rates of individuals with diabetes in different age groups.

The researchers identified 1 189 079 Australian individuals with diabetes (7.3% with type 1 diabetes) who were registered on the National Diabetes Service Scheme between 2000 and 2011, and were subsequently linked to the National Death Index. The mortality rates from the total population were age-standardized to the Australian population in 2001. They then calculated mortality rates for individuals between 0 and 40 years of age, ≥40 and <60 years, and ≥60 to ≤85 years.


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Among individuals with type 1 diabetes, all-cause ASMRs decreased each year by 0.61 per 1000 person-years, CVD ASMRs decreased by 0.35 per 1000 person-years, and diabetes ASMRs decreased by 0.14 per 1000 person years (Ptrend<.05).

For individuals with type 2 diabetes, all-cause, CVD, and diabetes ASMRs decreased each year by 0.18, 0.15, and 0.03 per 1000 person-years, respectively (Ptrend<.001). Researchers also noted that cancer mortality rates remained unchanged in this population.

Researchers observed significant decreases in all-cause, CVD, and diabetes-related mortality for type 1 and type 2 diabetes in all age-groups, except among individuals between 0 to 40 years of age. In type 2 diabetes patients, there were actually significant increases in all-cause and cancer mortality, and no change for CVD and diabetes mortality.

“Our data support recently published studies suggesting that young-onset type 2 diabetes is the more lethal phenomenon of diabetes and is associated with a greater mortality, more diabetes complications, unfavorable CVD risk factors, and greater difficulty in achieving glycemic control, even compared with type 1 diabetes,” the authors of the study wrote.

“Given the increasing incidence of young-onset type 2 diabetes and its severity, there is an urgent need for diabetes prevention efforts to be targeted toward youth.”

The authors also emphasized concern over the unchanged cancer mortality rates. “The absence of a decline in cancer mortality rates in diabetes is likely to lead to a higher burden of cancer among people with diabetes,” the authors wrote. “This warrants urgent attention.”

Reference

  1. Harding JL, Shaw JE, Peeters A, et al. Age-specific trends from 2000-2011 in all-cause and cause-specific mortality in type 1 and type 2 diabetes: A cohort study of more than one million people. Diabetes Care. 2016. doi:10.2337/dc15-2308.