diabetes ups risks of death for all factors

[Guest guest]

Diabetes Ups Risk of Death from All Causes

Diabetes not only doubles vascular death risk but also substantially raises

risk of death from nonvascular causes, including cancer and infectious

disease, researchers found....

Advertisement

Danish, MSc, DPhil, of the University of Cambridge, England, and

colleagues in the Emerging Risk Factors Collaboration reported that a

50-year-old with diabetes can expect to die six years earlier than a

nondiabetic peer, with nonvascular deaths accounting for about 40% of the

survival difference.

By comparison, smoking takes about seven years off life expectancy, the

group noted.

Their patient-level pooled analysis of 820,900 individuals across 97

prospective studies appeared in the March 3 issue of the New England Journal

of Medicine.

Bergenstal, MD, of the International Diabetes Center at Park

Nicollet in Minneapolis, Minn., commented, " The magnitude of both the study

and the risks highlights how serious and complicated diabetes is. We should

be taking a broader view of diabetes. " " We sometimes get completely wrapped

up in the metabolism of the A1c and glucose and we forget about the

associated effects on quality of life and depression, and other

consequences. "

The researchers examined 12.3 million person-years of mortality follow-up

for individuals without a history of vascular disease at enrollment in the

97 studies. The baseline diabetes prevalence was 6%. Those with diabetes

were 80% more likely to die from any cause during the study periods, after

adjustment for age, sex, smoking status, and body mass index (95% confidence

interval 1.71 to 1.90). Vascular disease took top place as a cause of death,

followed by cancer.

Not surprisingly, diabetes patients carried a 2.32-fold higher adjusted risk

of death from vascular causes than their non-diabetic counterparts (95% CI

2.11 to 2.56). But they were also at significantly elevated risk of death

from cancer (adjusted HR 1.25, 95% CI 1.19 to 1.31) and from other

nonvascular, non-cancer causes (adjusted HR 1.73, 95% CI 1.62 to 1.85).

Diabetes moderately increased risk of death from the following as well:

* Cancers of the liver, pancreas, ovary, colorectum, lung, bladder,

and breast

* Renal disease

* Liver disease

* Pneumonia and other infectious diseases

* Mental disorders

* Nonhepatic digestive diseases

* External causes

* Intentional self-harm

* Nervous-system disorders

* Chronic obstructive pulmonary disease

Links with kidney, digestive, and infectious disease could reflect

nephropathy, fatty liver disease, and suppression of cellular immunity from

diabetes, the researchers suggested. The greater risk of injury-related

deaths could be related to end-organ complications, such as neuropathy and

eye disease, or episodes of hypoglycemia, they added.

The elevated mortality risk with diabetes appeared independent of blood

pressure, lipids, the inflammatory marker C-reactive protein, fibrinogen,

alcohol use, kidney function, and socioeconomic status.

Fasting glucose or HbA1c, though, appeared to account for some of the

mortality risk of diabetes, as adjustment for these factors " considerably "

attenuated the excess risk associated with diabetes.

Each 18 mg/dL higher fasting glucose level above 100 mg/dL was associated

with a 5% higher risk of death from cancer, 13% higher risk of vascular

death, and 10% higher risk of death from other causes -- for a 10% overall

higher risk of death from any cause, all statistically significant. Fasting

glucose levels in the 70 to 100 mg/dL range were not significantly

associated with death.

These findings support a direct impact of hyperglycemia on mortality risk,

Danesh's group argued.

A consensus statement from the ADA and American Cancer Society last year

cautioned that it wasn't clear whether the elevated cancer risk seen with

diabetes is direct or due to shared risk factors or other indirect factors.

Bergenstal warned that this is still the case. " We still can't say if it's

the glucose or something associated with the hypoglycemia, " he commented,

noting that the study did not control for diet, activity, and many other

potentially confounding factors. However, he agreed with the researchers

that the findings reinforce the need for people with diabetes to get

appropriate cancer screening tests on a regular basis.

Practice Pearls:

* Explain that an analysis of 97 prospective studies found that

diabetes and fasting blood sugars >100 mg/dL were associated with increased

all-cause mortality.

* Note that an association with increased mortality was found for

vascular disease but also nonvascular conditions such as cancer, infectious

diseases, injury, liver and renal disease, self-harm, and nervous system

disorders.

Emerging Risk Factors Collaboration " Diabetes mellitus, fasting glucose, and

risk of cause-specific death " N Engl J Med 2011; 364: 829-841.