Cause‐specific and total mortality in the Canterbury (New Zealand) insulin‐treated Diabetic Registry population: a 15‐year follow‐up study

Florkowski, Christopher M; Scott, Russell S.; Graham, Patrick; Han, Dezhu; Moir, Cameron L.

doi:10.1046/j.1464-5491.2003.00895.x

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…The meta-analysis and meta-regression used 88 observations from 26 different studies [5], [9], [12], [14], [16], [19]–[40]. Only 1 study estimated RR using hazard ratios [37] and all other studies used SMRs.…”

Section: Resultsmentioning

confidence: 99%

A Meta-Analysis of the Relative Risk of Mortality for Type 1 Diabetes Patients Compared to the General Population: Exploring Temporal Changes in Relative Mortality

et al. 2014

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AimsType 1 diabetes has been associated with an elevated relative risk (RR) of mortality compared to the general population. To review published studies on the RR of mortality of Type 1 diabetes patients compared to the general population, we conducted a meta-analysis and examined the temporal changes in the RR of mortality over time.MethodsSystematic review of studies reporting RR of mortality for Type 1 diabetes compared to the general population. We conducted meta-analyses using a DerSimonian and Laird random effects model to obtain the average effect and the distribution of RR estimates. Sub-group meta-analyses and multivariate meta-regression analysis was performed to examine heterogeneity. Summary RR with 95% CIs was calculated using a random-effects model.Results26 studies with a total of 88 subpopulations were included in the meta-analysis and overall RR of mortality was 3.82 (95% CI 3.41, 3.4.29) compared to the general population. Observations using data prior to 1971 had a much larger estimated RR (5.80 (95% CI 4.20, 8.01)) when compared to: data between; 1971 and 1980 (5.06 (95% CI 3.44, 7.45)); 1981–90 (3.59 (95% CI 3.15, 4.09)); and those after 1990 (3.11 (95% CI 2.47, 3.91)); suggesting mortality of Type 1 diabetes patients when compared to the general population have been improving over time. Similarly, females (4.54 (95% CI 3.79–5.45)) had a larger RR estimate when compared to males (3.25 (95% CI 2.82–3.73) and the meta-regression found evidence for temporal trends and sex (p<0.01) accounting for heterogeneity between studies.ConclusionsType 1 diabetes patients’ mortality has declined at a faster rate than the general population. However, the largest relative improvements have occurred prior to 1990. Emphasis on intensive blood glucose control alongside blood pressure control and statin therapy may translate into further reductions in mortality in coming years.

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Section: Resultsmentioning

confidence: 99%

A Meta-Analysis of the Relative Risk of Mortality for Type 1 Diabetes Patients Compared to the General Population: Exploring Temporal Changes in Relative Mortality

et al. 2014

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“…A UK study linked cause of death data to a register of those with diabetes and found that those with type‐1 diabetes only accounted for 18 (5%) of all deaths within the study; because of this they did not undertake separate analysis for cause of death among those with this form of diabetes 38. Other studies were characterised by their inclusion of numbers of concurrent type‐1 diabetes and cancer too small to elicit statistically viable results 39–42…”

Section: Resultsmentioning

confidence: 99%

Epidemiological evidence of a relationship between type‐1 diabetes mellitus and cancer: A review of the existing literature

Gordon-Dseagu

Shelton

Mindell

2012

Intl Journal of Cancer

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This review explores the epidemiological evidence relating to type-1 diabetes (T1DM) and cancer incidence and mortality. Mortality rates among those with T1DM are higher in every age group compared with the general population; the majority of this mortality is due to factors related to the consequences of diabetes, such as cardiovascular and renal disease. For over 100 years, researchers have explored the relationships between diabetes and cancer and although there is now a large body of work on the subject, consensus has not been reached. Such research has tended to focus upon type-2 diabetes, with the result that very little is known about T1DM and cancer. As incidence of T1DM increases, by around 3% annually among children, the need for further research into its impact upon cancer incidence and mortality increases. Within this review, findings varied by study method utilised, T1DM definition used and study region and outcome measure explored. None of the case-control studies found a statistically significant link between the two diseases, whereas both of the meta-analyses did. Cohort studies produced mixed results. There were also mixed findings among research that defined T1DM in the same way (e.g. defining individuals with the disease as those diagnosed with diabetes before 30 years of age). The review found a number of studies which explored cause-specific cancer mortality among those with diabetes; such studies also had mixed findings. This inconsistency within results suggests the need for further research to understand better the potential relationships between T1DM and cancer.

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“…We used a χ 2 test for trend to compare differences in the proportion of amputations by renal disease status (12). We used an α of 0.05 and 95% CI in the analysis.…”

Section: Methodsmentioning

confidence: 99%

Impact of Chronic Kidney Disease on Survival After Amputation in Individuals With Diabetes

et al. 2010

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OBJECTIVETo identify factors that influence survival after diabetes-related amputations.RESEARCH DESIGN AND METHODSWe abstracted medical records of 1,043 hospitalized subjects with diabetes and a lower-extremity amputation from 1 January to 31 December 1993 in six metropolitan statistical areas in south Texas. We identified mortality in the 10-year period after amputation from death certificate data. Diabetes was verified using World Health Organization criteria. Amputations were identified by ICD-9-CM codes 84.11–84.18 and categorized as foot, below-knee amputation, and above-knee amputation and verified by reviewing medical records. We evaluated three levels of renal function: chronic kidney disease (CKD), hemodialysis, and no renal disease. We defined CKD based on a glomerular filtration rate <60 ml/min and hemodialysis from Current Procedural Terminology (CPT) codes (90921, 90925, 90935, and 90937). We used χ2 for trend and Cox regression analysis to evaluate risk factors for survival after amputation.RESULTSPatients with CKD and dialysis had more below-knee amputations and above-knee amputations than patients with no renal disease (P < 0.01). Survival was significantly higher in patients with no renal impairment (P < 0.01). The Cox regression indicated a 290% increase in hazard for death for dialysis treatment (hazard ratio [HR] 3.9, 95% CI 3.07–5.0) and a 46% increase for CKD (HR 1.46, 95% CI 1.21–1.77). Subjects with an above-knee amputation had a 167% increase in hazard (HR 2.67, 95% CI 2.14–3.34), and below-knee amputation patients had a 67% increase in hazard for death.CONCLUSIONSSurvival after amputation is lower in diabetic patients with CKD, dialysis, and high-level amputations.

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Cause‐specific and total mortality in the Canterbury (New Zealand) insulin‐treated Diabetic Registry population: a 15‐year follow‐up study

Abstract: Mortality rates are high for insulin-treated diabetic individuals relative to the general population.

Cited by 13 publications

References 22 publications

A Meta-Analysis of the Relative Risk of Mortality for Type 1 Diabetes Patients Compared to the General Population: Exploring Temporal Changes in Relative Mortality

A Meta-Analysis of the Relative Risk of Mortality for Type 1 Diabetes Patients Compared to the General Population: Exploring Temporal Changes in Relative Mortality

Epidemiological evidence of a relationship between type‐1 diabetes mellitus and cancer: A review of the existing literature

Impact of Chronic Kidney Disease on Survival After Amputation in Individuals With Diabetes

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