Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

Tomic, Dunya; Morton, Jedidiah I; Chen, Lei; Salim, Agus; Gregg, Edward W.; Pavkov, Meda E.; Arffman, Martti; Balicer, Ran D.; Baviera, Marta; Dam, Elise Boersma-van; Brinks, Ralph; Carstensen, Bendix; Chan, Juliana C.N.; Cheng, Yiling J.; Fosse-Edorh, Sandrine; Fuentes, Sonsoles; Gardiner, Hélène; Gulseth, Hanne Løvdal; Gurevičius, Romualdas; Ha, Kyoung Hwa; Hoyer, Annika; Jermendy, György; Kautzky‐Willer, Alexandra; Keskimäki, Ilmo; Kim, Dae Jung; Kiss, Zoltán; Klimek, Peter; Leventer‐Roberts, Maya; Lin, Chun-Yi; Ruiz, Paz Lopez‐Doriga; Luk, Andrea O. Y.; Ma, Stefan; Mata-Cases, Manel; Mauricio, Daniel; McGurnaghan, Stuart J.; Imamura, Tomoaki; Paul, Sanjoy K.; Peeters, Anna; Pildava, Santa; Porath, Avi; Robitaille, Cynthia; Roncaglioni, Maria Carla; Sugiyama, Takehiro; Wang, Kang-Ling; Yekutiel, Naama; Shaw, Jonathan E.; Magliano, Dianna J.

doi:10.1016/s2213-8587(22)00252-2

Cited by 21 publications

(13 citation statements)

References 26 publications

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“…However, postprandial hyperglycaemia increases to a larger extent in women as they age, contributing to a higher prevalence of undiagnosed diabetes in women after the age of 60, and of total diabetes after 70 [ 2 ]. Although the burden remains substantial, an improvement in life expectancy for patients with type 2 diabetes was recently reported for both sexes [ 3 ]. Lifetime risk of type 2 diabetes was generally higher in men, but years of life lost varied strongly between regions and sexes.…”

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confidence: 99%

Sex differences in type 2 diabetes

2023

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The prevalence of type 2 diabetes mellitus is increasing in both sexes, but men are usually diagnosed at a younger age and lower body fat mass than women. Worldwide, an estimated 17.7 million more men than women have diabetes mellitus. Women appear to bear a greater risk factor burden at the time of their type 2 diabetes diagnosis, especially obesity. Moreover, psychosocial stress might play a more prominent role in diabetes risk in women. Across their lifespan, women experience greater hormone fluctuations and body changes due to reproductive factors than men. Pregnancies can unmask pre-existing metabolic abnormalities, resulting in the diagnosis of gestational diabetes, which appears to be the most prominent risk factor for progression to type 2 diabetes in women. Additionally, menopause increases women’s cardiometabolic risk profile. Due to the progressive rise in obesity, there is a global increase in women with pregestational type 2 diabetes, often with inadequate preconceptual care. There are differences between men and women regarding type 2 diabetes and other cardiovascular risk factors with respect to comorbidities, the manifestation of complications and the initiation of and adherence to therapy. Women with type 2 diabetes show greater relative risk of CVD and mortality than men. Moreover, young women with type 2 diabetes are currently less likely than men to receive the treatment and CVD risk reduction recommended by guidelines. Current medical recommendations do not provide information on sex-specific or gender-sensitive prevention strategies and management. Thus, more research on sex differences, including the underlying mechanisms, is necessary to increase the evidence in the future. Nonetheless, intensified efforts to screen for glucose metabolism disorders and other cardiovascular risk factors, as well as the early establishment of prophylactic measures and aggressive risk management strategies, are still required for both men and women at increased risk of type 2 diabetes. In this narrative review we aim to summarise sex-specific clinical features and differences between women and men with type 2 diabetes into risk factors, screening, diagnosis, complications and treatment. Graphical abstract

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confidence: 99%

Sex differences in type 2 diabetes

2023

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“…Despite the decrease over time in association with a decrease in T2D incidence in most of the regions studied, lifetime risk generally exceeded 30%. Life expectancy for persons with T2D at age 20 was 44–59 years in men and 54–64 years in women, and T2D was associated with a range from 3 to 13 years of life lost, particularly with development at younger ages 2 …”

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“…Life expectancy for persons with T2D at age 20 was 44-59 years in men and 54-64 years in women, and T2D was associated with a range from 3 to 13 years of life lost, particularly with development at younger ages. 2 A study using administrative health care data for >10 000 000 persons from Ontario, Canada analyzed the 5-year risk association between diabetes and cardiovascular disease (CVD) from 1994 to 2019, during which time the prevalence of diabetes increased from 3.1% to 9.0% and that of CVD increased from 2.5% to 3.7% of the population. The relative risk of CV events with either diabetes alone or CVD alone in 1994 was 2.06-and 2.16-fold greater than in persons with neither condition.…”

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Diabetes epidemiology: Analysis of trends over time

Bloomgarden

2022

Journal of Diabetes

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“…countries including the United States, 3 Australia, 4 and the United Kingdom. 5 As life expectancies of people with diabetes continue to increase, 6 dementia and other age-related diseases are emerging as notable causes of mortality among those with diabetes. 7 However, the relative contribution of these conditions to the total mortality burden in those with diabetes has not been comprehensively studied.…”

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Causes of death among Australians with type 1 or type 2 diabetes, 2002–2019

Tomic,

Chen,

Moran

et al. 2023

Diabet Med

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AimsThis population‐based study sought to explore in detail the conditions driving the diversification in causes of death among people with diabetes.MethodsWe linked Australians with type 1 or type 2 diabetes of all ages on the National Diabetes Services Scheme to the National Death Index for 2002‐2019. We investigated the proportional contributions of different causes of death to total deaths over time across eight categories of causes of death, stratified by sex and diabetes type. Underlying causes of death were classified according to the International Classification of Diseases, Tenth Revision codes.ResultsBetween 2002‐2019, there was a shift in the causes of death among Australians with diabetes away from cardiovascular disease. The proportion of deaths attributed to cardiovascular disease declined in both sexes (Ptrend < 0.001), most substantially among women with type 2 diabetes from 48.2% in 2002 to 30.7% in 2019. Among men with type 2 diabetes, cancer replaced cardiovascular disease as the leading cause of death. The proportion of deaths due to dementia increased overall, from 2% in 2002 to over 7% in 2019, and across all age‐groups, notably from 1% to 4% in those aged 70‐79. The proportion of deaths due to falls and Parkinson's disease also increased.ConclusionsThere has been a shift of causes of death among those with diabetes away from cardiovascular disease. The proportion of deaths due to conditions such as dementia and falls is increasing among those with diabetes, which will require consideration when planning future resource allocation.

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Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

Cited by 21 publications

References 26 publications

Sex differences in type 2 diabetes

Sex differences in type 2 diabetes

Diabetes epidemiology: Analysis of trends over time

Causes of death among Australians with type 1 or type 2 diabetes, 2002–2019

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