Mortality in people with Type 2 diabetes in the UK

Mulnier, Henrietta; Seaman, Helen E.; Raleigh, Veena S; Soedamah‐Muthu, Sabita S.; Colhoun, Helen M.; Lawrenson, Ross

doi:10.1111/j.1464-5491.2006.01838.x

Cited by 182 publications

(206 citation statements)

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“…Overweight and obesity are associated with increased risks of cardiovascular morbidity and mortality in the general population [8][9][10][11][12][24][25][26][27], but only a few previous studies of type 2 diabetic patients have addressed the topic, and with somewhat conflicting results [13][14][15][16][28][29][30][31]. Our large observational study clearly shows an increased risk of fatal/non-fatal CHD (15%), stroke (11%), CVD (13%) and total mortality (27%) with a 5 unit increase in BMI at baseline after adjustment for age, sex, diabetes duration, type of hypoglycaemic treatment and smoking (model 1), and the risks were attenuated, but remained significant (except for stroke), when also adjusted for additional cardiovascular risk factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…The results of our study, with obesity increasing the risk of total mortality by 71% (model 1), are supported by an observational study from Italy that followed 3,398 type 2 diabetic patients for 10 years, showing that obesity increased the risk of overall mortality by 74% in younger patients (<65 years old) (adjustment as in model 1), whereas excess weight predicted better survival in older patients [16]. An increased risk for total mortality with obesity was seen in the large UK General Practice Research Database (GPRD) study on type 2 diabetic patients (N=44,230, age 35-89 years, followed from 1992 to 1998), showing 13% and 43% increases in risk for BMI 30-34 kg/m 2 and 35-54 kg/m 2 compared with 20-24 kg/m 2 , respectively (adjustment as in model 1) [28]. An older, smaller WHO study found no association between BMI and total mortality [13].…”

Section: Discussionmentioning

confidence: 99%

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Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients

et al. 2008

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Aims/hypothesis The aim of this study of type 2 diabetic patients in the Swedish National Diabetes Register was to study the associations of BMI, overweight (BMI 25-29.9 kg/m 2 ) and obesity (BMI≥30 kg/m 2 ) with cardiovascular disease in type 2 diabetes, as these associations have not previously been clarified. Methods Patients aged 30-74 years with no previous CHD or stroke (N=13,087) were followed for a mean of 5.6 years until 2003 for fatal or non-fatal CHD, stroke, cardiovascular disease (CHD or stroke) and total mortality. In total, 1,922 cardiovascular-disease events occurred, based on 64,864 person-years.Results The relative risks of CHD, stroke, cardiovascular disease and total mortality for a 5 unit increase in BMI at baseline were 15%, 11%, 13% and 27%, respectively, using Cox regression analysis, after adjusting for age, sex, diabetes duration, hypoglycaemic treatment and smoking (model 1), and were 9%, 4% (not significant), 7% and 20%, respectively, when adjusting also for HbA 1c , blood pressure, antihypertensive drugs, lipid-reducing drugs and microalbuminuria (model 2). Adjusted hazard ratios (model 1) for CHD, cardiovascular disease and total mortality with overweight were 1.27 (95% CI 1.09-1.48), 1.24 (1.09-1.41) and 1.16 (0.94-1.45), respectively, and 1.49 (1.27-1.76), 1.44 (1.26-1.64) and 1.71 (1.36-2.14) with obesity, as compared with normal weight. Significant hazard ratios were attenuated when adjusted according to model 2. For a 1 unit increase in BMI during follow-up, the relative risk of CHD (model 2) was 1.13 (1.04-1.23; p=0.005). Conclusions/interpretation Both overweight and obesity independently increased the risk of CHD and cardiovascular disease in patients with type 2 diabetes. The CHD risk was higher with increasing BMI than with stable or decreasing BMI during the study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients

et al. 2008

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“…Diabetes has been found to increase significantly mortality due to coronary heart disease and stroke in normal population (Laakso et al 1995;Tuomilehto et al 1996;Mulnier et al 2006;Raymond et al 1995;Whiteley et al 2005). Among the elderly Finnish population, survival of non-diabetics is better compared to diabetics in both genders.…”

Section: Discussionmentioning

confidence: 99%

Lower limb amputations

Heikkinen

Saarinen

Suominen

et al. 2007

Prosthetics &Amp; Orthotics International

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The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 -1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p 5 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10 6 inhabitants/year) (p 5 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p ¼ 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes.

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“…Patients with type 2 diabetes were identified using an algorithm based on age at diagnosis and type of treatment. Full details of the cohort selection have been published elsewhere [22][23][24]. For each patient with type 2 diabetes five comparison subjects of the same age and sex and with no record of or treatment for diabetes at any time before 1992 or during the follow-up period were selected at random from the database.…”

Section: Methodsmentioning

confidence: 99%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

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Aims/hypothesis Risk estimates for stroke in patients with diabetes vary. We sought to obtain reliable risk estimates for stroke and the association with diabetes, comorbidity and lifestyle in a large cohort of type 2 diabetic patients in the UK. Materials and methods Using the General Practice Research Database, we identified all patients who had type 2 diabetes and were aged 35 to 89 years on 1 January 1992. We also identified five comparison subjects without diabetes and of the same age and sex. Hazard ratios (HRs) for stroke between January 1992 and October 1999 were calculated, and the association with age, sex, body mass index, smoking, hypertension, atrial fibrillation and duration of diabetes was investigated. Results The absolute rate of stroke was 11.91 per 1,000 person-years (95% CI 11.41-12.43) in people with diabetes (n=41,799) and 5.55 per 1,000 person-years (95% CI 5.40-5.70) in the comparison group (n=202,733). The ageadjusted HR for stroke in type 2 diabetic compared with non-diabetic subjects was 2.19 (95% CI 2.09-2.32) overall, 2.08 (95% CI 1.94-2.24) in men and 2.32 (95% CI 2.16-2.49) in women. The increase in risk attributable to diabetes was highest among young women (HR 8.18; 95% CI 4.31-15.51) and decreased with age. No investigated comorbidity or lifestyle characteristic emerged as a major contributor to risk of stroke. Conclusions/interpretation This study provides risk estimates for stroke for an unselected population from UK general practice. Patients with type 2 diabetes were at an increased risk of stroke, which decreased with age and was higher in women. Additional risk factors for stroke in type 2 diabetic patients included duration of diabetes, smoking, obesity, atrial fibrillation and hypertension.

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Mortality in people with Type 2 diabetes in the UK

Cited by 182 publications

References 25 publications

Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients

Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients

Lower limb amputations

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

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