Prognosis of diabetes mellitus in a geographically defined population

Abstract

The centralised registration and care of all diabetics in a geographically defined population has provided an epidemiological basis for a longitudinal investigation of the prognosis of this disease. Records of all newly diagnosed diabetics who had been registered in the Erfurt district (population 1.25 million) in 1966 were studied in relation to the time period 1966-1976. Of the known 2,560 diabetics (910 men, 1,650 women; 93.7% greater than 40 years of age), 1,054 had died during the 10-year follow-up period. Cardiovascular causes accounted for the majority of deaths (63%). In almost all age classes proportionally more men than women had died at follow-up; there was a significant difference in the 60-69 year group (men 61.6%, women 46.2%). In comparison with the general population, excess mortality ranged from 2.1 to 1.0, decreasing with age at onset without significant differences between men and women. Excess mortality was present in most age classes and was evident within the first year after diagnosis. Current life-table analysis confirmed the shortened life expectancy of the diabetics. The lower life expectancy of noninsulin-dependent diabetics may not be due to hyperglycaemia alone but probably also involves a variety of atherongenic risk factors.

A long-term follow-up study of Japanese diabetic patients: Mortality and causes of death

“…The high frequency of cerebro-cardiovascular and renal diseases as causes of death in diabetes was also noted in two previous Japanese reports [12,16], and resembles closely findings obtained in studies on diabetic patients in the West [4,6,8,14]. However, the frequency of three major angiopathies in our study somewhat differs from that in the West.…”

“…The O/E ratios found in our male and female patients correspond to most of those found in studies carfled out in the West [5,7,8]. In our study, a higher mortality was found in diabetic men than in diabetic women, which agrees with some [4,5], but not other studies from Western countries [1,5,7,14].…”

“…Kessler [5] found standardized mortality ratios of 1.74 for men and 1.27 for women at the Joslin Clinic, and Kr61ewski et al [6] reported O/E ratios of 1.31 for men and 1.27 for women in diabetic patients in Warsaw. An excessive mortality of diabetic patients was also observed in the district of Erfurt, Germany [4], while the mortality rate of male diabetic patients was found to be increased by a factor of 2.62 in a 10-year study on employees at the Du Pont Company [8]. Similarly, a survey in Birmingham, UK, indicated mortality in diabetic patients to be 1.37 times higher than in the general population [9].…”

“…The relatively high incidence of renal disease as cause of death in diabetic patients was striking. Malignant neoplasms of liver and of pancreas and cirrhosis were also associated with increased ratio of observed to expected number of deaths in the patients.Key words: Prognosis of diabetic patients, long-term followup, excess mortality, causes of death, vascular complications, Japan.Studies on diabetic patients in Western countries have consistently shown a poor prognosis compared with the life expectancy of the general population [1][2][3][4][5][6][7][8][9]. This is due largely to late manifestation of cardiovascular complications of the disease [5][6][7][8].…”

Mortality and causes of death in the WHO multinational study of vascular disease in diabetes

“…This loss of survival advantage has been noted in other studies for women with diabetes [15,16] and could be due to a relative loss of protection from cardiovascular deaths among women with diabetes [8,17]. This study also found that women with Type I diabetes tended to have a higher excess mortality than men with Type I diabetes.…”