The Effect of Diabetes and Impaired Glucose Tolerance on Mortality in Malta

Abstract

A random sample of the middle-aged population of Malta was studied in a diabetic survey in 1981. Among the 1537 survey responders, in 659 men and 878 women aged 40 years or more the prevalence of diabetes was 16% in men and 18% in women, and that of IGT 5% in both sexes. By the end of 1985, 90 subjects (49 men: 41 women) had died. Mortality/100 (95% CI) was among subjects with normal, impaired glucose tolerance and diabetes in the age group 40-59 years 12 (5-19), 25 (23-73), and 61 (17-148), and in the age group of more than 60 years, 102 (68-136), 148 (59-237), and 178 (122-234), respectively. Age standardized mortality/1000 was in men 51, 28, and 100, and in women 34, 33, and 72 in the three categories of glucose tolerance, respectively. Among diabetic subjects aged 40-64 years the risk of death was increased seven-fold as compared with normoglycaemic subjects. Among men there was an inverse association between body mass index and mortality in all categories of glucose tolerance. Among women, no clear trend between body mass index and mortality was found. The relative risk of death for subjects with diabetes adjusting for age, sex, and body mass index was 2.2 (odds ratio: 95% CI 1.40 to 3.42) as compared with non-diabetic subjects. The age-adjusted survival curves for normoglycaemic subjects were similar for men and women. Among subjects with abnormal glucose tolerance the survival was slightly better in women than in men (p = 0.056). About half of the deaths were from cardiovascular disease and 7% from diabetes mellitus.

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

“…1). Following detailed assessments, and after the inclusion of three articles identified from manual searches, 21 articles were included in the quantitative analysis (21 studies and 24 unique cohorts; Table 1) [7,8,11,15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Study characteristics and the NOS scores are provided in ESM Tables 1-3.…”

Subclinical States of Glucose Intolerance and Risk of Death in the U.S.

“…Since 1990, at least 12 epidemiological studies have related glucose tolerance to mortality (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14); of these studies, 9 had follow-up periods Ͼ5 years (3)(4)(5)(6)(7)(8)(9)(10)(11)14). All nine studies showed increased risk of death among individuals with abnormal glucose tolerance, but all had important limitations.…”

“…However, less is known about the relationship between mortality and subclinical states of glucose intolerance, namely impaired glucose tolerance (IGT) and undiagnosed type 2 diabetes. Whereas previous studies have generally indicated increased mortality related to these states (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), they have been limited by nonstandard methods of glucose tolerance assessment (4,6 -8), short follow-up (7,11), small numbers of events (10,11), suboptimal classification schemes (6,8,10,13), and samples atypical of the general U.S. population (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Moreover, it remains unclear whether this excess mortality is conferred by glucose intolerance per se or rather by other known cardiovascular disease risk factors that commonly accompany diabetes, i.e., high blood pressure, dyslipidemia, and obesity (15,16).…”

“…Moreover, it remains unclear whether this excess mortality is conferred by glucose intolerance per se or rather by other known cardiovascular disease risk factors that commonly accompany diabetes, i.e., high blood pressure, dyslipidemia, and obesity (15,16). Many previous studies did not evaluate the relationship between subclinical states of glucose intolerance and death independent of these potential confounding factors (4,6,8,10,12). Establishing an independent association of IGT and undiagnosed diabetes with mortality in the general population would support the idea that improved screening programs and early intervention may help reduce diabetesrelated mortality in the U.S.…”

Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults

“…The association of an increased risk of all-cause and CVD mortality with hyperglycemia has been reported in a number of populations (4,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)20). However, few of these previous studies have been conducted in a sample representative of the general U.S. population (4,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)20). Moreover, it is unclear whether this excess mortality is conferred by PCH per se or rather by fasting hyperglycemia or CVD risk factors that commonly accompany diabetes, such as high blood pressure, dyslipidemia, and obesity (1,(21)(22)(23)(24)(25).…”