The Mortality of Elderly People with Diabetes

Croxson, Simon; Price, David E.; Burden, Mary; Jagger, Carol; Burden, A C

doi:10.1111/j.1464-5491.1994.tb00267.x

Cited by 43 publications

(38 citation statements)

References 8 publications

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“…CONCLUSIONS -In this study, men diagnosed with type 2 diabetes after 65 years of age had no increased risk of mortality compared with nondiabetic men of the same age. This result contrasts sharply with the significant effect of diabetes on mortality in a population of older diabetic people that included newly diagnosed individuals and those with a longer duration of disease (5). Studies that have found small differences in mortality, even in men diagnosed at a later age, have not adjusted for the confounding effect of deprivation (possibly independently associated with diabetes prevalence [13] and mortality).…”

Section: Research Design and Methods -The Darts/memo (Diabetes Audit mentioning

confidence: 80%

“…However, older people with diabetes are a heterogeneous group, including newly diagnosed people and those whose diagnosis may have occurred up to 20 years previously (2)(3)(4). Some research suggests that the effect on mortality of a diagnosis of diabetes becomes progressively less as age at diagnosis increases (5). A group of older people whose diabetes was detected by screening had an increased risk of mortality (6), and even patients who were diagnosed with diabetes over the age of 80 years had a reduced life expectancy of ϳ1 year (7).…”

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confidence: 99%

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Diagnosis of Type 2 Diabetes at an Older Age

et al. 2004

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OBJECTIVE -To compare the mortality of people who were diagnosed with type 2 diabetes over 65 years of age with that of nondiabetic individuals. RESEARCH DESIGN AND METHODS-Using a population-based diabetes information system for an observational cohort study in Tayside, Scotland, people who were diagnosed with type 2 diabetes over the age of 65 years between 1993 and 2002 were identified. Nondiabetic comparators, matched for age and sex, were identified from the nondiabetic population. The two cohorts were followed up for mortality and cardiovascular mortality according to death certification records.RESULTS -There were 3,594 people with type 2 diabetes (48% male) and 7,188 matched comparators identified in the study. Over a mean follow-up period of 4.6 Ϯ 2.9 years for 3,594 people with type 2 diabetes and 7,188 comparators, 909 (25.3%) patients in the diabetic cohort and 1,651 (23.0%) in the nondiabetic cohort died. The adjusted relative risk for mortality in the diabetic cohort compared with the nondiabetic cohort was 1.06 (95% CI 0.94 -1.19) for men and 1.29 (1.15-1.45) for women. Cardiovascular deaths accounted for 49.4% of the deaths in people with and 45.2% in those without diabetes (adjusted relative risk 1.01 [0.93-1.10]).CONCLUSIONS -Men diagnosed with type 2 diabetes over the age of 65 years have no excess mortality compared with their nondiabetic counterparts, a finding that was not replicated for women. Diabetes Care 27:2797-2799, 2004D iabetes is known to reduce life expectancy in older people (1). However, older people with diabetes are a heterogeneous group, including newly diagnosed people and those whose diagnosis may have occurred up to 20 years previously (2-4). Some research suggests that the effect on mortality of a diagnosis of diabetes becomes progressively less as age at diagnosis increases (5). A group of older people whose diabetes was detected by screening had an increased risk of mortality (6), and even patients who were diagnosed with diabetes over the age of 80 years had a reduced life expectancy of ϳ1 year (7). However, two European studies found no difference in mortality between men diagnosed with diabetes over the age of 75 years and nondiabetic men (8,9). We compared all-cause and cardiovascular mortality in cohorts of people diagnosed with type 2 diabetes at an older age with that in nondiabetic individuals. RESEARCH DESIGN AND METHODS -The DARTS/MEMO (Diabetes Audit and Research in TaysideScotland/Medicines Monitoring Unit) Collaboration (9) works on the record linkage of health care data to facilitate epidemiological and health services research in the population of Tayside, Scotland (estimated population of 389,800 in 1998). Record linkage is enabled by the widespread use of a unique health care identifier (community health index number) that is allocated to people when they register with a general practitioner in Scotland. This study was conducted in a defined population of general practitioner-registered people who were known to be residents of Tayside during the entire ...

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Section: Research Design and Methods -The Darts/memo (Diabetes Audit mentioning

confidence: 80%

mentioning

confidence: 99%

Diagnosis of Type 2 Diabetes at an Older Age

et al. 2004

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“…Within the U.K., recent estimates of increased risk of mortality for various diabetic cohorts have ranged from just over 1 to almost 5 (1)(2)(3)(4)(5). The bulk of this excess, which has also been observed in other international cohorts, has been attributed to circulatory diseases.…”

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confidence: 99%

Relationship between diabetes and mortality: a population study using record linkage.

2000

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A population study using record linkage O R I G I N A L A R T I C L EOBJECTIVE -To determine patterns and causes of mortality for patients with diabetes in a district health authority.RESEARCH DESIGN AND METHODS -The study used cross-sectional record linkage, combining an electronic death register with a diabetic patient register constructed from a variety of routine health data sources collected from 1991 to 1997. The study was conducted in Cardiff and the Vale of Glamorgan, Wales, U.K., and included all diabetic deaths between 1993 and 1996.RESULTS -Of 1,694 deaths in patients with known diabetes, only 674 (39.8%) had diabetes recorded as an immediate or antecedent cause of death. Mortality rates were 41.8 per 1,000 for the diabetic population and 10.1 per 1,000 for the nondiabetic population. The standard mean ratio for the diabetic population was 1.24 (95% CI 1.12-1.35), with the risk of mortality relative to the nondiabetic population decreasing with age. Males with diabetes lost an average of 7.0 years from the year of diagnosis, and females with diabetes lost an average of 7.5 years. The most common cause of death was cardiovascular disease, which accounted for 49.1% of deaths in the diabetic population.CONCLUSIONS -Diabetes is recorded as a cause of death on a minority of death certificates for patients with diabetes. Using death certificates in isolation, therefore, is a poor method of estimating diabetic mortality, but results can be improved with the use of record linkage techniques. Patients with diabetes have an excess risk of mortality compared with the nondiabetic population. Life-years lost for patients with diabetes is strongly related to age at diagnosis and is a means of expressing mortality without relying on accurate prevalence data.

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“…In the Melton Mowbray study (Croxson et al, 1994) the age and sex adjusted relative risk (RR) of death over 4.5 years compared with people with normal glucose tolerance was in people with known diabetes, 3.0 (1.3-6.6) in people newly diagnosed through a detection program for type 2 diabetes and 1.7 (0.8-3.5) in people with IGT. The Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study included data on over 25,000 people from a range of European countries (DECODE, 1999a).…”

Section: Undiagnosed Type 2 Diabetes Is Not a Benign Conditionmentioning

confidence: 99%

Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice

Paul

Ishiguchi

DʼEste

et al. 2017

Medical Journal of Australia

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Objectives: To determine the proportion of Aboriginal Controlled Community Health Service (ACCHS) patients tested according to three national diabetes testing guidelines; to investigate whether specific patient characteristics were associated with being tested. Design, setting and participants: Cross‐sectional study of 20 978 adult Indigenous Australians not diagnosed with diabetes attending 18 ACCHSs across Australia. De‐identified electronic whole service data for July 2010 – June 2013 were analysed. Main outcomes measures: Proportions of patients appropriately screened for diabetes according to three national guidelines for Indigenous Australians: National Health and Medical Research Council (at least once every 3 years for those aged 35 years or more); Royal Australian College of General Practitioners and Diabetes Australia (at least once every 3 years for those aged 18 years or more); National Aboriginal Community Controlled Health Organisation (annual testing of those aged 18 years or more at high risk of diabetes). Results: 74% (95% CI, 74–75%) of Indigenous adults and 77% (95% CI, 76–78%) of 10 760 patients aged 35 or more had been tested for diabetes at least once in the past 3 years. The proportions of patients tested varied between services (range: all adults, 16–90%; people aged 35 years or more, 23–92%). 18% (95% CI, 18–19%) of patients aged 18 or more were tested for diabetes annually (range, 0.1–43%). Patients were less likely to be tested if they were under 50 years of age, were transient rather than current patients of the ACCHS, or attended the service less frequently. Conclusions: Some services achieved high rates of 3‐yearly testing of Indigenous Australians for diabetes, but recommended rates of annual testing were rarely attained. ACCHSs may need assistance to achieve desirable levels of testing.

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The Mortality of Elderly People with Diabetes

Cited by 43 publications

References 8 publications

Diagnosis of Type 2 Diabetes at an Older Age

Diagnosis of Type 2 Diabetes at an Older Age

Relationship between diabetes and mortality: a population study using record linkage.

Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice

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