Diabetes duration, control impact cause-specific mortality in Mexico
medwireNews: Deaths from vascular, renal, and infectious causes substantially increase with increasing diabetes duration and worsening glycemic control, results of the Mexico City Prospective Study show.
Therefore, “[d]elaying the onset of type 2 diabetes, as well as improving its treatment, is essential to reduce premature adult mortality in Mexico,” Jonathan Emberson (University of Oxford, UK) and co-investigators remark.
During a median follow-up period of nearly 14 years, 7683 of 133,662 participants in the Mexico City Prospective Study died before they were 75 years of age, most commonly from vascular, renal, or infectious causes. All participants were aged 35–74 years with no other chronic diseases at baseline.
Compared with participants without diabetes (n=110,181), the relative risk (RR) for death from any of these three causes was 3.0 in participants with undiagnosed diabetes (n=6541), 4.5 in those with a diagnosed diabetes duration of less than 5 years (n=5042), 6.6 in those with a duration of 5–10 years (n=7713), and 11.7 in the participants with a duration of 10 years or more (n=4185). Rates were similar for men and women of all ages.
Similarly, at any given time since diabetes diagnosis, the RR for death from vascular, renal, or infectious causes increased with increasing glycated hemoglobin (HbA1c) level, from 5.2 in those with a HbA1c level below 9% to 10.5 for those with a HbA1c level of 11% or higher, when compared with individuals without diabetes.
The researchers note that, in line with previous observations, the RRs for death from renal disease were particularly high. For example, individuals with a diabetes duration of 5–10 years or baseline HbA1c of 9–11% had RRs for death from renal disease of 24.2 and 22.6, respectively, whereas the corresponding figures for vascular disease were 3.8 and 4.4.
Emberson and team calculated that diabetes accounted for 35% of all deaths and half of those from a vascular, renal, or infectious cause (including 80% of renal deaths). By contrast, less than 10% of deaths from other causes, apart from diabetic crisis, were attributable to diabetes.
Writing in The Lancet Diabetes and Endocrinology, the authors conclude: “Strategies to both delay the onset of type 2 diabetes as well as improve glycaemic and associated risk factor control could substantially reduce the number of premature adult deaths in countries such as Mexico, where the resources to treat diabetes have not been able to keep pace with the growing obesity and diabetes epidemic.”
In a comment that accompanies the study, Armando Arredondo, from the National Institute of Public Health in Cuernavaca, Mexico, says that the findings “provide state-of-the-art knowledge with respect to the issue of cause-specific mortality for people with diabetes in middle-income countries.”
He agrees that there is a “need for greater allocation of resources for the detection of diabetes early in the disease course and to improve glycaemic control strategies,” and adds that “[h]ealth-service resources should also be used to strengthen service delivery for patients with diabetes and comorbidities, including kidney disease, vascular disease, and infections.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group