Diabetes exacts heavy price in middle-income countries
medwireNews: Diabetes accounts for around a third of all adult deaths among the inhabitants of Mexico City, report researchers.
This is in stark contrast to the situation in high-income countries, they say, in which self-reported diabetes increases mortality less than twofold, compared with around fourfold in the current study.
Jonathan Emberson (University of Oxford, UK) and study co-authors attribute this partly to the prevalence of diabetes, which was diagnosed in around a quarter of the 146,046 participants by the time they reached 60 to 74 years of age. By comparison, rates are 15% in the USA and 7% in the UK, they say.
But the team also believes that poorer access to healthcare in middle- versus high-income countries plays a part, resulting in poor glycemic control. The average glycated hemoglobin level among participants with a diabetes diagnosis at the time of recruitment was 9.0%, and 36% had a level greater than 10.0%, compared with a reported 5% of diabetes patients in high-income countries.
And this was reflected in the causes of death during 12 years of follow-up, with 8% of deaths among patients with a baseline diabetes diagnosis due to acute diabetes crises, whereas the reported rate for the USA is less than 1%, say the researchers.
It is noteworthy that these data pertain to the capital city, where medical care would probably be better than that in outlying districts.
The impact of diabetes on mortality was greatest in younger patients, with a mortality rate ratio of 7.5 for participants with versus without diabetes at age 35–44 years, declining to a still significant 2.7 by age 65–74 years.
The effect of diabetes was greatest for renal causes of death, followed by infective and vascular causes, and peptic ulcer. The risk was again greatest among the youngest patients. For example, among participants aged 35−59 years the rate ratio for death from renal causes was 31.1 for those with versus without diabetes.
“Assuming causality, approximately three quarters of the deaths between 35 and 74 years of age among Mexicans with diabetes were due (directly or indirectly) to their diabetes,” write the researchers in The New England Journal of Medicine.
Because diabetes-related mortality risk rose with increasing duration of diabetes, “the lifetime hazard would be even greater for persons in whom diabetes develops in early adult life rather than in later adult life,” they add.
Although the research was conducted in Mexico City, the team stresses that the findings “are relevant to many other populations worldwide, including many millions of U.S. Mexican Americans, among whom the prevalence of diabetes is twice as high as that among U.S. non-Hispanic white persons and glycemic control is worse.”
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