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Mortality Trends in Subjects With and Without Diabetes During 33 Years of Follow-up
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
2010 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 33, no 3, 551-556 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE - Mortality rates have declined substantially over the Past decades in the general population, but the situation among diabetic subjects is less clear. The aim of this study was to analyze mortality trends in diabetic and nondiabetic subjects during 1972-2004. RESEARCH DESIGN AND METHODS - Since 1972, all patients With diabetes are entered in a diabetes register at Laxa Primary Health Care Center; 776 incident cases were recorded Up to 2001. The register has been supplemented with a nondiabetic population of 3,880 subjects and with data from the National Cause of Death Register during 1972 to 2004. RESULTS - During the 33-year follow-up period, 233 (62.0%) diabetic women and 240 (60.0%) diabetic men and 995 (52.9%) nondiabetic women and 1,082 (54.1%) nondiabetic men died. The age-adjusted hazard ratio (HR) for all-cause mortality among diabetic and nondiabetic subjects was 1.17 (P < 0.0021) for all, 1.22 (P < 0.007) for women, and 1.13 (P = 0.095) for men. The corresponding cardiovascular disease (CVD) mortality HRs were 1.33 (P < 0.0001), 1.41 (P < 0.0003), and 1.27 (P < 0.0093), respectively. The CVD Mortality reduction across time was significant in nondiabetic subjects (P < 0.0001) and in men with diabetes (P = 0.014) but not in diabetic women (P = 0.69). The results regarding coronary heart disease (CHD) were similar (P < 0,0001, P < 0.006, and P = 0.17, respectively). The CVD and CHD mortality rate change across time was fairly linear in all groups. CONCLUSIONS - Diabetic subjects had less mortality rate reduction during follow-up than nondiabetic subjects. However the excess mortality risk for diabetic subjects was smaller than that found in Other Studies.

Place, publisher, year, edition, pages
2010. Vol. 33, no 3, 551-556 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-136927DOI: 10.2337/dc09-0680ISI: 000275562700019PubMedID: 20009100OAI: oai:DiVA.org:uu-136927DiVA: diva2:377701
Available from: 2010-12-14 Created: 2010-12-14 Last updated: 2017-12-11Bibliographically approved
In thesis
1. A Longitudinal Study of Diabetes Mellitus: With Special Reference to Incidence and Prevalence, and to Determinants of Macrovascular Complications and Mortality
Open this publication in new window or tab >>A Longitudinal Study of Diabetes Mellitus: With Special Reference to Incidence and Prevalence, and to Determinants of Macrovascular Complications and Mortality
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives. To investigate diabetes prevalence, incidence, mortality trends, the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment, and the effect of screening detection on total and cardiovascular disease (CVD), myocardial infarction (MI) and stroke incidence.

Study population and methods. Between 1972 and 2001 all patients with diabetes, some detected clinically and some by case-finding procedures (screening), were entered in a diabetes register at Laxå Primary Health Care Center in Sweden. The register included information on medical treatment and laboratory data as well as information on mortality and morbidity from National Registers. The register was supplemented with five non-diabetic subjects, matched to each diabetes patients by age, sex, and year of detection.

Results. During the study period 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. Age standardised incidence and prevalence rates for type 1 and type 2 diabetes did not increase over time. Diabetic patients had 17% higher mortality rate than non-diabetic persons, 22% in women and 13% in men. The corresponding over-mortality in CVD was 33%, 41% in women and 27% in men. CVD mortality decreased across time in non-diabetic subjects and in diabetic men but not in diabetic women. Results regarding coronary heart disease (CHD) were similar. CVD incidence increased with fasting blood glucose (FBG), body mass index (BMI), mean arterial blood pressure (MABP), and decreased with metformin treatment and sulfonylurea. Myocardial infarction incidence increased with FBG, BMI and MABP, and decreased with metformin treatment. Stroke incidence increased with MABP. There was no difference in prognoses between those detected by screening or clinically.

Conclusions. Diabetes prevalence and incidence did not change over time. The over-mortality according to diabetes was moderate. CVD and MI during follow up were negatively affected by hypertension and hyperglycaemia, and positively by pharmacological diabetic treatment. For stroke no pharmacological protective effect was seen. Screening did not improve prognosis.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 132 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 955
Keyword
Diabetes mellitus, clinical epidemiology, longitudinal study, prevalence, incidence, mortality, macrovascular complications, pharmacological diabetes treatment, hypertension treatment, screening
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-210916 (URN)978-91-554-8819-2 (ISBN)
Public defence
2014-01-17, Wilandersalen, Universitetssjukhuset, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2013-12-18 Created: 2013-11-17 Last updated: 2014-01-24

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