DIABETES LINKED TO EARLIER DEATH

The individuals were followed up for a median of 10 years, and their medical records were reviewed and linked to the official death registry to determine their vital status and causes of death.

A total of 55,292 individuals from across Spain were included, of whom 15.6% had diabetes. Individuals with diabetes were significantly older; less likely to smoke; and had a higher body mass index (BMI), systolic blood pressure, triglycerides, and blood glucose than those without diabetes.

Over the 10-year follow-up, there were 1710 (3.8%) deaths among participants without diabetes and 781 (9.1%) among those with diabetes. No cause of death was available for 220 and 85 deaths, respectively.

Diabetes Significantly Increases Many Causes of Death

A multivariate model that incorporated smoking status, BMI, systolic blood pressure, and total and HDL cholesterol showed that diabetes significantly increased the risk of cardiovascular, cancer, noncardiovascular, noncancer, and overall death in both sexes compared with the general population.

The team assessed the mortality risk in two statistical ways — as the cause-specific hazard (CSH) and the proportional subdistribution hazard (PSH), with the former providing a direct measure of the association of diabetes with a single cause of death, while the latter includes competing risks.

Hazard Risk of Premature Death in Those With Diabetes* 

	Men		Women
Cause of death	CSH	PSH	CSH	PSH
Cardiovascular	2.03	1.99	2.28	2.23
Cancer	1.37	1.35	1.68	1.66
Noncardiovascular, noncancer death	1.53	1.50	1.89	1.84

*Compared with general population

Diabetes was associated with an increased risk of cardiovascular death, at a CSH of 2.03 and a PSH of 1.99 in men and a CSH of 2.28 and PSH of 2.23 in women, which was largely attributable to myocardial infarction, stroke, and heart failure.

The risk of cancer death was also increased among individuals with diabetes, at a CSH of 1.37 and a PSH of 1.35 in men and a CSH of 1.68 and a PSH of 1.66 in women. The results indicated that the primary causes of cancer-related death were liver, colorectal, and lung cancer.

The researchers also found that the risk of noncardiovascular and noncancer death was increased in diabetic individuals, at a CSH of 1.53 and PSH of 1.50 in men and a CSH of 1.89 and a PSH of 1.84 in women, with the majority of deaths associated with infections, chronic obstructive pulmonary disease, and liver and kidney disease.

This work was supported by MARATO TV3, Instituto de Salud Carlos III – Fondo Europeo de Desarrollo Regional – European Regions Development Funds, the Agency for Management of University and Research Grants, Consortium for Biomedical Research in Epidemiology and Public Health, and Consortium for Biomedical Research in Obesity and Nutrition. Dr Grau was supported by the Instituto de Salud Carlos III – Fondo Europeo de Desarrollo Regional – European Regions Development Fund FEDER. The authors report no relevant financial relationships.

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Diabetes Care. Published online August 4, 2016. Abstract