Improving Diabetes Control Means Decreasing Mortality

Marcus Lind, M.D., Ph.D Department of Medicine, Uddevalla Hospital Uddevalla, Swede

MedicalResearch.com Interview with:
Marcus Lind, M.D., Ph.D
Department of Medicine, Uddevalla Hospital
Uddevalla, Swede


Medical Research: What is the background for this study?

Dr. Lind:  One of the main goals of the diabetes care is to reduce excess mortality in individuals with type 2 diabetes close to that of the general population. We want patients to have a similar life expectancy as individuals in the general population. Earlier studies have shown that targeting good glucose levels, blood lipid and blood pressure levels are beneficial with respect to decrease cardiovascular disease being the main cause for mortality. We wanted to evaluate the prognosis for individuals with type 2 diabetes today in Sweden.

Further, earlier population-based studies have generally assessed mortality rates only on a group level whereas we believe the prognosis differs greatly depending on various factors such as how well risk factor control is obtained in clinical practice. The Swedish Diabetes Registry include more than 90% of all individuals with type 2 diabetes in Sweden and information of e.g. the glycaemic control, measured by a biomarker called A1c exists for most persons. There were 97% who had at least 1 measurement. Also most patients had information of other risk factors, among others renal complications which we believed were of special concern. 

Medical Research: What are the main findings?

Dr. Lind: Up to year 2000 the excess risk of mortality in individuals with type 2 diabetes was generally considered to be doubled (around 100%) compared to the general population, implying a doubled risk to die during the next following years. In the current report we show that this has dropped to historical low levels of 15%.

However, the prognosis varies greatly depending on age, glycaemic control and renal complications. In individuals 75 years or older mortality rates were in principle similar as in the general population. However, it is essential to notice that if renal complications existed also an excess risk mortality existed or if very poor glycaemic control was present. It is therefore essential to continue preventing diabetic complications also in older individuals.

In those 65 years or older mortality rates were also similar to the general population if good glycaemic control was present and no renal complications existed. In fact it was even lower in individuals with type 2 diabetes who had glycaemic levels on target and no renal complications than for individuals in the general population. This is a large patient group today who are 65 years or older and target these levels. Hence, it is promising that we can identify that if reaching current target in diabetes guidelines in individuals 65 years or older we can lower the mortality rate to that in the general population, i.e. guidelines are working. However, it is essential to notice that if individuals had clearly high HbA1c or renal complications had started to appear which often is a result of earlier poor glycaemic control, there was a clear excess mortality also in this age group.

For younger individuals, especially those lower than 55 years we found a clearly increased mortality although glycaemic control was on target and no renal complications had appeared. These results are more difficult to interpret. There were e.g. considerably more smokers among individuals with diabetes. However, the results imply that further improvements in the care for this patient group is needed.

Citation:

Excess Mortality among Persons with Type 2 Diabetes

Mauro Tancredi, M.D., Annika Rosengren, M.D., Ann-Marie Svensson, Ph.D., Mikhail Kosiborod, M.D., Aldina Pivodic, M.Sc., Soffia Gudbjörnsdottir, M.D., Ph.D., Hans Wedel, Ph.D., Mark Clements, M.D., Ph.D., Sofia Dahlqvist, and Marcus Lind, M.D., Ph.D.

N Engl J Med 2015; 373:1720-1732 October 29, 2015

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Marcus Lind, M.D., Ph.D (2015). Improving Diabetes Control Means Decreasing Mortality 

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