Increased Mortality Risk in People with Type 2 Diabetes Mellitus in Lithuania.

Donata Linkeviciute-Ulinskiene,Audrius Dulskas,Lina Zabuliene,Auguste Kaceniene,Giedre Smailyte,Ausvydas Patasius

doi:10.3390/ijerph17186870

Abstract

This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death–from death certificates. Sex, age, and calendar period-standardized mortality ratios (SMRs) were calculated. In addition, 89,512 patients were followed-up between 2010 and 2017, contributing to the observation period of 592,321 person-years. Overall mortality risk was increased for both sexes (overall SMR = 1.35, 95% confidence interval (CI) 1.34–1.37). Greatest mortality risk was in the age group of 40–49 years at diabetes diagnosis (SMR = 1.68, 95% CI 1.60–1.76) and among those who had died before the age of 50 (SMR = 22.04, 95% CI 18.82–25.81). Patients treated with insulin only had the highest SMR (2.43, 95% CI 2.32–2.55). Mortality risk increased with increasing diabetes duration and was higher in women in all these groups. The highest cause-specific SMRs were infection-related causes (SMR = 1.44), particularly septicemia (SMR = 1.78), diseases of the circulatory system (SMR = 1.42), especially ischemic heart (SMR = 1.46) and cerebrovascular diseases (SMR = 1.38), as well as diseases of the digestive system (SMR = 1.35). Cancer mortality risk was elevated for women (SMR = 1.13), but not for men (SMR = 0.93). In conclusion, people with T2DM had an excess mortality risk, which was higher in women compared to men, younger people, in those who were diagnosed with T2DM at a younger age, had longer diabetes duration, and who required treatment with insulin.

Highlights

Type 2 diabetes mellitus (T2DM) and its complications have been an increasing burden of mortality and disability globally
Excess mortality in T2DM was substantially higher in people who were diagnosed with T2DM at a younger age, in those who died at a younger age, those who had a longer diabetes duration, or those who required treatment with insulin
The findings showed that diabetes at the baseline was associated with increased mortality risk due to cardiovascular diseases (CVD), chronic lower respiratory diseases, influenza and pneumonia, and kidney disease, but not with cancer or Alzheimer’s disease [18]

Summary

Introduction

Type 2 diabetes mellitus (T2DM) and its complications have been an increasing burden of mortality and disability globally. The Global Burden of Disease Study 2013 identified diabetes as the ninth major cause of reduced life expectancy [1]. It was estimated that diabetes caused 4.2 million deaths in adults aged 20–79 years during 2019, which is 11.3% of global mortality. Res. Public Health 2020, 17, 6870; doi:10.3390/ijerph17186870 www.mdpi.com/journal/ijerph

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