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Author's personal copy diabetes research and clinical practice 92 (2011) 400–404
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Diabetes Research and Clinical Practice jou rna l hom ep ag e: w ww.e lse v ier .com/ loca te /d iab res
Improvements in life expectancy in adult type 2 diabetes patients in the last six decades Sorin Ioacara a,*, Cristian Guja a, Constantin Ionescu-Tirgoviste a, Simona Fica b, Sorin Sabau c, Stefania Radu a, Andrei Micu a, Cristina Tiu d a
‘‘N. Paulescu’’ National Institute of Diabetes, Nutrition and Metabolic Diseases, Diabetes 1, Bucharest, Romania ‘‘Elias’’ Hospital, Endocrinology and Diabetes, Bucharest, Romania c ‘‘Tokai’’ University, Statistics, Sapporo, Japan d ‘‘University’’ Hospital, Neurology, Bucharest, Romania b
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Article history:
Aim: To investigate the historical changes in survival with diabetes in adult type 2 diabetes
Received 8 January 2011
patients.
Received in revised form
Methods: We analyzed 9066 deaths, 54.2% males, registered at ‘‘I. Pavel’’ Bucharest Diabetes
8 March 2011
Centre, aged 40–64 years and deceased between 1943 and 2009. We split the analysis in three
Accepted 14 March 2011
time periods according to year of death: 1943–1965, 1966–1988 and 1989–2009.
Published on line 13 April 2011
Results: The mean age at diabetes onset was 55.5 6.2 years, with mean disease duration at death 12.7 8.2 years and mean age at death 68.2 8.7 years. The mean disease duration at
Keywords:
death was 9.9 7.3 years in 1943–1965 period, followed by a significant ( p < 0.001) rise to
Survival
12.2 8.2 years in 1966–1988, and 14 8.1 years ( p < 0.001) in 1989–2009. There was a
Age at onset
significant increase for coronary heart diseases and cancer and a significant decrease for
Age at death
infections and end-stage renal disease as causes of death.
Disease duration
Conclusion: We found a significant increase in age at onset and survival with diabetes
Causes of death
leading to a significant increase in age at death. # 2011 Elsevier Ireland Ltd. All rights reserved.
1.
Introduction
Diabetes mellitus is one of the major health problems of modern societies, reaching epidemic proportions in the last decades [1]. Moreover, predictions for the next 20 years show that diabetes prevalence will continue to rose, reaching 7.7% (439 million adults worldwide) by 2030 [2]. Several studies indicated that type 2 diabetes (T2DM) significantly reduces life expectancy [3,4], mainly as a consequence of increased rates of cardiovascular events [5]. Estimating mortality due to diabetes is difficult since routine health statistics have been shown to underestimate
it [6]. For example, if an acute diabetic complication is not the direct cause of death, frequently diabetes is not mentioned at all on the death certificate or is not specified as the underlying cause of death. However, numerous studies provided estimates of mortality rates in T2DM and suggested that patients may have up to a threefold increase in mortality compared with general population [5,7]. It is worth to note that large worldwide variations in mortality rates between different regions were reported [6]. Only a few studies followed T2DM patients from diagnosis and suggested that the relative risk of mortality decreases with increasing age at diabetes diagnosis [8].
* Corresponding author. Tel.: +40 722137717; fax: +40 212102295. E-mail address:
[email protected] (S. Ioacara). Abbreviations: T2DM, type 2 diabetes; FBG, fasting blood glucose; BMI, body mass index; CHD, coronary heart disease; ESRD, end stage renal disease. 0168-8227/$ – see front matter # 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2011.03.022
Author's personal copy diabetes research and clinical practice 92 (2011) 400–404
We previously reported the survival of Romanian type 1 diabetes patients [9]. The aim of our current study was to analyze the dynamic of survival with diabetes in T2DM patients with disease onset between 40 and 65 years, deceased between 1943 and 2009, in Bucharest, Romania. To our best knowledge, this is the first report of mortality rates in this age group of T2DM patients in Romania.
2.
Patients and methods
The Bucharest Diabetes Registry was founded in 1941 and is probably the oldest one in Europe. It includes virtually all patients discovered with diabetes in the area because this was the only site where diabetes medication was available (for free). Although several advertising methods were used, including dispensing of meat, hard to be obtained during the war time, diabetes patients were hard to be motivated to register and return for regular visits in the first years. As time goes by and the war time was left behind the enrolment rate significantly rise and this ambitious project turned out to be a real success. During 1941–2005, the Bucharest Diabetes Centre was the only provider of diabetes care for Bucharest and the surrounding area. Since 2006, diabetes medication started to be distributed by all regular pharmacies and some patients were probably lost from the Registry, because of the less tight control of provided treatment. Nonetheless, the representativeness of our cohort remained extremely high because most of the new diabetes care providers reported their subjects to us on a monthly base. This is a retrospective study of deaths encountered during 1943–2009 in adult oral treated T2DM subjects, aged 40 to under 65 years at diabetes onset. The inclusion criteria were: (a) patient registered at Bucharest Diabetes Centre; (b) deceased between 1943 and 2009. The exclusion criteria were: (a) age
