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. 2017 Dec 16;5(1):e000451.
doi: 10.1136/bmjdrc-2017-000451. eCollection 2017.

All-cause mortality in adults with and without type 2 diabetes: findings from the national health monitoring in Germany

Susanne Röckl  1 , Ralph Brinks  2 , Jens Baumert  1 , Rebecca Paprott  1 , Yong Du  1 , Christin Heidemann  1 , Christa Scheidt-Nave  1
Affiliations

All-cause mortality in adults with and without type 2 diabetes: findings from the national health monitoring in Germany

Susanne Röckl et al. BMJ Open Diabetes Res Care. .

Erratum in

Abstract

Objective: To estimate age-specific and sex-specific all-cause mortality among adults with and without type 2 diabetes (T2D) in Germany.

Research design and methods: The German National Health Interview and Examination Survey 1998 (GNHIES98) included a mortality follow-up (median follow-up time 12.0 years) of its nationwide sample representative of the population aged 18-79 years. After exclusion of participants with type 1 diabetes, age- and sex-stratified mortality rates (MR) were calculated for 330 GNHIES98 participants with diagnosed T2D (self-reported diagnosis or antidiabetic medication), 245 with undiagnosed T2D (no diagnosed T2D, glycated hemoglobin A1c ≥6.5% (≥48 mmol/mol)), and 5975 without T2D. Mortality rate ratios (MRR) comparing MR of persons with and without T2D were estimated. Age-/sex-standardized MR and MRR were calculated including persons aged 45 years or older. MRR were used to estimate the number of years of life lost (YLL) due to diagnosed diabetes in 2010.

Results: Over 75 994 person-years, 73 persons with undiagnosed T2D, 103 with diagnosed T2D, and 425 persons without T2D died. MRR were significantly higher in younger age groups, except for analyses limited to women or diagnosed T2D. Age- and sex-standardized MRR (95% CI) among persons aged 45 years or older were 1.96 (1.41 to 2.71) for undiagnosed, 1.68 (1.26 to 2.23) for diagnosed, and 1.82 (1.45 to 2.28) for total (undiagnosed or diagnosed) T2D. Sex-stratified analysis revealed similar age-standardized MRR for undiagnosed (1.56 (0.79 to 3.06)) and diagnosed T2D (1.56 (1.03 to 2.37)) among women, and a higher age-standardized MRR for undiagnosed (2.06 (1.43 to 2.97)) than diagnosed T2D (1.70 (1.10 to 2.63)) among men. YLL due to diagnosed diabetes in Germany in 2010 were 164 600 (35 000 to 279 300) among women and 169 900 (28 300 to 328 300) among men.

Conclusions: In Germany, age- and sex-standardized all-cause mortality is almost twice as high for adults with T2D as for adults without T2D. The T2D-associated excess risk of mortality appears to be most pronounced in younger adults and among men unaware of their T2D.

Keywords: mortality; national health surveys; public health/surveillance; type 2 diabetes.

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Conflict of interest statement

Competing interests: CSN reports grants from the Federal Ministry of Health, Germany, grant number GE 2015 03 23, during the conduct of the study.

Figures

Figure 1
Figure 1
GNHIES98 sample and definition of type 2 diabetes.
Figure 2
Figure 2
Mortality rates by T2D status with rate ratios for German National Health Interview and Examination Survey 1998 participants. Mortality rates as deaths per 1000 person-years with corresponding rate ratios comparing persons with and without T2D. Diagrams with logarithmic scale.  e, number of events (deaths); n, number of persons; n.a., not assessable due to low numbers; T2D, type 2 diabetes. RReference: no T2D; #controlled for sex; *95% CI missing because of ≤1 event in stratum. All data except e and n are weighted to the German population as of December 31, 1997. Standardized estimates are age-and sex-standardized to the German population as of December 31, 1997. Age groups for standardization: 45 to <65, 65 to <75, 75 to <85, and 85 to <92 years of current age. Data of the German population 85–89 years were used as reference weight for the age group 85 to <92 years.
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References

    1. Workshop Report. Diabetes care and research in Europe: the Saint Vincent declaration. Diabet Med 1990;7:360. - PubMed
    1. Read SH, Kerssens JJ, McAllister DA, et al. . Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013. Diabetologia 2016;59:2106–13. 10.1007/s00125-016-4054-9 - DOI - PMC - PubMed
    1. Harding JL, Shaw JE, Peeters A, et al. . Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997-2010. Diabetes Care 2014;37:2579–86. 10.2337/dc14-0096 - DOI - PubMed
    1. Tancredi M, Rosengren A, Svensson AM, et al. . Excess Mortality among Persons with Type 2 Diabetes. N Engl J Med 2015;373:1720–32. 10.1056/NEJMoa1504347 - DOI - PubMed
    1. Carstensen B, Kristensen JK, Ottosen P, et al. . The Danish National Diabetes Register: trends in incidence, prevalence and mortality. Diabetologia 2008;51:2187–96. 10.1007/s00125-008-1156-z - DOI - PubMed