Review

Mortality Trends in Type 2 Diabetes

Catherine C. Cowie¹, Sarah Stark Casagrande², Andy Menke², Michelle A. Cissell³, Mark S. Eberhardt⁴, James B. Meigs⁵, Edward W. Gregg⁶, William C. Knowler⁷, Elizabeth Barrett-Connor⁸, Dorothy J. Becker⁹, Frederick L. Brancati¹⁰, Edward J. Boyko¹¹, William H. Herman¹², Barbara V. Howard¹³, K. M. Venkat Narayan¹⁴, Marian Rewers¹⁵, Judith E. Fradkin¹⁶

, editors.

In: Diabetes in America. 3rd edition. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018 Aug. CHAPTER 36.

Affiliations

¹ Dr. Klara J. Rosenquist is the Associate Medical Director of Quality, Safety and Population Health Management at North Shore Physicians Group in Peabody, MA
² Dr. Caroline S. Fox is the Director of Metabolic Research at the Framingham Heart Study and the Associate Director at the Center for Population Studies in Framingham, MA. She is also a senior investigator at the Laboratory for Metabolic and Population Health of National Heart, Lung, and Blood Institute and an Associate Clinical Professor of Medicine at the Brigham and Women’s Hospital and Harvard Medical School, Boston, MA

Book Affiliations

¹ Senior Advisor and Director for Diabetes Epidemiology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
² Senior Research Analyst, Social & Scientific Systems, Inc., Silver Spring, MD
³ Science Writer/Editor, Chicago, IL
⁴ Epidemiologist, Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
⁵ Professor of Medicine, Harvard Medical School, and Physician, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
⁶ Chief, Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
⁷ Chief, Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
⁸ Distinguished Professor, Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
⁹ Professor of Pediatrics, Division of Endocrinology and Diabetes, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
¹⁰ Distinguished Service Professor of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD
¹¹ Professor, University of Washington, and Staff Physician, Veterans Affairs Puget Sound, Seattle, WA
¹² Professor, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
¹³ Professor of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, Georgetown University Hospital, and Senior Scientist, MedStar Health Research Institute, Hyattsville, MD
¹⁴ Director, Emory Global Diabetes Research Center, Ruth and O.C. Hubert Professor of Global Health and Epidemiology, Rollins School of Public Health, and Professor of Medicine, School of Medicine, Emory University, Atlanta, GA
¹⁵ Professor of Pediatrics and Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
¹⁶ Director, Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

PMID: 33651566
Bookshelf ID: NBK568010

Free Books & Documents

Review

Mortality Trends in Type 2 Diabetes

Klara J. Rosenquist et al.

Free Books & Documents

In: Diabetes in America. 3rd edition. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018 Aug. CHAPTER 36.

Authors

Klara J. Rosenquist¹, Caroline S. Fox²

Book Editors

Affiliations

¹ Dr. Klara J. Rosenquist is the Associate Medical Director of Quality, Safety and Population Health Management at North Shore Physicians Group in Peabody, MA
² Dr. Caroline S. Fox is the Director of Metabolic Research at the Framingham Heart Study and the Associate Director at the Center for Population Studies in Framingham, MA. She is also a senior investigator at the Laboratory for Metabolic and Population Health of National Heart, Lung, and Blood Institute and an Associate Clinical Professor of Medicine at the Brigham and Women’s Hospital and Harvard Medical School, Boston, MA

Book Affiliations

¹ Senior Advisor and Director for Diabetes Epidemiology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
² Senior Research Analyst, Social & Scientific Systems, Inc., Silver Spring, MD
³ Science Writer/Editor, Chicago, IL
⁴ Epidemiologist, Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
⁵ Professor of Medicine, Harvard Medical School, and Physician, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
⁶ Chief, Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
⁷ Chief, Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
⁸ Distinguished Professor, Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
⁹ Professor of Pediatrics, Division of Endocrinology and Diabetes, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
¹⁰ Distinguished Service Professor of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD
¹¹ Professor, University of Washington, and Staff Physician, Veterans Affairs Puget Sound, Seattle, WA
¹² Professor, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
¹³ Professor of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, Georgetown University Hospital, and Senior Scientist, MedStar Health Research Institute, Hyattsville, MD
¹⁴ Director, Emory Global Diabetes Research Center, Ruth and O.C. Hubert Professor of Global Health and Epidemiology, Rollins School of Public Health, and Professor of Medicine, School of Medicine, Emory University, Atlanta, GA
¹⁵ Professor of Pediatrics and Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
¹⁶ Director, Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

PMID: 33651566
Bookshelf ID: NBK568010

Excerpt

The overall population in the United States has experienced a marked decline in both all-cause mortality and cardiovascular-related mortality over the last several decades, including a decline in mortality of individuals with diabetes. However, in association with the obesity epidemic, the prevalence and incidence of type 2 diabetes continue to increase. Despite improvements in primary and secondary prevention of cardiovascular disease (CVD), diabetes is an increasingly important risk factor for CVD, and individuals with diabetes as compared to those without diabetes continue to have an increased risk of both all-cause and cardiovascular mortality.

The evaluation of long-term trends in mortality rates of diabetes is particularly challenging. The changing definition of diabetes over the last several decades makes the proportion of diabetes deaths hard to interpret. In addition, death certificate data regarding diabetes are often incomplete and likely underestimate the association of diabetes and mortality.

Diabetes is the seventh leading cause of death in the United States, and individuals with diabetes have a twofold to threefold increased risk of mortality compared to individuals without diabetes. Individuals with diabetes have a decreased life expectancy by up to 8 years compared to contemporary individuals without diabetes. This decrease is due in part to an increased risk of CVD and an increasing attributable risk of cardiovascular mortality associated with diabetes. The most common nonvascular causes of death from diabetes include cancer, renal disease, liver disease, and pneumonia. Individuals with diabetes have increased all-cause mortality even after adjusting for baseline characteristics, including age, sex, smoking status, and body mass index. Control of cardiovascular risk factors has improved over the last several decades in the general population, as well as in individuals with diabetes. However, many individuals with diabetes remain suboptimally controlled based on current standards. Cardiovascular risk factor control has contributed to a decrease in national mortality rates over time, but both women and men with diabetes remain at higher risk of all-cause and cardiovascular mortality than those without diabetes.

The above trends highlight several important points. First, the prevalence and incidence of diabetes continue to increase. Second, despite improvements in cardiovascular risk factor treatment, individuals with diabetes are not optimally controlled. Further, the proportion of CVD due to diabetes has increased over time, emphasizing the impact of increasing diabetes incidence on the burden of CVD. Finally, these findings point to the importance of aggressive diabetes and cardiovascular risk factor management to help decrease diabetes morbidity and mortality.

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Conflict of interest statement

DUALITY OF INTEREST

The authors reported no conflicts of interest.

Sections

References

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Mortality Trends in Type 2 Diabetes

Affiliations

Book Affiliations

Mortality Trends in Type 2 Diabetes

Authors

Book Editors

Affiliations

Book Affiliations

Excerpt

Conflict of interest statement

Sections

References

Publication types

LinkOut - more resources

Full Text Sources

Medical