Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Nov;27(11):6341-6352.
doi: 10.1111/dom.70025. Epub 2025 Sep 1.

Trends in mortality and hospitalisations for cardiovascular, kidney and liver disease in people with type 2 diabetes in England, 2009-2019

Naomi Holman  1   2 , Bob Young  3 , Edward W Gregg  1   2 , Nick Wareham  4 , Stephen Sharp  4 , Kamlesh Khunti  5 , Naveed Sattar  6 , Jonathan Valabhji  7   8   9
Affiliations

Trends in mortality and hospitalisations for cardiovascular, kidney and liver disease in people with type 2 diabetes in England, 2009-2019

Naomi Holman et al. Diabetes Obes Metab. 2025 Nov.

Abstract

Aims: To assess longitudinal trends in total and cause-specific mortality rates and in hospitalisation rates for diabetes complications among people with type 2 diabetes in England between 2009 and 2019; and to assess how trends differ by patient characteristics.

Materials and methods: A sequential cohort study of people with type 2 diabetes aged ≥20 years was performed using data from the National Diabetes Audit. Discretised Poisson regression models, adjusted for age, sex, ethnicity, socio-economic deprivation and diabetes duration, were used to calculate total and cause-specific mortality rates, as well as hospitalisation rates for myocardial infarction, stroke, heart failure, kidney and liver disease.

Results: Total mortality declined in people aged 20-74 years (rate ratio [RR] 0.96, 95% CI 0.95-0.97) and aged ≥75 years (0.93, 0.92-0.94) between 2009-2011 and 2018-2019, predominantly due to reductions in cardiovascular deaths. Over the same time period, in those aged 20-74 years, total mortality declined in people of South Asian (0.92:0.0.87-0.96) but was unchanged in people of White (1.00: 0.99-1.01) ethnicities. Total mortality declined more in people living in the least (0.91:0.88-0.94) compared to the most (0.97:0.95-1.00) deprived areas. A composite endpoint of cardiovascular hospitalisations and mortality increased between 2009-2011 and 2018-2019 in those aged 20-49 years (1.20:1.14-1.27) and 50-74 years (1.04:1.03-1.05) but declined in those aged ≥75 years (0.85:0.84-0.86). Rates of hospitalisation for kidney and liver disease increased in all age groups.

Conclusions: By examining longitudinal trends in mortality and hospitalisations according to different characteristics in people with type 2 diabetes in England, we have identified important targets for improvement through changes in health policy and care delivery.

Keywords: heart failure; macrovascular disease; real‐world evidence; type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

KK has acted as a consultant, speaker, or received grants for investigator‐initiated studies for AstraZeneca, Bayer, Novartis, Novo Nordisk, Sanofi‐Aventis, Lilly, and Merck Sharp & Dohme, Boehringer Ingelheim, Oramed Pharmaceuticals, Roche, and Applied Therapeutics. NS has received grants from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics, and consulting fees from Abbott Laboratories, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi. NH has received payments from AstraZeneca for participation in trials as a patient. KK (Chair), NH, BY, and JV are members of the NDA Research Group. JV was National Clinical Director for diabetes and obesity at NHS England from 2013 to September 2023.

Figures

FIGURE 1
FIGURE 1
Cumulative mortality rates by cause adjusted for age, sex, ethnicity, deprivation and duration of diagnosed diabetes for people aged 20–74 years and aged 75 years and older.
FIGURE 2
FIGURE 2
Trends in hospitalisation rates for myocardial infarction, stroke, heart failure, kidney disease and liver disease adjusted for age, sex, ethnicity, socio‐economic deprivation and diabetes duration for people aged 20–49 years, 50–74 years and 75 years and older.
See this image and copyright information in PMC

References

    1. National Audit Office . The management of adult diabetes services in the NHS – NAO report. May 23, 2012. Accessed May 26, 2025. https://www.nao.org.uk/reports/the-management-of-adult-diabetes-services...
    1. National Audit Office . The management of adult diabetes services in the NHS progress review. October 21, 2015. Accessed May 26, 2025. https://www.nao.org.uk/wp‐content/uploads/2015/10/The‐managements‐of‐adu...
    1. Office of National Statistics . Changing trends in mortality in England and Wales: 1990 to 2017 (Experimental Statistics). 2018. Accessed June 17, 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...
    1. Gregg EW, Cheng YJ, Srinivasan M, et al. Trends in cause‐specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics data. Lancet. 2018;391(10138):2430‐2440. - PubMed
    1. Chen L, Islam RM, Wang J, et al. A systematic review of trends in all‐cause mortality among people with diabetes. Diabetologia. 2020;63(9):1718‐1735. - PMC - PubMed

MeSH terms