Nav: Home

Longer survival likely to be reason for increased numbers with diabetes, rather than increased incidence

July 28, 2016

Overall incidence of type 2 diabetes has stabilised over recent years, according to a new study published in Diabetologia (the journal of the European Association for the Study of Diabetes), whilst mortality has declined, suggesting that increasing prevalence of the disease within the population may be attributed not to increasing numbers but to longer survival of patients with diabetes. The findings were not equal across the population, however: significant differences are noted based on gender, age, and socioeconomic status.

Prevalence of type 2 diabetes is increasing in all high-income countries, with significant health and economic implications. The International Diabetes Federation estimates that USD 156 billion was spent on diabetes health care in 2015, and that this is likely to rise to USD 174 billion by 2040. In Scotland, the prevalence of all types of diabetes has increased from 3.2% in 2004 to 5.1% in 2013. The distribution of demographic characteristics across the country is stable, so trends in prevalence are influenced by the balance between changes in incidence and mortality. The authors suggest that an understanding of these trends is necessary as new approaches in prevention and treatment are planned, so that interventions can be targeted to those sections of the population that are most at risk.

The study focused on trends between 2004 and 2013 in Scotland, and was conducted by Dr Stephanie Read, University of Edinburgh, UK, with colleagues from various Scottish universities and NHS (National Health Service) organisations, on behalf of the Scottish Diabetes Research Network. Data regarding diabetes diagnosis, population estimates, and numbers of deaths each year grouped by age, sex, and deciles of SIMD (Scottish Index of Multiple Deprivation) were obtained from the Scottish Care Information - Diabetes database and National Records Scotland. Incidence was considered as events per 1000 person years. Trends in incidence and mortality were analysed across the age, sex and SIMD groupings. The age range considered was 39-90.

The study found that incidence rates over the whole study period decreased for older men and women, increased slightly for younger women, and increased for younger men, although the incidence rate for younger men declined after 2009. Whilst incidence declined over all socioeconomic groups the decline was slower in the more deprived groups and from 2010 the incidence in the most deprived groups appeared to increase, which the authors suggest may lead to widening inequality in diabetes incidence. Incidence in men was higher than for women in all age groups.

The authors suggest that incidence rates may have stabilised partly because of a reducing pool of undiagnosed cases. This comes after marked increases in incidence during the 1990s and 2000s following changes in the diagnostic criteria made by the World Health Organisation in 1998, and an intensification of diagnostic activities in these decades. They also suggest that stabilisation of the incidence of adult obesity, an established risk factor for type 2 diabetes, will have helped stabilise diabetes incidence rates. Other European studies have also noted a stabilisation and/or decline in incidence of type 2 diabetes.

Overall, standardised mortality rates declined by 11.5% for men and 15.7% for women during the study period, with similar declines across all ages and deprivation groups. Mortality rates were higher in the most deprived groups compared to the least deprived groups (We are only able to provide estimates for the most deprived and least deprived men and women aged 65 years, as shown in figure 2 in the full paper.

The finding that mortality rates for people with type 2 diabetes had declined has been mirrored in previous studies, including in Denmark, Australia and the USA. The authors note, however, that the decline in mortality might not be due to earlier diagnosis or improved diabetes care. Whilst in 2014 the Scottish Diabetes Survey showed that during the study period there had been an increase in the numbers of people showing good diabetes control (as indicated by glycated haemoglobin [HbA1c] below 7.5% (58 mmol/mol)), mortality rates for people with type 2 diabetes remained 40% and 80% higher, for men and women respectively, than for those without diabetes. The authors recommend further research to identify the relative contributions of better treatment and better survival rates for people with type 2 diabetes.

The authors conclude: "Despite improved mortality rates, type 2 diabetes confers an excess risk of death compared with the non-diabetic population...there is still scope to address the increased mortality associated with diabetes."

They add: "Major inequalities by age, sex and socioeconomic status in type 2 diabetes incidence and mortality indicate that effective approaches to treatment and control will need to address existing inequalities."


Related Diabetes Articles:

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).
Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.
People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.
Diabetes, but not diabetes drug, linked to poor pregnancy outcomes
New research indicates that pregnant women with pre-gestational diabetes who take metformin are at a higher risk for adverse pregnancy outcomes -- such as major birth defects and pregnancy loss -- than the general population, but their increased risk is not due to metformin but diabetes.
New oral diabetes drug shows promise in phase 3 trial for patients with type 1 diabetes
A University of Colorado Anschutz Medical Campus study finds sotagliflozin helps control glucose and reduces the need for insulin in patients with type 1 diabetes.
Can continuous glucose monitoring improve diabetes control in patients with type 1 diabetes who inject insulin
Two studies in the Jan. 24/31 issue of JAMA find that use of a sensor implanted under the skin that continuously monitors glucose levels resulted in improved levels in patients with type 1 diabetes who inject insulin multiple times a day, compared to conventional treatment.
Complications of type 2 diabetes affect quality of life, care can lead to diabetes burnout
T2D Lifestyle, a national survey by Health Union of more than 400 individuals experiencing type 2 diabetes (T2D), reveals that patients not only struggle with commonly understood complications, but also numerous lesser known ones that people do not associate with diabetes.
A better way to predict diabetes
An international team of researchers has discovered a simple, accurate new way to predict which women with gestational diabetes will develop type 2 diabetes after delivery.
The Lancet Diabetes & Endocrinology: Older Americans with diabetes living longer without disability, US study shows
Older Americans with diabetes born in the 1940s are living longer and with less disability performing day to day tasks than those born 10 years earlier, according to new research published in The Lancet Diabetes & Endocrinology journal.
Reverse your diabetes -- and you can stay diabetes-free long-term
A new study from Newcastle University, UK, has shown that people who reverse their diabetes and then keep their weight down remain free of diabetes.
More Diabetes News and Diabetes Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.