4.6.3 Mortality from Diabetes Outline Patients with diabetes mellitus (DM) are at 60% increased risk of premature mortality. The most common cause of mortality in DM patients is cardiovascular disease, with those with type 2 diabetes (T2DM) having a 3 fold increased risk of death due to cardiovascular disease compared with the general population. Despite a fall in death rate due to coronary heart disease in the general population over the last 35 years, this fall has not been mirrored in patients with diabetes.
It is estimated that approximately 4.2% deaths in males and 7.7% deaths in females in the UK are due to diabetes. However, this is likely to be an underestimate as diabetes is not always recorded as the underlying cause of death.
Evidence from the United Kingdom Prospective Diabetes Study has shown that there is a continuous relationship between glycaemic control and cardiovascular complications, with a 1% reduction in HbA1c resulting in a 25% reduction in diabetes related deaths. Also, a reduction of blood pressure to 140/82mmHg significantly reduced diabetes related deaths.
Data Description Diabetes mortality trend data for 1993 to 2007 is available for England, East Midlands and NHS Northamptonshire from NCHOD. This data examines 3 year rolling average mortality for all persons all ages and allows future projections to be made. Comparisons of mortality rates between NHS Northamptonshire and other PCTs in England as well as comparisons between districts in Northamptonshire and other districts in England are made utilising NCHOD data. Data from the Public Health Mortality File (ONS) allows analysis of data to determine mortality by deprivation levels, urban / rural classification and “people and places”. Key Issues
¾ From 1993/05 to 2005/07, all persons all ages diabetes mortality rates in England has fallen
from 8.65 to 6.29 per 100,000. Over this same time period, mortality rates in the East Midlands have remained consistently higher than England rates. Northamptonshire mortality rates have varied between the East Midland rates and England rates. Since 2004-06, Northamptonshire rates have been similar to England rates.
¾ Compared with other PCTs in England, mortality rates in Northamptonshire for all persons all
ages from diabetes for 2005/07 were in the “average” quintile.
¾ Comparing diabetes mortality rates for districts in Northamptonshire with other districts in
England, South Northamptonshire and East Northamptonshire are in the best 20-40% of districts. Kettering, Northampton, Wellingborough, Daventry and Corby, are all in the worst 20-40% of districts in England. However, the confidence intervals are broad due to the small numbers of deaths and the resulting high degree of uncertainty in these figures.
¾ A review of diabetes mortality rates for all persons for 2005-07 by deprivation quintiles shows
that mortality is higher for quintiles 1, 2 and 3 (more deprived populations) compared with quintiles 4 and 5 (least deprived populations). Mortality rates in quintile 1 (most deprived) were almost double that for quintile 5 (least deprived).
¾ For the period 2005-07, diabetes mortality rates for all persons were higher in urban areas
compared with “town and fringe” and “village, hamlet and isolated dwellings”.
¾ Diabetes mortality rates in 2005-07 were highest amongst “new starters”, “multicultural centres”
and “urban challenge” populations. This information needs to be treated with caution as there are large confidence intervals around this data due to the small number of events.
Consequences Much of the mortality from diabetes is preventable, with interventions such as lifestyle interventions e.g. exercise, medical treatment to improve glycaemic control and early detection and treatment of cardiovascular and renal complications reducing mortality rates.
Of concern is the higher mortality rate in the more deprived parts of the population, as this is could serve to increase inequalities in the county. Corby, which is the most deprived district in Northamptonshire, has a mortality rate that is in the worst 20-40% of local authorities in England. This has been highlighted in a Diabetes Health Needs Assessment for the county, along with recommendations to target interventions at more deprived populations.
Department of Health. 2001. National Service Framework for Diabetes: standards (Online). Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002951
National Collaborating Centre for Chronic Conditions. 2008. Type 2 diabetes: national clinical guideline for management in primary and secondary care (update) (Online). Available from: http://www.rcplondon.ac.uk/pubs/contents/7db731d7-2731-4b14-aaf1-2bab37370d6b.pdf
NHS National Institute for Clinical Excellence. 2004. Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. Clinical Guidelines 15 (Online). Available from: http://www.nice.org.uk/nicemedia/pdf/CG015NICEguideline.pdf
Department of Health. 2009. Key publications on diabetes (Online). Available from: http://www.dh.gov.uk/en/Healthcare/Diabetes/DH_4015717
El-Atat F. et al. 2004. Diabetes, hypertension and cardiovascular derangements: pathophysiology and management. Current Hypertension Reports. 6 (3).pp. 215-223.
Sewrs, J.R. et al. 2001. Diabetes, hypertension and cardiovascular disease: an update. Hypertension. 37 (4). pp. 1,053-1,059.
British Medical Association. 2004. Diabetes mellitus: an update for healthcare professionals (Online). Available from: http://www.bma.org.uk/images/pdf/diabetes_tcm41-20213.pdf.
UK Prospective Diabetes Study Group. 1998. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352 (9131). pp.837–853.
UK Prospective Diabetes Study Group. 1998. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998 (317).pp. 703–713.
UK Prospective Diabetes Study Group. 1998. Efficacy of atenolol and captopril in reducing risk of both macrovascular and microvascular complications in type 2 diabetes (UKPDS 39). BMJ 1998 (317) pp. 713–720. tio la u p o p 0 0 ,0 0 0 r 1 e p te a Figure 126.96.36.199 Mortality from diabetes, all persons, all ages, 1993 to 2007, with a linear projection to 2012 Figure 188.8.131.52 Mortality from diabetes, all persons, all ages, 2005-07, benchmarked against all PCTs in England Local Authorities Figure 184.108.40.206 Mortality from diabetes, all persons, all ages, 2005-07, benchmarked against all districts in England Deprivation Quintiles Figure 220.127.116.11 Mortality from diabetes, all persons, all ages, 2005-07, Northamptonshire by Deprivation Quintiles 0 0 ,0 0 0 r 1 tly c ire D Rural Urban Classification Figure 18.104.22.168 Mortality from diabetes, all persons, all ages, 2005-07, Northamptonshire by Rural/Urban classification A tly c ire People & Places groups Figure 22.214.171.124 Mortality from diabetes, all persons, all ages, 2005-07, Northamptonshire by People & Places Trees
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