The excess mortality related to cardiovascular diseases and cancer among adults pharmacologically treated for diabetes-the 2001-2006 ENTRED cohort

• Published in: Diabetic medicine 2014-08, Vol.31 (8), p.946-953
• Main Authors: Romon, I., Rey, G., Mandereau-Bruno, L., Weill, A., Jougla, E., Eschwège, E., Simon, D., Druet, C., Fagot-Campagna, A.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cohort Studies; Colorectal Neoplasms - complications; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - mortality; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Follow-Up Studies; France - epidemiology; Fundamental and applied biological sciences. Psychology; Humans; Hypoglycemic Agents - therapeutic use; Liver Neoplasms - complications; Liver Neoplasms - epidemiology; Liver Neoplasms - mortality; Male; Medical sciences; Middle Aged; Mortality; National Health Programs; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - mortality; Registries; Risk Factors; Sex Characteristics; Survival Analysis; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12435

Aims To compare the 5‐year mortality (overall and cause‐specific) of a cohort of adults pharmacologically treated for diabetes with that of the rest of the French adult population. Methods In 2001, 10 000 adults treated for diabetes were randomly selected from the major French National Health Insurance System database. Vital status and causes of death were successfully extracted from the national registry for 9101 persons. We computed standardized mortality ratios. Results Over 5 years, 1388 adults pharmacologically treated for diabetes died (15% of the cohort, 32.4/1000 person‐years). An excess mortality, which decreased with age, was found for both genders [standardized mortality ratio 1.45 (1.37–1.52)]. Excess mortality was related to: hypertensive disease [2.90 (2.50–3.33)], ischaemic heart disease [2.19 (1.93–2.48)], cerebrovascular disease [1.76 (1.52–2.03)], renal failure [2.14 (1.77–2.56)], hepatic failure [2.17 (1.52–3.00)] in both genders and septicaemia among men [1.56 (1.15–2.09)]. An association was also found with cancer‐related mortality: liver cancer in men [3.00 (2.10–4.15)]; pancreatic cancer in women [3.22 (1.94–5.03)]; colon/rectum cancer in both genders [1.66 (1.28–2.12)]. Excess mortality was not observed for breast, lung or stomach cancers. Conclusions Adults pharmacologically treated for diabetes had a 45% increased risk of mortality at 5 years, mostly related to cardiovascular complications, emphasizing the need for further prevention. The increased risk of mortality from cancer raises questions about the relationship between cancer and diabetes and prompts the need for improved cancer screening in people with diabetes. What's new? In this first mortality study of a French 5‐year cohort of adults pharmacologically treated for diabetes, the 45% excess mortality related to diabetes is mostly attributable to cardiovascular complications and, to a lesser extent, renal failure. While the cardiovascular risk profile of people with diabetes has improved, further prevention is required. This study raises questions about the relationship between diabetes and cancer and highlights the need for screening for cancer in people with diabetes. Diabetes is reported only in 35% of the death certificates of adults pharmacologically treated for diabetes and in 47% of those mentioning diabetes complications.