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

Diabet Med. 2014 Aug;31(8):946-53. doi: 10.1111/dme.12435. Epub 2014 Apr 7.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality*
  • Cohort Studies
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / mortality*
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Liver Neoplasms / complications
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / mortality*
  • Male
  • Middle Aged
  • Mortality
  • National Health Programs
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / epidemiology
  • Pancreatic Neoplasms / mortality*
  • Registries
  • Risk Factors
  • Sex Characteristics
  • Survival Analysis

Substances

  • Hypoglycemic Agents