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Impact of Age, Gender, and Diagnosis of T2D on Overall Mortality

Feb 24, 2018

Study conducted in Germany demonstrates all-cause mortality to be doubled in patients with both diagnosed and undiagnosed type 2 diabetes.

While it is a widely known verity that individuals who have type 2 diabetes have an increased risk of mortality, the magnitude of the surge is not known. This data is not generally available in many countries in the world, including Germany. The data that is available allows researchers to estimate the risk, yet the degree of peril is mostly unknown due to difficulty with tracking proper diagnosis and reasons of death.  Assessment of the all-cause mortality owing to diabetes is beneficial for expanding the national policies in prevention, early diagnosis and recognition, and management of diabetes. As such, the study researchers sought to determine the relative risk of all-cause of mortality in patients who are diagnosed with type 2 diabetes, those who are not, and estimate the impact age and gender have on the diabetes-related death.  


Researchers in Germany used the data from The German National Health Interview and Examination Survey conducted in 1998 to screen for potential enrollment into the study.  The patients who agreed to be contacted post-survey were invited to participate in the study if they were between the ages of 17 and 79 and were not diagnosed with type 1 diabetes. Computer-assisted personal interviews were conducted with subjects. Those individuals who recorded a history of physician-diagnosed T2D were labeled as individuals with baseline diabetes. Subjects who did not have diagnosed diabetes, but their HbA1c levels were above the range of 6.5%, were labeled as individuals with undiagnosed diabetes. And, those individuals with undiagnosed T2D and normal HbA1c range were identified as individuals without T2D. Age-specific and gender-specific mortality rates were calculated for all three groups of subjects; by extrapolating the data from mortality rate ratios, researchers were also able to assess the years of life lost, and examine them according to age and gender.

At the termination of the 12-year follow-up, prevalence of undiagnosed diabetes was significantly higher in male gender, with the p-value of 0.075. It was determined that mortality risk increases proportionally with aging, regardless of diabetes diagnosis.  However, with respect to diagnosis of T2D, younger patients were affected by the additional risk of diabetes-related death, predominantly males. Individuals older than 45 years of age who were undiagnosed with diabetes were twice as likely to have an increased overall morality, while the risk was increased by 70% for patients who were diagnosed with diabetes. Undiagnosed, older males had an increased relative risk of all-cause mortality when compared to their counterparts who were diagnosed with diabetes, as shown with mortality relative ratio of 2.06 and 1.70, respectively.  On the other hand, females who were diagnosed with diabetes and those who were not had similar relative risk of all-cause mortality. However, both diagnosed and undiagnosed diabetes in females increased the chance of death from all causes by 60%. Lastly, years of life lost for German adults in 2010 was estimated to be 164,000 in females, and 169,900 in males.

While the study presented was not able to differentiate between patients with T2D and those with gestational diabetes, or other types of diabetes (excluding T1D), the results presented by German researchers prove the magnitude of mortality risk diabetes instigates in both younger and older individuals, specifically, of the burden seen in younger, male individuals. The differences seen amongst genders and more so in younger population should alert practitioners to begin employing population-based strategies for prevention, treatment, and prompt diagnosis of diabetes. The future practice should focus on creating a study that analyzes the screening practices for T2D and how they are related to secondary prevention and risk of diabetes-related death.

Practice Pearls:

  • Under-diagnosis of diabetes is more prominent in males than it is in females.
  • Diabetes-associated risk of mortality was found to be greatest in younger adults.
  • Individuals who are above the age of 45 and who have both diagnosed and undiagnosed diabetes have a two-fold increased overall-mortality.


Susanne Rockl, Ralph Brinks, Jens Baumert, et al. “All-cause mortality in adults with and without type 2 diabetes: findings from the national health monitoring in Germany.” BMJ Open Diabetes Research and Care. 2017. http://drc.bmj.com/content/5/1/e000451. Accessed on Jan. 2018.

Lamija Zimic, PharmD(c), University of South Florida, College of Pharmacy