Less Decrease in Death Rates in Younger Patients with Diabetes

 Why are younger patients with diabetes not seeing the same improvements as those over 45?  

According to a new study, older adults with diabetes are experiencing greater declines in all-cause mortality rates in contrast to young adults. This study, conducted by Dr. Andrea Luck and colleges at The Chinese University of Hong Kong, discovered that the death rates from all-cause mortality, cardiovascular disease, and cancer are decreasing in adults ages 45 to 64, but the rates for adults aged 24 to 44 do not see as much of a change. 

The study, conducted from 2001 to 2016, consisted of the entire population of Hong Kong.  390,071 men and 380,007 women aged 20 years and older and diagnosed with diabetes were identified and placed in the Hong Kong Diabetes Surveillance Database. Researchers also utilized the Hong Kong Hospital Authority electronic medical record system to evaluate the mortality patterns in patients diagnosed with diabetes and the Hong Kong Death Registry to link the deaths.   

During these 16 years, there was a total of 96,645 deaths among men, and 88,436 deaths among women, diagnosed with diabetes. Results revealed that the male subjects’ mortality rates for all-cause, cardiovascular disease, and cancer among the patients with diabetes declined by 52.3%, 72.2%, and 65.1%.  In 2016, men with diabetes were 1.5 more times more likely to die from all-cause mortality than those without. Female subjects’ mortality rates also declined for all-cause, cardiovascular disease, and cancer by 53.5%, 78.5%, and 59.6%, respectively. It was also shown that in 2016 women with diabetes were 1.7 times more likely to die from all-cause mortality than those without. The possibility of all-cause death in patients with diabetes in comparison to those without diabetes for both men and women decreased from being roughly two times higher in 2001.   

The overall death rates of younger adults remained lower in comparison to older adults; however, this statistic differed when comparing younger adults with diabetes.  In 2001 the data showed that the difference in death rates between younger people with and without diabetes was much more extensive and this fact remained the same in 2016. In 2011, men aged 20-44 years old with diabetes were eight times more likely to have an all-cause mortality event in comparison to in 2016, when the chances decreased to five times more likely.  Women diagnosed with diabetes and aged 20-44 years old were six times more likely to have an all-cause mortality event in 2001, and five times more likely in 2016.   

Researchers noted non-statistically significant difference, finding that the all-cause mortality in people with diabetes aged 20-44 years declined by 33.8% for men and 6.9% for women from 2001 to 2016 when looking at the total fall in mortality. However, for the older individuals diagnosed with diabetes, the all-cause mortality declined by 58.9% for men, and 63.6% for women from 2001 to 2016, which showed to be statistically significant.  

Overall, the data did reveal declines in mortality rates from all causes, cardiovascular disease, and cancer and mortality relative to people without diabetes in both men and women with diabetes.  But these declines were seen more in older diabetes patients than younger diabetes patients.  This suggests that maybe more efforts from healthcare professionals in prevention and care strategy should be used for these younger patients. Diabetes is an ongoing problem worldwide. Even though the study represents subjects in Hong Kong, researchers say that the data is consistent with studies and patient population in the U.S.A., Canada, the U.K., and Australia.    

Practice Pearls 

• There are less marked improvements in mortality in young adults with diabetes, which calls for urgent action to improve care in these patients. 
• Older adults diagnosed with diabetes have reduced all-cause mortality rates compared to younger adults. However, care for these individuals still requires due diligence.  
• Data from this study represent subjects from one country, but the results are significant worldwide.  

Wu, H., Lau, E.S.H., Ma, R.C.W., et al. Secular trends in all-cause and cause-specific mortality rates in people with diabetes in Hong Kong, 2001–2016: a retrospective cohort study. Diabetologia 63, 757–766 (2020). https://doi.org/10.1007/s00125-019-05074-7 

Chardae Whitner, 2020 PharmD. Candidate, Lake Erie College of Osteopathic Medicine