Taking the “Die” Out of Diabetes

Diabetes and prediabetes patients may need to do more to improve survival rates

March 14, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Although many diabetes patients take effective medications and pursue a healthy lifestyle, survival rates don't seem to be improving. Studies suggest that more needs to be done to extend lives.

Healthcare providers today encourage patients with diabetes or pre-diabetes (dysglycemia) to maintain a healthy weight, eat foods that support good health and stay physically fit.

They also recommend medications to achieve target blood sugar levels.

While evidence has shown that these approaches may improve health, survival rates for dysglycemic patients do not appear to be improving, according to a new study.

"Eat right and exercise regularly."

Andrew Stokes, a PhD student in demography at the Population Studies Center at the University of Pennsylvania in Philadelphia, led the research comparing data from two nationally represented groups.

Stokes and his colleague, Neil Mehta from the Department of Global Health at Emory University in Atlanta, crunched numbers on 10,291 patients with no diabetes, 2,339 with pre-diabetes and 2,050 with diabetes. Subjects were age 35 to 74 at baseline, and all participated in the National Health and Nutrition Examination Survey.

In comparing two populations—one from 1988 to 1994 and one from 1999 to 2002—the mortality (death) rate for individuals with pre-diabetes increased from 11.19 to 14.02 deaths per 1,000 person-years. The mortality rate among those with diabetes increased from 20.34 to 20.82 deaths per 1,000 person-years.

Authors described the death rate change for those with diabetes and pre-diabetes as a "non-significant increase in mortality over time."

In contrast, the death rate decreased from 7.81 to 6.04 deaths per 1,000 person-years when comparing populations with normal blood sugar (no diabetes).

Stokes told dailyRx News, “We found that individuals with pre-diabetes and diabetes, taken together, experienced persistently higher mortality rates compared to the normo-glycemic population during 1988-2006, with no evidence of a narrowing gap.”

Normo-glycemic means that patients have normal blood sugar (glucose) levels compared to those who have dysglycemia, or abnormal blood sugar levels.

Investigators categorized patients according to blood sugar levels based on measures of hemoglobin A1c (HbA1c). The authors said that their study was different from other similar studies that had been based only on self-reported diabetes.

“Our use of the HbA1c criteria allowed us to incorporate data from individuals at high-risk for diabetes [pre-diabetes] and those with undiagnosed diabetes,” said Stokes. Some of these patients, he remarked, may be particularly vulnerable to premature death because they have not been officially diagnosed with diabetes and are not receiving treatment.

“The lack of improvement in mortality in the dysglycemic population is concerning and suggests that individuals with pre-diabetes and diabetes should be an important focus of future interventions aimed at improving population health in the US,” concluded the authors.

Stokes added, “Future work should verify these findings in larger datasets and using more recent cohort experience. Trends should also be examined in more detail—by gender, race/ethnicity and separately for individuals with pre-diabetes versus diabetes.”

This study was published February 28 in Population Health Metrics. The authors reported no conflict of interest.