How many people inject insulin? UK estimates from 1991 to 2010

Aims: We set out to estimate the prevalence rate of insulin use in the UK population, the total number of people in the UK who use insulin, the proportion of users with type 1 and type 2 diabetes and changes between 1991 and 2010. Methods: Patients receiving prescriptions for insulin were identified in the Clinical Practice Research Datalink and attributed a diagnosis of type 1 or type 2 diabetes. The annual prevalence of insulin use was calculated and applied to population data. Results: The crude prevalence rate of insulin use increased from 2.43 (95% CI 2.38–2.49) per 1000 population in 1991 to 6.71 (6.64–6.77) per 1000 in 2010. The largest change was an increase in the prevalence of insulin users with a diagnosis of type 2 diabetes from 0.67 (0.64–0.70) to 4.34 (4.29–4.39) per 1000 population. The absolute number using insulin increased from 137 000 people (121 000–155 000) in 1991 to 421 000 (400 000–444 000) in 2010. The proportion taking insulin alone (as against combination with oral agents) decreased from 97% in the first decade to 37% in the second. Conclusion: The number of people using insulin trebled between 1991 and 2010, largely due to a considerable increase in the number of people with type 2 diabetes using insulin

Mortality from cerebrovascular disease in a cohort of 23 000 patients with insulin-treated diabetes

Mortality from cerebrovascular disease in a cohort of 23 000 patients with insulin-treated diabetes. Background and Purpose: Disease of the cardiovascular system is the main cause of long-term complications and mortality in patients with type I (insulin-dependent) and type 11 (non- insulin-dependent) diabetes. Cerebrovascular mortality rates have been shown to be raised in patients with type 11 diabetes but have not previously been reported by age and sex in patients with type I diabetes. Methods: A cohort of 23 751 patients with insulin-treated diabetes, diagnosed under the age of 30 years from throughout the United Kingdom, was identified during 1972 to 1993 and followed up for mortality until the end. of December 2000. Age- and sex-specific mortality rates and standardized mortality ratios (SMRs) were calculated. Results: There were 1437 deaths during the follow-up, 80 due to cerebrovascular disease. Overall, the cerebrovascular mortality rates in the cohort were higher than the corresponding rates in the general population, and the SMRs were 3.1 (95% Cl, 2.2 to 4.3) for men and 4.4 (95% Cl, 3.1 to 6.0) for women. When stratified by age, the SMRs were highest in the 20- to 39-year age group. After subdivision of cause of death into hemorrhagic and nonhemorrhagic origins, there remained a significant increase in mortality from stroke of nonhemorrhagic origin. Conclusions: Analyses of mortality from this cohort, essentially one of patients with type I diabetes, has shown for the first time that cerebrovascular mortality is raised at all ages in these patients. Type I diabetes is at least as great a risk factor for cerebrovascular mortality as type II diabetes