Diabetes and all-cause mortality, a 18-year follow-up study

This study compared mortality rates and decline in life expectancy of Iranian patients with type 2 diabetes (T2DM) with the general population. A retrospective study of 2451 patients with T2DM was conducted in the Isfahan Endocrine and Metabolism Research Center, Iran, between 1992 and 2010. The mean (SD) of diabetes duration and median (Q1,Q3) of follow-up period were 15.5(8.0) and 8(5, 10) years. The main outcome was all-cause mortality. 732(29.87%) of patients died during the follow-up. Overall mortality rates (95%CI) per 1000 person-years in men and women were 56.3(52.0-62.1) and 27.3(24.5-30.4), respectively. The relative risks (95%CI) of all-cause mortality in males vs. females with T2DM aged 45-49, 50-54, 55-59, 60-64, 65-69, 70-74 were [3.02(1.49-6.11) vs. 2.09(0.96-4.57)], [4.05(2.73-6.01) vs. 2.29(1.52-3.45)], [4.13(3.26-5.24) vs. 1.70(1.23-2.35)], [2.42(1.90-3.07) vs. 1.82(1.46-2.27)], [2.36(2.02-2.76) vs. 1.49(1.25-1.78)] and [1.71(1.50-1.95) vs. 1.04(0.88-1.23)] times more than the general population, respectively. Men and women living with diabetes lost an average of 13.2(6.3) and 13.9(6.0) life-years from the year of diagnosis, respectively (p = 0.101). The estimated life-years lost were greater in younger patients and a gradual decline was observed with increasing the age at diagnosis. In conclusion, Iranians with diabetes had higher risk of death and lower life expectancy compared to the general population

Body mass index and the all-cause mortality rate in patients with type 2 diabetes mellitus

Aims - The relationship between obesity and mortality rate among diabetic patients is a controversial topic. The aim of this study was to investigate the association between obesity and all-cause mortality risk in patients with type 2 diabetes. Methods - In this retrospective database study, 2383 patients with type 2 diabetes, who had been registered in the Isfahan Endocrine and Metabolism Research Center, Iran, were enrolled between 1992 and 2010. The mean (SD) of diabetes duration and follow-up period was 15.5 (8.0) and 7.8 (3.9) years. The main outcome was all-cause mortality. All-cause mortality rates were calculated for the body mass index (BMI) categories of underweight, normal, overweight and class I, II and III obese. Cox proportional hazard models were used to estimate the adjusted hazard ratio for BMI as categorical variable using BMI of 18.5–24.9 kg/m2 as the reference group. Results - The mortality rate in patients with normal weight was higher than overweight patients (59.11 vs. 33.17 per 1000 person-years). The adjusted hazard ratios of all-cause mortality were 0.82 [95%CI 0.68–0.99; P = 0.037], 0.79 [95%CI 0.61–1.02; P = 0.069], 0.71 [95%CI 0.42–1.19; P = 0.191] and 1.36 [95%CI 0.55–3.33; P = 0.507] for overweight, class I, II and III obesity, respectively. When BMI was included in the Cox model as a time-dependent variable, the U-shaped relationship between BMI and all-cause mortality did not change. Conclusions - The results show a U-shaped association of BMI with all-cause mortality in patients with type 2 diabetes with the lowest risk observed among the overweight patients