• Falling mortality rates in Type 2 diabetes mellitus in the Wirral Peninsula: a longitudinal and retrospective cohort population-based study

      Nwaneri, Chukwuemeka; Bowen-Jones, David; Cooper, Helen; Chikkaveerappa, Krishnamurthy; Afolabi, Banjo A.; University of Chester ; Wirral University Teaching Hospital Foundation NHS Trust ; University of Chester ; Wirral University Teaching Hospital Foundation NHS Trust ; Aintree University Hospitals NHS Foundation Trust (BMJ journals, 2012-08-17)
      Objectives To determine the life expectancy and mortality rates in patients with type 2 diabetes mellitus when compared with the UK general population; to measure the years of life lost. Design Longitudinal and retrospective cohort study. Setting The Wirral Peninsula in the northwest of England. Participants Total of 13 620 patients with type 2 diabetes mellitus on the Wirral Diabetes Register. Main Outcome measure All-cause mortality, from 1 January 2000 to 31 December 2007. Over the 8-year period of the study, there were a total of 16 692.5 person-years lived and 3888 deaths; 2041 (52.5%) males and 1847 (47.5%) females with corresponding mean ages at death of 75.6610.3 years and 80.2610.2 years, respectively. Although prevalence rates increased linearly (from 1.06% in 2000 to 4.39% in 2007) a decrease in mortality rates (from 117 to 46 per 1000 population) in both sexes was observed. This coincided with a progressive fall in cardiovascular risk factors in this population. A survival time curve of life lived until death showed that males had 8.0 years reduction in life span and females’ life span was reduced by 9.6 years when compared with UK general population. In both sexes, life expectancy was reduced by between 2 and 11 years dependent on the age of diagnosis, with males showing a greater degree of reduction. Conclusion Type 2 diabetes mellitus is associated with a significant reduction in life expectancy, more markedly in men, and in those diagnosed before age 70 years. However, annual mortality rates have fallen progressively in our population and may contribute to longer survival and life expectancy in future years.
    • Mortality in type 2 diabetes mellitus: Magnitude of the evidence from a systematic review and meta-analysis

      Nwaneri, Chukwuemeka; Cooper, Helen; Bowen-Jones, David; University of Chester ; University of Chester ; Alder Hey Children’s NHS Foundation Trust (SAGE, 2013-07-15)
      Type 2 diabetes is associated with an increase in age-related mortality. A systematic review and metaanalysis were performed to define the relative risks (RR) of all-cause or cause-specific mortality in type 2 diabetes and to determine gaps in current research. A comprehensive literature search was undertaken for studies (published 1990–2010) on mortality in type 2 diabetes. The study reports on the measure of mortality as defined by RR for all-cause and cause-specific mortality, heterogeneity, sensitivity analyses and biases. In total 35 studies (220,689 patients; mean follow-up of 10.7 years) were eligible for inclusion: 33 studies reported increased mortality risks; 24 had full data on 95% confidence intervals (CIs), one study reported no excess mortality in men diagnosed after 65 years whereas three reported increased mortality in similar age groups in both sexes. Meta-analysis showed RR = 1.85 (95% CI 1.79–1.92) for all-cause mortality [men RR=1.57 (95% CI 1.46–1.68); women RR=2.0 (95% CI 1.89–2.12)], RR=1.76 (95% CI 1.66–1.88) for cardiovascular mortality and RR=2.26 (95% CI: 1.7-3.02) for stroke. There was no statistically significant evidence of publication bias. Conclusion: Type 2 diabetes increases mortality approximately two-fold increase and macrovascular disease is the principal cause of death.