Diabetes Takes Years Off Life Expectancy

Diabetes was linked to increased mortality — especially in urban areas – due to a range of cardiovascular and non-cardiovascular diseases, according to the results of a new report about diabetes in China.

An international team of researchers conducted a prospective study of more than half a million adults aged 30 to 79 years in order to assess the link between mortality associated with diabetes in rural compared to urban areas. The participants were recruited from five rural and five urban areas between June 2004 and July 2008, with follow-ups continuing until January 2014. The study authors wrote that in China, where the participants were analyzed, the diabetes prevalence has quadrupled over the past few decades; however, there were no reliable estimates of the excess mortality rate linked to diabetes. Typically, diabetes analysis is conducted in high income countries where patients can easily manage their illness, they added.

A total of 30,280 patients, or 5.9%, had diabetes, the researchers found: 4.1% of patients in rural areas compared 8.1% of patients in urban areas. Of those patients, 3.1% had been previously diagnosed and in 2.8% diabetes was detected through screenings. The diabetes patients were found to have twice the risk of dying during the follow-up period compared to their non-diabetic counterparts, and this risk was higher in rural compared to urban areas. A total of 3,384 individuals with diabetes died over the course of the follow-up period, with 24,909 deaths overall.

The patients with diabetes had a significantly increased risk for all-cause mortality compared to the healthy subjects; this risk was even higher in rural areas than it was in urban areas, the researchers determined. Having diabetes presented the patients with a higher risk for ischemic heart disease, stroke, chronic liver disease, infections, and cancer of the liver, pancreas, and, in females, breast cancer and cancer of the reproductive system. Additionally, in diabetes patients, 10 percent of deaths were due to definitive or probable diabetic ketoacidosis or coma (16%) in patients from rural areas, 4% in urban areas). This rate was much higher than in high-income countries, the study authors added.

For patients with diabetes aged 50 years, the 25 year the probability of death was 69%, compared to 38% among non-diabetic patients, the researchers concluded. This difference corresponded to about a nine-year loss of life: 10 years for rural area patients and eight years for patients in urban areas. This risk increased even further as the time since diabetes diagnosis increased, the researchers added.

"As the prevalence of diabetes in young adults increases and the adult population grows, the annual number of deaths related to diabetes is likely to continue to increase, unless there is substantial improvement in prevention and management,” the study authors wrote. “Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.”

The paper, titled “Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China,” was published in JAMA.

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