Cardiovascular and All-Cause Mortality Over a 23-Year Period Among Chinese With Newly Diagnosed Diabetes in the Da Qing IGT and Diabetes Study

An, Yi; Zhang, Ping; Wang, Jinping; Gong, Qi; Gregg, Edward W.; Yang, Wenying; Li, Hui; Zhang, Bo; Shi, Ying; Chen, Yanyan; Engelgau, Michael M.; Cheng, Yiling J.; Hu, Yinghua; Bennett, Peter H.; Li, Guangwei

doi:10.2337/dc14-2498

Cited by 80 publications

(78 citation statements)

References 26 publications

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“…The latest data from Sweden suggest that the overall excess risk of death had dropped to a historically low level of 15 % [8]. In the Da Qing Study, the ageadjusted relative risk of death from all causes in those with diabetes was three times higher compared with those without diabetes [16]. However, the Da Qing study started in 1980s, and over the past three decades there has been substantial development in the primary and secondary prevention of diabetes.…”

Section: Discussionmentioning

confidence: 96%

“…However, overweight and residence (urban/ rural) were not associated with any increase in risk of mortality for those with diabetes. A two to three times excess risk of mortality has often been found among those with diabetes as compared with those without diabetes [10,16]. Reductions in all-cause mortality among those with diabetes have occurred over time [26].…”

Section: Discussionmentioning

confidence: 98%

“…In China, most of the studies on the association between diabetes and mortality are hospital-based clinical studies or from chronic disease registries [14,15]. There is only one general populationbased study-the Da Qing IGT and Diabetes Studywhich was conducted in northern China [16] and was based on a trial population. White rice has a high glycaemic index, and a high intake of refined rice increases the risk of diabetes [17].…”

Section: Introductionmentioning

confidence: 99%

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Association of impaired fasting glucose, diabetes and dietary patterns with mortality: a 10-year follow-up cohort in Eastern China

et al. 2016

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Aims To examine the association between impaired fasting glucose (IFG)/type 2 diabetes and mortality as well as to explore any interactions with dietary intake patterns in a Chinese population. Methods We followed 2849 Chinese adults aged 20 years and older for 10 years. Fasting plasma glucose was measured at baseline in 2002. Dietary patterns were constructed using factor analysis. Hazard ratios (HRs) and 95 % confidence interval (CI) were calculated by Cox proportional hazards analysis (all-cause mortality) and competing risks regression [cardiovascular disease (CVD)]. ResultsOf the 2849 participants, 102 had diabetes and 178 had impaired fasting glucose (IFG) at baseline. We documented 184 deaths (70 CVD deaths) during 27,914 person-years of follow-up. Diabetes was associated with death from all causes (HR 2.69, 95 % CI 1.62-4.49) after adjusting for sociodemographic and lifestyle factors. Diabetes had a HR of 1.97 (95 % CI 0.84-4.60) for CVD death. IFG had 83 % increased risk of all-cause mortality. Among those with low and high intake of a vegetable-rich dietary pattern, the HR of IFG/diabetes for all-cause mortality was 3.25 (95 %CI 1.95-5.44) and 1.38 (95 % CI 0.75-2.55) (p for interaction 0.019), respectively.Conclusions Diabetes and IFG are associated with a substantial increased risk of death in Chinese adults. Dietary patterns associated with a high intake of vegetable were associated with a decrease in the risk of mortality for those with IFG/diabetes.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Association of impaired fasting glucose, diabetes and dietary patterns with mortality: a 10-year follow-up cohort in Eastern China

et al. 2016

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“…During the 23-year follow-up period, 32% of IGT participants died, with cumulative mortality intermediate between those Da Qing residents with newly diagnosed type 2 diabetes (56%) and NGT (21%) (3). …”

Section: Discussionmentioning

confidence: 99%

“…While excess risk for death among people with diabetes is well-documented in Western populations and in some Asian populations (3–9), IGT also predicts excess mortality (10–18). Most studies of mortality in people with IGT have had relatively short-term follow-up and lack follow-up evaluations to determine whether they subsequently developed diabetes.…”

Section: Introductionmentioning

confidence: 99%

Changes in Mortality in People With IGT Before and After the Onset of Diabetes During the 23-Year Follow-up of the Da Qing Diabetes Prevention Study

Gong

Zhang

Wang³

et al. 2016

Diabetes Care

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OBJECTIVEPeople with impaired glucose tolerance (IGT) have increased risk of mortality and a high risk of progression to diabetes, but the extent that the excess mortality is associated with IGT per se or is the result of subsequent diabetes is unclear.RESEARCH DESIGN AND METHODSWe compared mortality before and after the development of diabetes among 542 persons with IGT initially who participated in a 6-year lifestyle diabetes prevention trial and were followed-up from 1986 to 2009.RESULTSDuring the 23-year follow-up, 174 (32.1%) died, with an overall death rate of 15.9/1,000 person-years. The majority of deaths (74.7%; 130 of 174) occurred after progression to type 2 diabetes, with age-adjusted death rates of 11.1/1,000 person-years (95% CI 8.2–12.0) before and 19.4/1,000 person-years (95% CI 11.9–23.3) after the development of type 2 diabetes. The cumulative mortality was 37.8% (95% CI 33.1–42.2%) in participants who developed type 2 diabetes during first 10 years of follow-up, 28.6% (95% CI 21.6–35.0%) in those who progressed to type 2 diabetes in 10–20 years, and 13.9% (95% CI 7.0–20.3%) in those who did not develop to type 2 diabetes within 20 years. Time-dependent multivariate Cox proportional hazards analyses, with adjustment for baseline age, sex, intervention, and other potential confounding risk factors, showed that the development of type 2 diabetes was associated with a 73% higher risk of death (hazard ratio 1.73 [95% CI 1.18–2.52]).CONCLUSIONSAs elsewhere, IGT is associated with increased risk of mortality in China, but much of this excess risk is attributable to the development of type 2 diabetes.

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Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China

Bragg

Holmes

Iona

et al. 2017

JAMA

395

316

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Importance In China diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes. Objective To assess the proportional excess mortality associated with diabetes, and to estimate the diabetes-related absolute excess mortality in rural and urban China. Design, setting, and participants A 7-year nationwide prospective study of 512,869 adults aged 30-79 years from 10 (5 rural, 5 urban) localities across China, recruited from 6/2004 to 7/2008 and followed until 1/2014. Exposure Diabetes (previously diagnosed or screen-detected) recorded at baseline. Main outcome measures All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratios (RRs) comparing those with versus without diabetes at baseline. Results Overall, the mean (SD) age was 51.5 (10.7) years, 59% (n=302,618) were women, and 5.9% (n=30,280) had diabetes (rural 4.1%, urban 8.1%, men 5.8%, women 6.1%, previously diagnosed 3.1%, screen-detected 2.8%). During 3.64 million person-years of follow-up, there were 24,909 deaths, including 3,384 among individuals with diabetes. Compared to adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100,000; adjusted RR, 2.00 [95%CI, 1.93 to 2.08]), which was higher in rural than urban areas (rural RR, 2.17 [95%CI 2.07 to 2.29]; urban RR, 1.83 [95%CI, 1.73 to 1.94]). Presence of diabetes was associated with increased mortality from ischaemic heart disease (3287 deaths; RR, 2.40 [95%CI, 2.19 to 2.63]), stroke (4444 deaths; RR, 1.98 [95%CI, 1.81 to 2.17]), chronic liver disease (481 deaths; RR, 2.32 [95%CI, 1.76 to 3.06]), infections (425 deaths; RR, 2.29 [95%CI, 1.76 to 2.99]), and cancer of the liver (1325 deaths; RR, 1.54 [95%CI 1.28 to1.86]), pancreas (357 deaths; RR, 1.84 [95%CI, 1.35 to 2.51]), female breast (217 deaths; RR, 1.84 [95%CI, 1.24 to 2.74]), and female reproductive system (210 deaths; RR, 1.81 [95%CI, 1.20 to 2.74]). For chronic kidney disease (365 deaths), the RR was higher in rural than urban areas (18.69 [95%CI, 14.22 to 24.57] versus 6.83 [95%CI, 4.73 to 9.88]). Among those with diabetes, 10% of all deaths (rural 16%, urban 4%) were due to definite or probable diabetic ketoacidosis or coma (408 deaths). Conclusions and relevance Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and non-cardiovascular diseases. Although diabetes was more common in urban areas, it was associated with a greater excess mortality in rural areas.

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Cardiovascular and All-Cause Mortality Over a 23-Year Period Among Chinese With Newly Diagnosed Diabetes in the Da Qing IGT and Diabetes Study

Cited by 80 publications

References 26 publications

Association of impaired fasting glucose, diabetes and dietary patterns with mortality: a 10-year follow-up cohort in Eastern China

Association of impaired fasting glucose, diabetes and dietary patterns with mortality: a 10-year follow-up cohort in Eastern China

Changes in Mortality in People With IGT Before and After the Onset of Diabetes During the 23-Year Follow-up of the Da Qing Diabetes Prevention Study

Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China

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