Causes of mortality in diabetes mellitus: data from a tertiary teaching hospital in India

Abstract

Background: Mortality studies can show the relative contribution of diabetes to mortality in the total population, and they can provide important descriptions of the changes in causes and frequency of diabetes mortality over time. Objective: To find the mortality pattern in people with diabetes admitted to a tertiary care hospital in a developing country, using underlying/contributory causes of death. Methods: In this retrospective study, mortality trends among people with diabetes admitted to Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India were reviewed by screening the hospital records of all people with diabetes who died over the last 9 years, carrying forward earlier observations from the same centre. Results: Of 234 776 people admitted to the centre during the review period, 16 690 (7.11%) died; 741 (383 men) of these had diabetes mellitus mentioned on the death certificate. The mean (SD) age at death for people with diabetes was 60.07 (13.62) years in men and 57.36 (13.40) years in women. The leading contributory causes of death were infections (40.9%), chronic renal failure (33.6%), coronary artery disease (16.9%), cerebrovascular disease (13.2%), chronic obstructive pulmonary disease (6.9%), acute renal failure (6.2%), malignancy (4.2%), hypoglycaemia (3.5%) and diabetic ketoacidosis (3.4%). The cause of death could not be ascertained in 2.8% of cases; in 52.9%, 36.3% and 8.0% cases one, two and three or more causes, respectively, were recorded as the cause of death. Conclusions: The aetiological spectrum of mortality in people with diabetes at this Indian centre continues to be dominated by infections and renal failure, which is different from that in the developed world, where coronary artery disease and cerebrovascular disease are the principal causes of death in people with diabetes.

Morbidity and Mortality Patterns Among Admitted Patients With Diabetes : A Hospital Based Study From North India.

“…Mean age at death was 63.7 years (60.8 years in males and 66.5 years in females) in our study ,consistent with the finding of AH Zargar et al [8] and Chin Hsiao Tseng [45] for males but higher age at death in females was seen in their study. Mean HbA1c level among mortalities was 8.31 + 1.53.It was highest in patients who died of infections (8.47) and lowest in those who died of hypoglycaemia (6.67).…”

“…Renal failure (17.2%) and myocardial infarction (12%) in our study were other causes of mortality. Chronic renal failure contributed to 33.6% deaths in the study of AH Zargar et al In his study, coronary artery disease and cerebrovascular disease were responsible for 16.9% and 13.2% of deaths respectively [8]. Hypoglycemia was responsible for death in 5.1% patients in the present study.…”

“…Mean HbA1c level among mortalities was 8.31 + 1.53.It was highest in patients who died of infections (8.47) and lowest in those who died of hypoglycaemia (6.67). More than half of patients died because of infections (60.3%).This has also been reported by AH Zargar et al [8] ,Wei et al [76] and BB Tripathy et al [48].However, the results are not in confirmity with the studies of Toshihiko Mihara et al [77] where acute cardiac failure was the leading cause of death and Shelagh I Dawson et al [78] reported same about cardiovascular disease in diabetics. Naveen Krishan Goel et al [79] also observed circulatory diseases as a leading cause of death.Next major cause of death in the present study was strokes (18.9%).These observations have been reported by AH Zargar et al [8] (13.2%) also.…”

Prevalence of Certain Chronic Complications of Diabetes among Type 2 Diabetic Patients in Rural Population of Kancheepuram District, Tamil Nadu- A Cross Sectional Study

“…Hyperlipidemia was prevalent among 85.9% (165/192) of the study diabetics in India 8 and two studies done in India showed that diabetes related deaths in India is dominated by infections and renal failure unlike cardiovascular or cerebrovascular causes which dominate the developed countries. 9,10 The type 2 diabetes burden in India is escalating, more prevalent in the southern region of the country primarily due to changes in socioeconomic conditions, dietary habits and reduced physical activity.…”

A review of mortality in type 2 diabetes mellitus

“…В связи с этим, основное значение для снижения смертности приобретают профилактические меропри-ятия, предупреждающие развитие ССЗ и включающие изменение образа жизни (отказ от курения, физиче-ская активность, диета), обучение в школах диабета, адекватное лечение и контроль уровня АД, глюкозы, лечение дислипидемий [34]. Снижение общей смерт-ности и смертности от ССЗ, заболевания почек, сеп-сиса, пневмонии, гриппа наблюдаются у больных СД c регулярными физическими нагрузками [45].…”