Determinants of mortality in patients with type 2 diabetes: a review

Abstract

The reduction in lifetime for 65 + -years-old patients having less than 10 years T2DM amounts to 1.8 years. Having T2DM for more than 10 years lifetime will be reduced by 2.7 years. However, the lifetime shortening factor of T2DM will even be stronger for 40 + -years-old patients at onset. Males will lose 11.6 years of life and 18.6 QUALYs. T2DM among females will reduce life by 14 QUALYs by 22 years. From a statistical point of view, the highest mortality rate will occur in an over 55-years-old European smoking and non-compliant diabetic woman with alcohol abuse living in a rural area with a low level of education and a low socio-economic status. Furthermore, other co-morbidities such as cardiovascular diseases, gout, and depression affect mortality. Additionally, mortality will increase with a BMI over 35 and also with a BMI under 20-25. This refers to the obesity paradox indicating a higher mortality rate among normal weight patients with T2DM compared to overweight patients with T2DM. HbA1c-levels between 6.5 % and 7 % are associated with the lowest impact on mortality.

Kidney Cadmium Toxicity, Diabetes and High Blood Pressure: The Perfect Storm

“…Yagihashi et al (2016) reported a reduction in pancreatic β-cell volume density in both a diabetic, obese American group and diabetic, lean Asian (Japanese and Korean) groups, but compensatory hyperplasia of pancreatic β-cells has been evident only in the diabetic, obese American group. These observations may explain lower mortality among diabetic obese people, compared with diabetic lean persons (Engelmann et al 2016). In a Chines population study (n = 5,544), Nie et al (2016) observed risk of pre-diabetes increases with Cd exposure in a dosedependent manner (OR 1.19, 95% CI 1.01-1.40 and OR 1.37, 95% CI 1.14-1.63), comparing blood Cd 0.81-2.94, ≥ 2.95 vs. ≤ 0.80 µg/L.…”

“…Nonalcoholic fatty liver disease (NAFLD) is a clinical manifestation of metabolic syndrome and insulin resistance, while non-alcoholic steatohepatitis (NASH) is closely associated with obesity and lipotoxicity (Cusi et al 2012). Paradoxically, however, obese diabetic persons appear to have lower mortality risk, compared with lean (non-obese) diabetic persons (Engelmann et al 2016). Exposure to Cd, especially of dietary origin, is the least expected and least recognized contributing factor in the global rising prevalence of diabetes.…”

Motivation und Diabetes – Zeit für einen Paradigmenwechsel? – Ein Positionspapier –

“…Angesichts der erfolglosen Bemühungen um Therapieadhärenz möglichst bei allen Patienten halten wir als interdisziplinäre Autorengruppe mit langjährigem diabetologischem, psychosomatischem und psychotherapeutischem Hintergrund den Zeitpunkt für gekommen, nicht immer ein "Mehr des Gleichen" (permanent neue Interventionen und Ansätze, um Patienten "zu motivieren") zu betreiben, sondern innezuhalten, um ein besseres Verständnis und eine bessere Akzeptanz der Gründe der Non-Adhärenz zu erlangen. [13,21]. Dementsprechend ist Non-Adhärenz auch ein erheblicher (wenn auch schwer zu beziffernder) Kostenfaktor im Gesundheitssystem [22 -24].…”

Solute Carrier Transporters as Potential Targets for the Treatment of Metabolic Disease

“…Overnutrition and an unhealthy diet coupled with a sedentary lifestyle dramatically increase the prevalence of obesity, fatty liver, insulin resistance, and T2D, particularly in genetically predisposed individuals. Despite modern therapies, including lifestyle intervention, medication, and surgery, patients with T2D exhibit two to three times increased mortality (Engelmann et al, 2016). Approximately 1.6 million people die each year from diabetes sequelae, particularly cardiovascular disease (www.who.int).…”