Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes – a 10‐year cohort study of older people with and without diabetes

Forbes, Angus; Murrells, Trevor; Sinclair, Alan J.

doi:10.1111/dme.13132

Cited by 19 publications

(36 citation statements)

References 29 publications

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“…Studies comparing people with and without diabetes show that diabetes is associated with excess mortality (21,22). In a recent UK retrospective cohort study, with 10 years follow-up of people aged ≥ 70 years with diabetes (n = 35,717) and without diabetes (n = 307,918), survival at 5 and 10 years was 8 and 11% lower, respectively, with an overall mortality hazard of 1.29(95%CI = 1.26-1.31), with a non-diabetes reference population (11). This study also showed that the relative risk of mortality was greater in females (HR 1.36; 95%CI = 1.33-0.140), although the absolute risk for premature mortality was higher in males, compared to people without diabetes.…”

Section: Mortality Riskmentioning

confidence: 99%

“…The review reposted a similar pattern for women, with relative risks 40 and 19% for the early and later diagnosed cohorts, respectively, compared to women without diabetes. A recent cohort study of people aged >70 years, reported showed that those who had diabetes for >10 years had a 37% higher risk of mortality compared to those with a duration of >3 years (11).…”

Section: Mortality Riskmentioning

confidence: 99%

“…Despite overall improvements in the life-expectancy for people living with diabetes in recent years, there is still a significant disparity in the mortality hazard for people with diabetes compared to those without (1)(2)(3)(4)(5). This disparity continues throughout the lifespan and while mortality hazards naturally increase with advancing years, the factors associated with this risk in older people with diabetes become more complex and include: diabetes related tissue damage and complications; polypharmacy; co-morbidity; and mental and physical frailty (6)(7)(8)(9)(10)(11). In addition, there is a growing recognition that the traditional diabetes care model of intensifying hypoglycemic therapies to reduce glucose exposure may not always be appropriate in managing diabetes in older age.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, there is a growing recognition that the traditional diabetes care model of intensifying hypoglycemic therapies to reduce glucose exposure may not always be appropriate in managing diabetes in older age. There has been some concern over: the use of some glucose lowering medications in the older population with diabetes, particularly sulfonylureas and insulin (12)(13)(14)(15); and in setting appropriate levels for glycemic control (11,(16)(17)(18)(19)(20). In older age, it is equally important to consider quality of life and the need to promote physical, social, and psychological functioning.…”

Section: Introductionmentioning

confidence: 99%

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Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research

Forbes

2020

Front. Endocrinol.

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This review considers the burden of mortality observed in the older population of people with diabetes and identifies the risk factors associated with mortality hazard in this population. The mortality gap between older people with and without diabetes is enduring, with excess mortality being 10% greater than in the general population. While early mortality in men with diabetes is significantly greater than females with diabetes, the relative mortality risk in females is much higher compared to women without diabetes. Older people who have developed diabetes in middle age have significantly higher mortality hazard compared to those who develop it in old age, emphasizing the continued importance of optimizing diabetes care in all ages. To minimize mortality hazard in older age it is important to address some of the factors that convey risk, these include: comorbidity; polypharmacy; physical and mental frailty; safe glycemic targets for older people; hypoglycemia; glycemic targets; and the hypoglycemic agents. While the data to determine optimal management approaches are limited, the overall need is for a more diligent approach in assessing the needs of older people with diabetes to inform individualized care strategies and therapy goals that minimize potential hazards.

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Section: Mortality Riskmentioning

confidence: 99%

Section: Mortality Riskmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research

Forbes

2020

Front. Endocrinol.

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“…This excess risk of mortality in diabetes patients was comparable to more recent studies. 19,26 For example, a large study from Sweden, followed up matched T2DM cases for 4.6 years and controls for 4.8 years and showed that the adjusted HR for all-cause mortality associated with diabetes was 1.15 (1.14; 1.16) between 1998 and 2011. 19 The investigators attributed this comparatively low excess risk to improved medical care over time.…”

Section: Prior Studiesmentioning

confidence: 99%

Examining trends in type 2 diabetes incidence, prevalence and mortality in the UK between 2004 and 2014

Zghebi

Steinke

Carr

et al. 2017

Diabetes Obesity Metabolism

127

111

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Aims Contemporary data describing type 2 diabetes prevalence, incidence and mortality are limited. We aimed to (i) estimate annual incidence and prevalence rates of type 2 diabetes in the UK between 2004 and 2014; (ii) examine relationships between observed rates with age, gender, socio-economic status and geographic region; and (iii) assess how temporal changes in incidence and all-cause mortality rates influence changes in prevalence.Methods Type 2 diabetes cases aged ≥16 years between January 2004 and December 2014 were identified using the Clinical Practice Research Datalink (CPRD). Up to five individuals without diabetes were matched to diabetes cases based on age, gender and general practice. Annual incidence, prevalence and mortality rates were calculated per 10,000 person-years at risk (95% CI). Survival models compared the mortality rates in patients with and patients without type 2 diabetes.Results Prevalence rates of type 2 diabetes increased from 3. 21% (3.19; 3.22) in 2004 to 5.26% (5.24; 5.29) in 2014. Incidence rates remained overall stable throughout the study period. Higher incidence and prevalence rates were related to male gender and deprivation. People with type 2 diabetes were associated with higher risk for mortality (Hazard ratio 1.26 [1.20; 1.32]. Mortality rates declined in patients with and without diabetes throughout the study period. The incidence and prevalence of type 2 diabetes in patients aged 16-34years increased over time. ConclusionsThe rising UK prevalence of type 2 diabetes over the last decade is likely to be explained by patients living longer rather than increasing type 2 diabetes incidence.3

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Real-World Hemoglobin A1c Changes, Prescribing Provider Types, and Medication Dose Among Patients with Type 2 Diabetes Mellitus Initiating Treatment with Oral Semaglutide

Frazer,

Swift,

Gronroos

et al. 2023

Adv Ther

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Introduction Given the lack of real-world data on oral semaglutide use outside clinical trials, the purpose of this study was to describe dose, prescriber specialty, and change in hemoglobin A1c (HbA1c) after 6 months of oral semaglutide treatment for patients with type 2 diabetes mellitus (T2DM). Methods This was a retrospective study among adult patients with T2DM with ≥ 1 claim for oral semaglutide between November 1, 2019`1–June 30, 2020. Patients had continuous health plan enrollment ≥ 12 months prior to (pre-index) and ≥ 6 months following (post-index) the date of the first oral semaglutide claim (index). Dose at initiation and specialty of the prescribing provider were captured. Change in HbA1c between the last post- and pre-index HbA1c measurement was calculated. Patients were stratified by pre-index HbA1c ≥ 9% (poorly controlled) and HbA1c < 9%. Results A total of 744 HbA1c < 9% and 268 poorly controlled patients were included in the study. Most patients had an initial oral semaglutide dose of 7 mg (49.3%) or 3 mg (42.9%), prescribed most frequently by a primary care provider (27.8%). Mean HbA1c reduction was 0.8% ( p < 0.001). Patients with poorly controlled T2DM had greater HbA1c reductions than patients with HbA1c < 9% (2.0% versus 0.4%, p < 0.001). Patients persistent with oral semaglutide (≥ 90 days continuous treatment) had a mean HbA1c reduction of 0.9% ( p < 0.001); persistent patients with poorly controlled T2DM had a mean reduction of 2.5%. Conclusions Patients with T2DM in this study experienced significant reductions in HbA1c within 6 months following initiation of oral semaglutide. Patients with a higher starting HbA1c experienced greater HbA1c reductions. The initial dose of oral semaglutide was higher than prescribing instructions indicated for more than half of the study patients.

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Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes – a 10‐year cohort study of older people with and without diabetes

Abstract: There is significant excess mortality in older people with diabetes, which is unexplained by comorbidity or polypharmacy. This excess is greatest in the younger old with longer disease duration, suggesting that it may be related to the effect of diabetes exposure.

Cited by 19 publications

References 29 publications

Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research

Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research

Examining trends in type 2 diabetes incidence, prevalence and mortality in the UK between 2004 and 2014

Real-World Hemoglobin A1c Changes, Prescribing Provider Types, and Medication Dose Among Patients with Type 2 Diabetes Mellitus Initiating Treatment with Oral Semaglutide

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