The risk of mortality among people with type 2 diabetes in Latin America: A systematic review and meta‐analysis of population‐based cohort studies

Abstract

Type 2 diabetes mellitus (T2DM) is associated with a high mortality risk, although the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all-cause and causespecific mortality in population-based cohort studies in LA.Systematic review and meta-analysis: inclusion criteria were (1) men and women 18 years old and above with T2DM; (2) study outcomes all-cause and/or causespecific mortality; and (3) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health, and LILACS) were searched. Risk of bias was evaluated with the ROBINS-I criteria. Initially, there were 979 identified studies, of which 17 were selected for qualitative synthesis; 14 were included in the meta-analysis (N = 416 821). Self-reported T2DM showed a pooled relative risk (RR) of 2.49 for all-causes mortality (I-squared [I 2 ] = 85.7%, p < 0.001; 95% confidence interval [CI], 1.96-3.15). T2DM based on a composite definition was associated with a 2.26-fold higher all-cause mortality (I 2 = 93.9%, p < 0.001; 95% CI, 1.36-3.74).The pooled risk estimates were similar between men and women, although higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I 2 = 59.2%; p < 0.061; 95% CI, 1.99-3.82) and for renal mortality 15.85 (I 2 = 0.00%; p < 0.645; 95% CI,). Using available population-based cohort studies, this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high-income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death.

Intermediate hyperglycaemia and 10‐year mortality in resource‐constrained settings: the PERU MIGRANT Study

“…As mentioned in the introduction, the association between type 2 diabetes mellitus and all‐cause mortality is well known; however, the estimations of the associations in the present study (HRs of 2.92–5.30 according to the different definitions) are higher in comparison to those in previous studies. The relatively recent systematic review of all‐cause mortality among individuals with type 2 diabetes in Latin America found a relative risk of between 2.26 (95% CI 1.36–3.74) and 2.49 (95% CI 1.96–3.15) using a composite definition and self‐reported diagnosis, respectively [7]. The highest association observed in the systematic review was an HR of 6.64 (95% CI 1.94–22.8) in a cohort in Brazil with 13 years of follow‐up [22], and another high value was the HR of 4.38 (95% CI 3.43–5.59) reported in a cohort in Mexico with a 15‐year follow‐up [23].…”

“…As far as we are aware, no study has reported on the association of intermediate hyperglycaemia with mortality in a Latin American country. However, recent studies have highlighted the higher mortality risk attributable to type 2 diabetes in Latin American countries compared to high‐income countries, as shown in a recent systematic review [7]. It is therefore important to assess whether impaired fasting glucose, impaired glucose tolerance or intermediate hyperglycaemia, defined according to HbA 1c levels, are associated with mortality in these populations.…”

Anthocyanins as Antidiabetic Agents—In Vitro and In Silico Approaches of Preventive and Therapeutic Effects

“…With an increase in age, the prevalence of DM also increases. About 25% of the population above 65 years of age has diabetes [ 5 ].…”

The Andean Latin-American burden of diabetes attributable to high body mass index: A comparative risk assessment

“…High BMI is the leading cause of type 2 diabetes. This is particularly true for Latin-America where diabetes prevalence has increased [2], the diabetes-associated mortality risk is higher than in any other world region [3], and diabetes is a significant threat to health systems, economy and population health [4,5]. The exact mechanisms underpinning the high BMI and diabetes association may vary by geographic region and different populations may have increased risk of diabetes at different BMI levels.…”