Unnatural Deaths in a National Cohort of People Diagnosed With Diabetes

Abstract

OBJECTIVETo examine risk of unnatural death among people diagnosed with diabetes irrespective of disease type. RESEARCH DESIGN AND METHODSWe conducted a matched cohort study of the entire Swedish population using interlinked national registers. From the National Diabetes Register we identified 252,191 people diagnosed with diabetes (type 1 or 2) during 1996-2009. Each cohort member was matched for age, sex, and county of birth to five unaffected individuals randomly sampled from the Total Population Register. Mortality was examined with complete ascertainment, and risk ratios (RRs) for all unnatural deaths and for specific causes (suicide, accident, homicide, and iatrogenic effects) were estimated using conditional fixed-effects Poisson regression. RESULTSRisk of any unnatural death was elevated versus the general population: 77.3 versus 32.1 per 10,000 (RR 2.2 [95% CI 2.1-2.4]), and these deaths occurred at a younger age in the diabetes cohort. Risk was increased for suicide ), accident (RR 2.0 [95% CI 1.9-2.1]), homicide (RR 3.1 [95% CI 1.6-6.1]), and iatrogenic effects (RR 2.4 [95% CI 1.9-3.2]). It was greatly elevated for fatal poisoning from a variety of agents, including psychotropic drugs and "other and unspecified medication," as well as narcotics, alcohol, and carbon monoxide. Almost 9% of all fatal poisoning cases in the diabetes cohort were identified as overdoses of insulin or oral hypoglycemic drugs.

The Magnitude of Suicidal Behaviour among People Living with Diabetes Mellitus Attending an Outpatient Department of Alamata General Hospital, Mekelle, Tigray, Ethiopia 2019: a Cross-Sectional Study

“…One study observed that the magnitude of suicidal behaviour in patients with type 2 diabetes was higher than the two-fold observed in the Mexican population (11.6% in patients with diabetes versus 5.2% in the general population) (33). The results were similar to previous reports showing that diabetes increases the risk of death by suicide (34,35). It was found that suicide attempters with T2DM showed higher levels of blood glucose than those without a history of suicide.…”

Excess mortality in Finnish diabetic subjects due to alcohol, accidents and suicide: a nationwide study

“…Intentional overdoses of insulin may underlie acute admissions for severe hypoglycemia of 'unknown' etiology, and this may also lead to the underestimation of suicide as a cause of death among patients with diabetes (20). However, the majority of suicides among the diabetic subjects in this study were attributable to psychotrophic drugs, as in the Swedish study (6) in which the use of insulin or hypoglycemic agents was identified as contributing to suicide in nine per cent of the cases. Nevertheless, according to the above-mentioned metaanalysis (5), the incidence ratio of suicide among diabetics was 2.85 per 10 000 person-years, on the basis of which it is estimated that globally there are about 94 000 suicides each year among diabetic individuals.…”

Risk factors for self-harm in people with epilepsy

“…We identified self-harm from primary care records using clinician-verified Read codes [15] and from HES using the following ICD-10 codes: X60-84, Y87.0 and Y87.2. We used these same codes to identify suicide from ONS mortality data, with the addition of Y10-34 (excluding Y33.9) [16]. These codes represent undetermined intent, which is included in the ONS definition of suicide [17].…”