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Mortality trends in type 2 diabetes mellitus patients in a primary care setting

Mortality trends in type 2 diabetes mellitus patients in a primary care setting . 1994 to 2011. Jelske Dekkers 6th year medical student. Introduction Research question Patients and methods Results Sociodemographic characteristics Mortality rates Clinical patient characteristics

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Mortality trends in type 2 diabetes mellitus patients in a primary care setting

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  1. Mortality trends in type 2 diabetes mellitus patients in a primary care setting 1994 to 2011 Jelske Dekkers 6th yearmedical student

  2. Introduction • Research question • Patients and methods • Results • Sociodemographiccharacteristics • Mortalityrates • Clinicalpatientcharacteristics • Survival analysis • Conclusion • Discussion • References

  3. Introduction – Diabetes mellitus • Diabetes mellitus • Type 1 • Type 2  90% • Prevalence • 2003: • Men 36/1000 • Women 39/1000 • 2007 • Men 40.1/1000 • Women 41.6/1000

  4. Introduction – Type 2 diabetes • Causes • Betaceldysfunction inadequate production of insulin • Insulinresistance • Associations • Hypertension • ObesityMetabolic syndrome or syndrome X • Hypercholesteromia • Complications • Cardiovascular disease  2-4 timesincreased risk of CVD associated death • Renal disease • Retinal disease • Polyneuropathy

  5. Research question • What is the trend in mortalityrates of type 2 diabetes patientscompared to the mortalityrates of the general Dutch populationfrom 1994 to 2011? • Is there a difference in clinicalcharacteristics of type 2 diabetes patientsfrom 1994 to 2011?

  6. Patients and methods • All type 2 diabetes patients in the NMP/HIS database between 1994 and 2011 • NMP/HIS database • Database of all patientswithchronicillnessestreated (partially) in 9 primary care practices • Includesclinicalpatientscharacteristicsfromevery check up

  7. Patients Patientswith type 2 diabetes (partially) treated in primary care, 1994-2011 N = 3748 Patientswith type 2 diabetes, nottreated in primary care N = 297 Patientswith type 2 diabetes N = 4045 Patients without a known date of diagnosis N = 31 Patientswith type 2 diabetes with a known date of diagnosis N = 4014

  8. Methods; database

  9. Methods – Mortalityrates • Mortalityrates type 2 diabetes patientsforeachyear • All patients • Men • Women • Comparisongroup: general Dutch population, adjustedforage, using CBS Statline Database • Complete population • Men • Women

  10. Methods – Clinicalpatientcharacteristics • Bloodpressure • Body mass index • HbA1c • Total cholesterol • HDL • Calculatedfor 1996, 2001, 2006 and 2011 • Clinicalcharacteristics of the patients in the NMP/HIS database  onlypatients (partially) treated in primary care

  11. Results – Sociodemographiccharacteristics

  12. Results – Sociodemographiccharacteristics, men and women

  13. Results; mortality

  14. Mortalityrates in comparison to the Dutch population

  15. Mortaliyrates – 2

  16. Mortalityfigures – all patients

  17. Mortalityfigures – men

  18. Mortalityfigures - women

  19. Clinicalpatientcharacteristics

  20. Kaplan Meier survival analysis

  21. Kaplan Meier Survival analysis; men and women

  22. Conclusion • Mortalityratesdeclinedbetween 1994 and 2011 • Since 2000 there is nodifference in mortality • In 2010 diabeticwomen had a lowermortalityrate • The meanbloodpressure and cholesterollevel have decreasedsignificantlyfrom 1996 to 2011 • In ourstudypopulation 50% of all type 2 diabeticswouldstillbealive 20 yearsafter diagnosis • The first 20 yearsafter diagnosis women have a better survival probabilitythan men • After 20 years, men have a better survival

  23. Discussion • Strengths • Large NMP/HIS database withsociodemographic and clinicalpatientcharacteristics of the majority of ourstudypopulation • Comparisongroup: complete Dutch population • Weaknesses • No clinicalpatientcharacteristics of patientswhoweren’ttreated in primary care  possibleunderestimation of clinicalcharacteristics • Transsitionfrom NMP to HIS as primarysource of information in 2006-2008  voids in yearly check ups and information • Second hand information • Only all causemortality, noinformationaboutcardiovascular associated deaths

  24. Discussion • Other studies onthis subject • Mortalityrates of type 2 diabetes patients are declining • Relativemortality risk compared to controlgroup is declining • Most studies stillfound a signifantdifferencebetweenmortalityrates of diabetics and non-diabetics • Greaterstudypopulation • Earlierperiod • Otherhealth care systems • Follow up study • Correlationbetweendecliningmortalityrates and decliningbloodpressure and cholesterol • Clinicalcharacteristics of all type 2 diabetes patients, includingthose of patientsnottreated in primary care

  25. Questionsorotherdiscussionpoints?

  26. References • Rutten G, Grauw de W, Nijpels G, Goudwaard A, Uitewaal P, Van der Does F, Heine R, Ballegooie van E, Verduijn M, Bouma M; NHG-standaard Diabetes Mellitus type 2 (tweede herziening); Huisarts Wet; 49; 137-152; 2006 • www.statline.cbs.nl • Charlton J, Latinovic R, Gulliford M.C; Explaining the Decline in Early Mortality in Men and Women with Type 2 Diabetes; Diabetes Care; 31; 1761-1766; 2008 • Eliasson M, Talbäck M, Rosén M; Improved survival in both men and women with diabetes between 1980 and 2004 – a cohort study in Sweden; Cardiovascular Diabetology; 7; 32; 2008 • Preis S.R, Hwang S.J, Coady S, Pencina M.J, D’Agostino R.B, Savage P.J, Levy D, Fox C.S; Trends in All-Cause and Cardiovascular Disease Mortality Among Women and Men With and Without Diabetes Mellitus in the Framingham Heart Study, 1950 to 2005; Circulation; 119; 1728-1735; 2009 • Gregg E.W, Cheng Y.J, Saydah S, Cowie C, Garfield S, Geiss L, Barker L.B; Trends in Death Rates Among U.S. Adults With and Without Diabetes Between 1997 and 2006; Diabetes Care; 35; 1252-1257; 2012 • Gulliford M.C, Charlton J; Is Relative Mortality of Type 2 Diabetes Mellitus Decreasing?; Am. J. Epidemiol; 169; 455-461; 2009 • Tierney E.F, Cadwell B.L, Thompson T.J, Boyle J.P, Paxon S.L, Moum K, Engelgau M.M; Reductions in excess mortality rates among people with diabetes by selected cause of death; Journal of Diabetes and Its Complications; 23; 77-82; 2009 • Gregg E.W, Gu Q, Cheng Y.J, Narayan V, Cowle C.C; Mortality Trends in Men and Women with Diabetes, 1971 to 2000; Ann Intern Med; 147; 149-155; 2007 • Lutgers H, Gerrits E, Sluiter W, Ubink-Veltmaat L, Landman G, Links T, Gans R, Smit A, Bilo H; Life Expectancy in a Large Cohort of Type 2 Diabetes Patients Treated in Primary Care (ZODIAC-10); PLoS ONE; vol 4; 8; e6817 • www.nationaalkompas.nl

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