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Life expectancy drops with type 2 diabetes plus cardiometabolic morbidities

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July 6, 2017

Korean adults with type 2 diabetes and other cardiometabolic comorbidities, including stroke and myocardial infarction, have decreased life expectancy and increased number of life-years lost vs. those without diabetes and other comorbidities, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

Chang Hee Jung, MD, PhD, of the department of internal medicine, Asan Medical Center, University of Ulsan College of Medicine in Korea, and colleagues evaluated data from the Korean National Health Insurance Service-National Sample Cohort on 569,831 adults enrolled between 2002 and 2006 and followed for a median of 12 years to determine mortality and reductions in life expectancy associated with cardiometabolic multimorbidity.

Participants were divided into five groups based on baseline disease status: none (reference group; n = 92.59%), diabetes (7.01%), diabetes and stroke (0.14%), diabetes and MI (0.06%) or diabetes, stroke and MI (0.01%).

All-cause mortality rate was highest among participants with diabetes, stroke and MI (115.52 per 1,000 person-years), followed by participants with diabetes and stroke (67.17 per 1,000), diabetes and MI (66.34 per 1,000) and diabetes only (19.86 per 1,000); the reference group had the lowest all-cause mortality rate (6.85 per 1,000). Similarly, the HRs for mortality were higher in participants with a history of diabetes (HR = 1.7; 95% CI, 1.66-1.75), diabetes and stroke (HR = 3.66; 95% CI, 3.32-4.03), diabetes and MI (HR = 3.56; 95% CI, 3.06-4.14) and diabetes, stroke and MI (HR = 4.79; 95% CI, 3.05-7.05) compared with the reference group.

Life expectancy decreased with increasing age. Compared with participants without diabetes, participants with diabetes lost an overall 6.1 life-years to diabetes. Compared with the reference group, life-years lost were higher in participants with diabetes and stroke (16.68), diabetes and MI (21.1) and diabetes, stroke and MI (23.8).

Younger age groups with comorbidities had a reduced life expectancy compared with younger age groups without the comorbidities.

“For the first time in Asia, we observed the additive mortality risk and significantly shorter age-specific life expectancy, depending on the number of cardiometabolic morbidities. ... Although the extent of the mortality risk and loss of life expectancy was less than that in Western studies, our results suggest that young Asians with diabetes should be followed and managed more stringently, according to their [CV] comorbidities,” the researchers wrote. – by Amber Cox

Disclosures: The researchers report no relevant financial disclosures.

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PERSPECTIVE
Dana Dabelea
Dana Dabelea

The study by Kang and colleagues showing an additive mortality risk for different combinations of cardiometabolic morbidity as well as significantly shorter life expectancy among a large national adult sample from Korea is important for many reasons. First, it provides new and unique data about the global burden of diabetes-related morbidity and mortality for the Asian subcontinent, a large geographic area with relatively scarce data, experiencing lifestyle “Westernization.” Second, it emphasizes the additive mortality risk associated with multiple comorbidities (diabetes alone, diabetes and stroke, diabetes and MI, and all three, compared with the reference population), especially relevant for clinicians, who are well aware that these conditions do not occur in isolation and, more often than not, cluster in the same patients. Third, and maybe mostly important, it shows much shorter life expectancy in those diagnosed at younger vs. older ages. In an era when we are seeing an increasingly younger age at onset of obesity and diabetes, such findings are particularly relevant as they speak about the potentially devastating societal and financial impact of these chronic conditions and the need for more effective preventive and therapeutic approaches. 


Dana Dabelea, MD, PhD

Conrad M. Riley Professor of Epidemiology and Pediatrics, Director, Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus

Disclosure: Dabelea reports no relevant financial disclosures.