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Suicide, alcohol-related and accidental deaths higher in diabetes

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September 17, 2018

Finnish adults newly diagnosed with diabetes are more likely to die of suicide, alcohol-related causes or accidents over 7 years vs. those without diabetes, suggesting a need for increased psychological and social support following disease diagnosis, according to findings from a registry-based study.

Leo Niskanen

“It is well-known that diabetic patients have a higher risk of developing cardiovascular disease, cancer and kidney disorders, which can lead to earlier death,” Leo Niskanen, MD, chief physician at the Abdominal Center, Helsinki University Hospital, Finland, told Endocrine Today. “Less attention has been given to non-natural causes of death related to this chronic disease. In this nationwide Finnish study, alcohol-related deaths, suicides or accidental causes of death in over 400,000 people with or without diabetes were assessed. The study reported that people with diabetes were much more likely to die from alcohol-related factors.”

Niskanen and colleagues analyzed data from 434,629 adults (208,257 women), including 208,148 adults with diabetes who had purchased and received reimbursement for at least one insulin prescription and/or oral antidiabetes drug between 1997 and 2010, and a reference group of adults without diabetes matched by age, sex and region. Within the reference group, 13,199 adults developed diabetes during follow-up; researchers treated these individuals as new cases and a new matched control was assigned to each. Researchers obtained data on mortality (date and cause of death) from Statistics Finland; cancer data were obtained from the Finnish Cancer Registry. Endpoints included death with an underlying cause from suicide and sequelae of intentional self-harm, accident, and alcohol-related disease and accidental poisoning by alcohol. Researchers used Poisson regression models separately for each endpoint, stratified by sex, with results reported as mortality-rate ratios (MRRs) and ORs for the case-cohort study.

During a mean follow-up of 7.1 years, researchers observed 2,832 deaths attributable to alcohol-related causes (1,981 in adults with diabetes), 3,187 attributable to accidents (1,707 in adults with diabetes) and 853 attributable to suicide (499 in adults with diabetes). The most frequent alcohol-related cause of death was cirrhosis of the liver (45% of all deaths).

Researchers found higher mortality for nearly all endpoints in adults with diabetes, especially among those prescribed insulin.

Compared with adults without diabetes, adjusted MMRs for alcohol-related deaths were 1.71 for men with diabetes prescribed oral antidiabetes drugs (95% CI, 1.56-1.89) and 6.92 for men with diabetes prescribed insulin (95% CI, 6.14-7.8), whereas the MMRs for alcohol-related deaths for women with diabetes were 2.1 (95% CI, 1.7-2.58) and 10.6 (95% CI, 8.14-13.79) for those prescribed oral antidiabetes drugs and insulin, respectively.

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Researchers also observed more accidental deaths among adults prescribed insulin therapy, with MMRs of 2.06 (95% CI, 1.73-2.46) and 1.53 (95% CI, 1.11-2.11) for men and women, respectively, when compared with those without diabetes. Additionally, researchers observed more suicides among men prescribed insulin (MMR = 2.1; 95% CI, 1.6-2.75) and women prescribed oral antidiabetes drugs (MMR = 1.62; 95% CI, 1.21-2.17) vs. those without diabetes.

“There is a need for more effective psychological and social support for people with diabetes,” Niskanen said. “Those patients with heavy mental burden or with excessive use of alcohol should discuss these issues with their physician or nurse. There are many ways that these problems can be managed.”

Niskanen said the findings suggest an association, but not the causality.

“The root causes to excessive mortality due to ‘unnatural’ causes of death should be explored in-depth,” he said. “In addition, the influence of drugs, such as antidepressants, the occurrence of diabetic complications, such as low blood glucose, or the socioeconomic status of patients should be considered.” – by Regina Schaffer

For more information:

Leo Niskanen, MD, can be reached at Helsinki University Hospital, Abdominal Center, Endocrinology and Diabetology, Third Floor, Tower Building, P.O. Box 340, FI-00029, Helsinki, Finland; email: leo.niskanen@hus.fi.

Disclosures: The authors report no relevant financial disclosures.

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