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National Diabetes Audit: Complications & Mortality Report

SamJB

SamJB

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Chester
Type of diabetes
Type 1
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Last month the National Diabetes Audit released its report of the prevelance of complications, the risk of death following a complication event and the general mortality of UK diabetics. The report can be viewed here:

http://www.hscic.gov.uk/catalogue/PUB12738/nati-diab-audi-11-12-mort-comp-rep.pdf

Some of you know that the NDA's HbA1c report highlighted just how poor the efficacy of UK diabetes is; with just 7% of Type 1s and 25% of Type 2s achieving the HbA1c efficacy target of 6.5%, where the risk of complications is at unity with the non-diabetic population. The Complications & Mortality report, is equally, if not, more grim. Here are the headlines:


Complication of Diabetes in England and Wales
  • Angina, heart attacks and heart failure were experienced by just over 10% of diabetics between April 2010 and March 2012. This would highlight to me the need for diabetics to take regular exercise and control their weight. I expect this statistic to be skewed by some of the Type 2s that are diabetic via lifestyle factors.
  • The prevalence of DKA for Type 1s was 6%, which means that just over 1 in 20 Type 1s experienced DKA between April 2010 and March 2012.
  • The additional risk (of a diabetic compared to a non-diabetic) of amputation and renal therapy is very startling, it’s quite remarkable to see such terribly high risk of these disorders. The risk of amputation is 336% and renal therapy is 164%.

Short term mortality
These plots are really interesting. They measure the odds of an individual dying a year after a complication event.
  • A socio-economic measurement shows that people from the most deprived areas are more likely to die following a complication event. Conversely, people from the least deprived areas are less likely to die following a complication event.
  • A very interesting find is that Type 1s with an HbA1c less than 51 mmol/mol (6.8%) have a higher risk of mortality following a complication event than someone with an HbA1c in the 61-70 mmol/mol range (7.7 - 8.6%). I know that sudden drops in HbA1c can make complications worse, so perhaps this is a manifestation of that and not that a low HbA1c is bad for you. This pattern is not true for Type 2s.
  • As expected though, for both types, the worse your HbA1c the higher your risk of mortality following a complication event.
  • The cholesterol plot is very interesting too. It seems a low cholesterol, particularly for Type 2s, below 3 is bad for mortality. A cholesterol level following a complication event that gives the best mortality rate is 4.1-5.0 for both Types.
  • The least survivable complication is renal replacement therapy, followed by heart failure, stroke, DKA.
  • The most survivable complication for both types is angina.
  • It must be said though, that these mortality odds are very grim. With renal replacement therapy, a Type 1 is 8 times (Type 2 is 6 times) more likely to die than a Type 1 who hasn’t had any complication in the same period.

CKD
  • The headline from this is that only 25% of diabetics have no CKD. I find this astonishing. Although the report says that it is CKD stages 3, 4 and 5 that require treatment. This means that the percentage of diabetics that require renal treatment is 18%. The 18% and the 25% don’t add to 100 because of a lack of data for 8% of patients.

Overall Mortality
  • Overall mortality has slightly improved since the previous audit. Be aware that although mortality has improved, there may be survivor bias in the data. So, I don’t know whether it would be accurate to say that mortality rates have improved.
  • Mortality for diabetics is significantly higher compared to non-diabetics. The additional risk of mortality for Type 1s is 130%, for Type 2s it is 35%.
  • The mortality risk for Type 1s is therefore significantly higher than that for Type 2s.
  • Type 1 and Type 2 females have a significantly greater risk of death than males. This is particularly true for Type 1 where females have a 27% greater risk of mortality than Type 1 males. Whereas for Type 2, females have a 10% greater risk of mortality than males.
  • When it is broken down by age, the mortality risk is even more frightening. Type 1 females aged between 15 and 34 have a mortality risk 7 times more than a non-diabetic female in that age range. Males in that age range have 4 times the risk of non-diabetic males.
  • These risks decrease with age. Probably because the poorly-controlled diabetics have died off, i.e. survivor bias
 
Last edited by a moderator:
mo1905 said:
Scary stats there Sam, any good news ?
Click to expand...

Unfortunately Mo, it's all a bit doom and gloom regarding UK diabetes care. The good news is that if you control your levels well, then you should be able to avoid all of this. In my opinion, the best thing that can be done is be joining an excellent forum such as this - the advice from experienced, well controlled diabetics is the thing that made the difference for me.
 
Pretty much no other countries even keep such data.
that includes the US and most of Europe. So worlwide the situation is probably worse.
Hana
 
Why is the a greater risk of death for a woman than a man, any ideas Sam?
 
Opposite to non diabetics where women have a greater life expectancy. Maybe because women have more aspects of managing diabetes that men don't have that effect control such as periods, pregnancy, menopause where fluctuating hormones can have a bigger impact on control

Sent from the Diabetes Forum App
 
brett said:
Opposite to non diabetics where women have a greater life expectancy. Maybe because women have more aspects of managing diabetes that men don't have that effect control such as periods, pregnancy, menopause where fluctuating hormones can have a bigger impact on control
Click to expand...

Possibly, but as you quite rightly say on the whole women do live longer than men and was wondering why it's so different in people with diabetes.
 
Is it possiblty that, without appearing to be sexist, men are generally more active at work etc ? Manual labour and sports ? Please don't be too harsh, I am well aware there are exceptions lol !


Sent from the Diabetes Forum App
 
Muscle mass may be a factor diabetic wise as more muscle helps absorbtion. Women naturally have less muscle mass than men, which is maybe also the reason women need fewer calories if compared to the opposite sex with same age, weight, height activity.

Sent from the Diabetes Forum App
 
mo1905 said:
Is it possiblty that, without appearing to be sexist, men are generally more active at work etc ? Manual labour and sports ? Please don't be too harsh, I am well aware there are exceptions lol
Click to expand...


But if that was the case Mo then men would live longer than women in the non-diabetic population.
 
noblehead said:
But if that was the case Mo then men would live longer than women in the non-diabetic population.
Click to expand...

not really because it does help control sugar levels. Not applicable to the non ds cause they havn't got insulin problems. If something helps keep sugars stable or reduce insulin usage then that will help when comparing diabetic men/women. Although diabetic wise what mo said will help in longevity of a diabetic man, doesnt mean he will then outlive a non diabetic lady or live longer than a non diabetic man, but longer than a diabetic lady. Hope that makes sense lol.

Sent from the Diabetes Forum App
 
brett said:
not really because it does help control sugar levels. Not applicable to the non ds cause they havn't got insulin problems. If something helps keep sugars stable or reduce insulin usage then that will help when comparing diabetic men/women. Although diabetic wise what mo said will help in longevity of a diabetic man, doesnt mean he will then outlive a non diabetic lady or live longer than a non diabetic man, but longer than a diabetic lady. Hope that makes sense lol.

Sent from the Diabetes Forum App
Click to expand...


Yeah I see what your saying about the positive effects of exercise on bg control, but then we'd have to assume that women with diabetes are less active than men, not so sure if this is true going by what people write on this forum and from personal experience talking to fellow diabetics.
 
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