How Diabetes Shortens Life or Mortality of Patients with Type 2 Diabetes

Reduction in Life Expectancy Depends on Age at Diagnosis of Type 2 Diabetes

Data regarding the reduction in life expectancy among diabetics varies slightly across different studies^{6, 8}, but they agree that the younger the age at which type 2 diabetes is diagnosed, the greater the reduction in life expectancy:

• When diagnosed with type 2 diabetes at the age of 50−59: by 6−7 years.
• When diagnosed with type 2 diabetes at the age of 60−69: by 4−5 years.
• When diagnosed with type 2 diabetes at the age of 70: by about 3 years.
• When diagnosed with type 2 diabetes at the age of 80: diabetes practically has no impact on life expectancy.

How About Younger Diabetics?

Data suggests that type 2 diabetes in younger individuals under 40 years old leads to a faster decline in beta-cell function compared to later onset diabetes.¹ 

Sattar et al., based on data from the Swedish National Diabetes Register, found the highest risk increase in those diagnosed with type 2 diabetes at the age ≤ 40 years. They found more than a 2-fold risk of death from any cause, nearly 3-fold risk of cardiovascular death, and more than a 4-fold risk of heart failure or ischemic heart disease. The risk of atrial fibrillation in this age category of diabetics was twice that of non-diabetics, and the risk of stroke more than 3-fold.⁸

Does Gender Matter?

Available data shows that both overall and cardiovascular mortality are higher in diabetics compared to non-diabetics, more so in women than in men. The reduction in cardiovascular disease mortality observed in the general population over recent decades applies only to men, not to women, in the presence of diabetes.³

Risks Multiply in Case of Comorbidities

Authors associated with the group Emerging Risk Factors Collaboration published in 2015 in JAMA an analysis of the relationship between mortality and cardiometabolic multimorbidity − this was defined as the presence of ≥ 2 of the following diagnoses: diabetes mellitus, stroke, myocardial infarction. Data from 689,300 participants from the ERFC registry from 1960−2007 was analyzed. The complete analysis included more than 135,000 deaths out of a total of 1.2 million people.

It was found that the presence of 1 of the monitored diagnoses doubled the risk of death, the presence of 2 of the monitored diagnoses quadrupled it, and the combination of all 3 diagnoses increased the risk up to 8-fold. Cardiometabolic multimorbidity with all 3 monitored diagnoses led to a reduction in life expectancy by an average of 23 years when diagnosed with type 2 diabetes at the age of 40, and by 15 years when diagnosed at the age of 60.¹⁰

Quality Care Can Significantly Prolong Life for Diabetics 

In the last quarter of the 20th century, the prognosis for newly diagnosed type 2 diabetes patients was critical − the life expectancy from diagnosis was then on average between 7 and 8 years. Now, based on the results of clinical intervention studies, it can be reasonably estimated that the life expectancy of patients with type 2 diabetes, with the management of all risk factors, can be close to that of non-diabetic peers.⁷  

Data from studies conducted over the past few decades indicates a globally declining trend in mortality and cardiovascular disease development among both diabetic and non-diabetic populations. Although both mortality and the incidence of cardiovascular disease are twice as high among diabetics compared to non-diabetics, the rate of decline in these parameters is steeper among diabetics. This can be attributed to improved glycemic control and management of cardiovascular risk factors due to advances in modern medicine. This trend is encouraging, but it is important not to overlook the growing prevalence of diabetes.⁵ 

How Do These Data Translate Into Clinical Practice?

The data described above highlight the need for tight diabetes management and cardiovascular risk factor control, which can have a significant impact on the prognosis of diabetics. Therapy should be sufficiently aggressive even in younger age categories of diabetics. Conversely, diabetes treatment in older individuals needs to be adjusted, considering the desired level of control and its individual benefit according to the current guidelines.⁸ The foundation remains a comprehensive approach to the patient utilizing available pharmacological and non-pharmacological methods.¹⁰

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Sources:
1. Magliano D. J., Sacre J. W., Harding J. L. et al. Young-onset type 2 diabetes mellitus − implications for morbidity and mortality. Nat Rev Endocrinol 2020; 16 (6): 321−331, doi: 10.1038/s41574-020-0334-z.
2. Visaria J., Iyer N. N., Raval A. et al. Incidence and prevalence of microvascular and macrovascular diseases and all-cause mortality in type 2 diabetes mellitus: a 10-year study in a US commercially insured and medicare advantage population. Clin Ther 2019; 41 (8): 1522−1536.e1, doi: 10.1016/j.clinthera.2019.05.012.
3. Jansson S. P. O., Andersson D. K., Svärdsudd K. Mortality trends in subjects with and without diabetes during 33 years of follow-up. Diabetes Care 2010; 33 (3): 551−556, doi: 10.2337/dc09-0680.
4. Koye N. D., Ling J., Dibato J. et al. Temporal trend in young-onset type 2 diabetes − macrovascular and mortality risk: study of U.K. primary care electronic medical records. Diabetes Care 2020; 43 (9): 2208−2216, doi: 10.2337/dc20-0417.
5. Htay T., Soe K., Lopez-Perez A. et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. Curr Cardiol Rep 2019; 21 (6): 45, doi: 10.1007/s11886-019-1133-9.
6. Weber P. Diabetes mellitus – specifika a komplikace ve stáří. Interní medicína pro praxi 2008; 10 (10): 456–460.
7. Kvapil M. Léčba diabetes mellitus u kardiaka. Kardiologická revue – Interní medicína 2006; 8 (3): 99−104.
8. Sattar N., Rawshani A., Franzén S. et al. Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks findings from the Swedish National Diabetes Registry. Circulation 2019; 139 (19): 2228−2237, doi: 10.1161/CIRCULATIONAHA.118.037885.
9. Tachkov K., Mitov K., Koleva Y. et al. Life expectancy and survival analysis of patients with diabetes compared to the non diabetic population in Bulgaria. PLoS One 2020; 15 (5): e0232815, doi: 10.1371/journal.pone.0232815.
10. Škrha J. Kardiovaskulární mortalita u diabetu. Vnitřní lékařství 2017; 63 (6): 447–449.