With both type 1 and type 2 diabetes on the rise in the United States and worldwide, it can sometimes be discouraging to look at long-term trends related to diabetes — even as treatments advance and improve the quality of life for millions of people. But a nugget of good news showed up in a recent study that looked at the risk of certain adverse outcomes, including death, in people with diabetes. Like many pieces of good news, though, it came with an asterisk.
Published in the Journal of Clinical Endocrinology & Metabolism, the study looked at 13,995 people in Australia, most of whom had type 2 diabetes. For every four people with diabetes, the study also recruited one person without diabetes. Participants came from two different groups: one group (including 1,291 people with diabetes) was recruited between the years 1993 and 1996, and the other group (including 1,509 people with diabetes) was recruited between 2008 and 2011. The average age of participants was about 65 years.
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The researchers wanted to look at a number of different outcomes, and how they varied among participants — in those with versus without diabetes, and in those recruited earlier versus later. Outcomes of interest included hospitalization for a heart attack or stroke, amputation of a lower extremity, developing heart failure, and death from cardiovascular disease as well as death from all causes.
The researchers found that compared with the earlier group of participants, those with diabetes in the later group had a lower overall risk of heart attack, stroke, heart failure, and death from cardiovascular disease. Compared to people without diabetes in the same period of study recruitment, those with diabetes in the later group saw their increased risk of these outcomes drop by more than 50%. These numbers suggest a substantial improvement in managing cardiovascular risk factors in the later versus earlier groups of people with diabetes.
But the risk of one important outcome didn’t change much over time in people with diabetes compared to those without it: death from all causes. After adjusting for certain risk factors for death other than diabetes, the researchers did find that the overall death risk was lower in the later group of participants with diabetes. But unlike for the other cardiovascular outcomes, the gap in overall death risk between people with and without diabetes didn’t shrink over time.
These numbers suggest that despite improvements in cardiovascular outcomes and a declining overall risk of death in people both with and without diabetes, the heightened risk of death that comes with diabetes remains the same. Future research may help reveal what non-cardiovascular factors could be responsible for the higher risk of death seen in people with type 2 diabetes, such as a possible higher risk of cancer or dementia.
Want to learn more about keeping your heart healthy with diabetes? Read “Tips for a Healthy Heart,” “Lower Your Risk of Heart Disease” and “Fight Off Heart Disease With These Five Heart-Healthy Foods.”