Mortality from Cerebrovascular Disease Type diabetes

Clinical aspects of stroke disease in people with diabetes are described in Chapter 7. Mortality from cerebrovascular disease is barely mentioned in epidemiological studies of patients with type 1 disease and usually only gets a passing mention in studies of patients with type 2 diabetes (Barrett-Connor and Khaw, 1988; Manson etal., 1991; Moss etal., 1991; Lehto etal., 1996). Cerebrovascular disease is generally manifest in later years and most cohort studies of younger patients do not continue follow-up beyond their 40s. Further, cerebrovascular disease complications are not as frequent as heart disease and many studies will therefore be too small, with too few events, to draw any conclusions. This lack of data has led some to suggest that 'in the patient with insulin-dependent diabetes mellitus the frequency of stroke and death from stroke is less than in the patient with non-insulin dependent diabetes mellitus' (Bell, 1994). None the less it is a significant cause of mortality in patients with both types of diabetes, and in the Diabetes UK Cohort Study accounts for 6% of all deaths overall, and 8% of deaths under the age of 40 years (Laing etal., 2003a). A similar proportion, 7% of the total mortality, was reported in a much smaller study of patients with type 1 diabetes by Deckert etal. (1979).

Table 1.3 Mortality from cerebrovascular disease in patients with type 1 diabetes. Data from the Diabetes UK Cohort Study.

Age at death (years)

Males

(per 100 000 person-years)

(per 100 000 person-years)

(95% CI)

1-19

2.3

4.6 (0.6-16.5)

2.5

6.1 (0.7-21.9)

20-30

10.2

5.2 (2.6-9.2)*

13.8

7.6 (4.0-12.9)*

40-59

100.3

4.6 (2.6-7.5)*

101.7

5.1 (2.6-8.9)*

60-84

458.7

1.7 (0.9-3.0)

548.4

2.8 (1.5-4.7)*

1-84

18.7

3.1 (2.2-4.3)*

21.1

4.4 (3.1-6.0)*

The Diabetes UK Cohort Study of type 1 diabetes has recently published rates and SMRs for mortality from cerebrovascular disease and these are shown in Table 1.3. During the follow-up (an average of 17 years per person) there was a total of 1437 deaths, 80 of which were from cerebrovascular disease. The rates were comparable for men and women at all ages. Overall the rates were raised compared with the general population, though not significantly so at ages 1-19, or in the men aged 60-84 years. In the 20-39 age group the risk of cerebrovascular mortality was increased more than fivefold in men and more than sevenfold in women. There are no other studies of cerebrovascular mortality rates by age and sex in patients with type 1 diabetes, probably because available studies have not been large enough or had sufficient follow-up. Other studies have either calculated risks of combined fatal and non-fatal cerebrovascular events (Manson etal., 1991) or calculated risks of cerebrovascular mortality based on only a few deaths (Moss etal., 1991).

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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