Circulation: Diabetes death rates falling--women still at higher risk

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All-cause mortality among women and men with diabetes mellitus is on the decline; however, mortality remains significantly higher among women and men with diabetes mellitus than those without, according to an analysis of the Framingham Heart Study in the April issue of Circulation.

Sarah Rosner Preis, ScD, from the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md., and colleagues compared two time periods; an earlier period from 1950 to 1975, and a later period from 1975 to 2005. They included subjects, ages 45-74 years, who completed at least one serial cohort exam. Diabetes mellitus was defined as having either a casual glucose of at least 200 mg/dl, fasting glucose of at least 126 mg/dl, or treatment for diabetes.

For the earlier time period, the researchers included 78,156 person-years, and for the later time period, 79,000 person-years. A total of 930 deaths occurred in the first time period, and 773 deaths occurred in the later time period.

The investigators found that all-cause mortality has declined in recent years among women with and without diabetes mellitus. They observed a similar pattern among the men. Women with diabetes mellitus had a threefold increased risk and men had a twofold increased risk for all-cause mortality compared to nondiabetics.

Cardiovascular mortality declined over time in women and men, according to the authors. Non-cardiovascular mortality also declined among both women and men without diabetes mellitus, whereas no change was observed for women with diabetes mellitus or men with or without diabetes mellitus.

However, Preis and colleagues said that the presence of diabetes mellitus increased the risk for all-cause mortality in the earlier time period and in the later time period.

Elizabeth A. Jackson, MD, from the division of cardiovascular medicine at the University of Michigan in Ann Arbor, wrote in a perspective on the study that diabetes mellitus continues to be a significant risk factor for mortality in both men and women. Given the high prevalence of obesity and diabetes mellitus in the U.S., efforts to prevent diabetes mellitus are critical to reducing all-cause and cardiovascular mortality, she wrote.