Cause-Specific Risk Factors of Death in Individuals with Diabetes: A Competing Risks Modeling

Overview

Journal Int J Endocrinol Metab

Publisher Brieflands

Specialty Endocrinology

Date 2019 Sep 10

PMID 31497037

Citations 1

Authors

Marjan Mansourian

Sahar Sadeghpour

Ashraf Aminorroaya

Masoud Amini

Tohid Jafari-Koshki

Affiliations

Soon will be listed here.

Abstract

Background: Diabetes is on the rise worldwide.

Objectives: This study aimed to evaluate the risk factors of various causes of death in people with type 2 diabetes (T2D).

Methods: In this cohort study on 2638 people with T2D, we applied cause-specific and sub-distribution hazards models to assess the impact of various factors on the risk of death. Moreover, we plotted a cumulative incidence curve to summarize cumulative failure rates over time.

Results: About 75% of individuals with T2D died from cardiovascular disease (CVD) and cerebrovascular accidents (CVA). Death from CVD was associated with the increased risk of hypertension (hazard ratio (HR) = 1.83, 95% CI: 1.37 - 2.46), hypercholesterolemia (HR = 1.58, 95% CI: 1.17 - 2.14), and diabetes duration. The risk of death from CVA was related to hypertension (HR = 2.76, 95% CI: 1.67 - 4.55) and hyperglycemia (HR = 4.34, 95% CI: 1.75 - 10.79). The CVA risk in patients with diabetes duration of 10 - 20 years was higher than the risk in patients with diabetes duration > 20 years (diabetes duration of ≤ 10 years as the reference category). Diabetes duration of longer than 20 years was associated with a higher risk of death from cancer (HR = 2.65, 95% CI: 1.05 - 6.68). The risk of death from foot infection and diabetic nephropathy increased in patients with longer diabetes duration after adjustment for sex, age, and body mass index.

Conclusions: Regardless of the cause, death rates in people with T2D increase over time and risk factors have different impacts on death from each cause. This should be acknowledged in risk management in individuals with T2D.

Citing Articles

Theater Performing Arts (TPA): Community Empowerment to Improve Blood Glucose Control Behavior in Yogyakarta.

Kusumo M, Hendrartini J, Sufro Z, Dewi F Int J Endocrinol Metab. 2021; 18(4):e103106.

PMID: 33613677 PMC: 7887461. DOI: 10.5812/ijem.103106.

References

Brun E, Nelson R, BENNETT P, Imperatore G, Zoppini G, Verlato G . Diabetes duration and cause-specific mortality in the Verona Diabetes Study. Diabetes Care. 2000; 23(8):1119-23. DOI: 10.2337/diacare.23.8.1119. View

Cho E, Rimm E, Stampfer M, Willett W, Hu F . The impact of diabetes mellitus and prior myocardial infarction on mortality from all causes and from coronary heart disease in men. J Am Coll Cardiol. 2002; 40(5):954-60. DOI: 10.1016/s0735-1097(02)02044-2. View

LaRosa J . Understanding risk in hypercholesterolemia. Clin Cardiol. 2003; 26(1 Suppl 1):I3-6. PMC: 6654622. DOI: 10.1002/clc.4960261303. View

Gaede P, Vedel P, Larsen N, Jensen G, Parving H, Pedersen O . Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003; 348(5):383-93. DOI: 10.1056/NEJMoa021778. View

Chobanian A, Bakris G, Black H, Cushman W, Green L, Izzo Jr J . Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42(6):1206-52. DOI: 10.1161/01.HYP.0000107251.49515.c2. View

Lu W, Resnick H, Jablonski K, Jain A, Jones K, Robbins D . Effects of glycaemic control on cardiovascular disease in diabetic American Indians: the Strong Heart Study. Diabet Med. 2004; 21(4):311-7. DOI: 10.1111/j.1464-5491.2004.01137.x. View

Imperatore G, Cadwell B, Geiss L, Saadinne J, Williams D, Ford E . Thirty-year trends in cardiovascular risk factor levels among US adults with diabetes: National Health and Nutrition Examination Surveys, 1971-2000. Am J Epidemiol. 2004; 160(6):531-9. DOI: 10.1093/aje/kwh232. View

Walters D, Gatling W, Mullee M, Hill R . The distribution and severity of diabetic foot disease: a community study with comparison to a non-diabetic group. Diabet Med. 1992; 9(4):354-8. DOI: 10.1111/j.1464-5491.1992.tb01796.x. View

Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini A, Chaudhry R . A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care. 2006; 29(8):1727-32. DOI: 10.2337/dc06-0116. View

10.

Janghorbani M, Hu F, Willett W, Li T, Manson J, Logroscino G . Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: the Nurses' Health Study. Diabetes Care. 2007; 30(7):1730-5. DOI: 10.2337/dc06-2363. View

11.

Boden-Albala B, Cammack S, Chong J, Wang C, Wright C, Rundek T . Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events: findings from the Northern Manhattan Study (NOMAS). Diabetes Care. 2008; 31(6):1132-7. DOI: 10.2337/dc07-0797. View

12.

Giovannucci E, Harlan D, Archer M, Bergenstal R, Gapstur S, Habel L . Diabetes and cancer: a consensus report. CA Cancer J Clin. 2010; 60(4):207-21. DOI: 10.3322/caac.20078. View

13.

Lim H, Zhang X, Dyck R, Osgood N . Methods of competing risks analysis of end-stage renal disease and mortality among people with diabetes. BMC Med Res Methodol. 2010; 10:97. PMC: 2988010. DOI: 10.1186/1471-2288-10-97. View

14.

Saberi H, Mohammadtaghvaei N, Gulkho S, Bakhtiyari S, Mohammadi M, Hanachi P . The ENPP1 K121Q polymorphism is not associated with type 2 diabetes and related metabolic traits in an Iranian population. Mol Cell Biochem. 2010; 350(1-2):113-8. DOI: 10.1007/s11010-010-0687-z. View

15.

Vupputuri S, Nichols G, Lau H, Joski P, Thorp M . Risk of progression of nephropathy in a population-based sample with type 2 diabetes. Diabetes Res Clin Pract. 2010; 91(2):246-52. DOI: 10.1016/j.diabres.2010.11.022. View

16.

Forsblom C, Harjutsalo V, Thorn L, Waden J, Tolonen N, Saraheimo M . Competing-risk analysis of ESRD and death among patients with type 1 diabetes and macroalbuminuria. J Am Soc Nephrol. 2011; 22(3):537-44. PMC: 3060447. DOI: 10.1681/ASN.2010020194. View

17.

Yamagishi S . Cardiovascular disease in recent onset diabetes mellitus. J Cardiol. 2011; 57(3):257-62. DOI: 10.1016/j.jjcc.2011.01.011. View

18.

Wannamethee S, Shaper A, Whincup P, Lennon L, Sattar N . Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med. 2011; 171(5):404-10. DOI: 10.1001/archinternmed.2011.2. View

19.

Chen G, McAlister F, Walker R, Hemmelgarn B, Campbell N . Cardiovascular outcomes in framingham participants with diabetes: the importance of blood pressure. Hypertension. 2011; 57(5):891-7. PMC: 3785072. DOI: 10.1161/HYPERTENSIONAHA.110.162446. View

20.

Koller M, Raatz H, Steyerberg E, Wolbers M . Competing risks and the clinical community: irrelevance or ignorance?. Stat Med. 2011; 31(11-12):1089-97. PMC: 3575691. DOI: 10.1002/sim.4384. View