HbA1c 3 months after diagnosis predicts premature mortality in patients with new onset type 2 diabetes

To determine 5-year mortality rates, following the diagnosis of Type 2 diabetes, in a large local cohort of individuals with new onset of Type 2 diabetes seen within a few weeks of diagnosis in a single, community-based education programme.

We reviewed referrals for people with Type 2 diabetes to our service over 5 years from 1999 to 2003 and determined, via regression analysis, which factors contributed significantly to mortality rates up to the end of 2007.

A total of 3781 new referrals were reviewed with an approximate doubling of referral rates over 5 years (546 in 1999-997 in 2003). Although the number of people developing the condition has increased, mortality rates over the 5 years from diagnosis has fallen from 11% in 1999-9% in 2003 (P < 0.005) Age at diagnosis was the strongest predictor of mortality (P < 0.001) but HbA(1c) at 3 months after diagnosis (P < 0.001), systolic (P < 0.001) and diastolic (P = 0.05) blood pressure, smoking status (P < 0.001) and gender (P = 0.04) were also significant predictors.

Our retrospective analysis adds weight to evidence suggesting that referral rates for people with Type 2 diabetes are increasing rapidly and that mortality rates are reducing but that the reasons for this are multifactorial. In addition to blood pressure, smoking and gender, the HbA(1c) achieved 3 months after the initial diagnosis also appears to predict subsequent mortality. It may be appropriate to consider early and intensive intervention for individuals with new onset type 2 diabetes.