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Are the Different Diabetes Subgroups Correlated With All-Cause, Cancer-Related, and Cardiovascular-Related Mortality?
Peng-Fei Li1,2, Wei-Liang Chen3,4,5
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical School, Taipei, Taiwan, Republic of China.
Insights
The mild age-related diabetes (MARD) subgroup showed higher cardiovascular disease (CVD) mortality compared to mild obesity-related diabetes (MOD). All-cause and cancer mortality rates were similar across diabetes mellitus (DM) subgroups, but retinopathy risk was higher in severe autoimmune diabetes (SAID) and severe insulin-deficient diabetes (SIDD) groups.
Area of Science:
- Endocrinology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in people with diabetes mellitus (DM).
- Previous research has not differentiated CVD mortality risk among distinct DM subgroups.
Purpose of the Study:
- To investigate all-cause, CVD-related, and cancer-related mortality across five defined diabetes mellitus subgroups.
- To assess the risk of retinopathy and nephropathy in these subgroups.
Main Methods:
- Analysis of data from 712 adults (age ≥ 20 years) in the National Health and Nutrition Examination Survey III (NHANES III).
- Evaluation of mortality risks (all-cause, CVD, cancer) and complication risks (retinopathy, nephropathy) using hazard ratios (HRs) and odds ratios (ORs) across five DM subgroups: severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD).
Main Results:
- The mild age-related diabetes (MARD) subgroup exhibited a trend towards higher CVD-related mortality compared to the mild obesity-related diabetes (MOD) subgroup (HR=4.75, P=0.04).
- No significant differences in all-cause or cancer-related mortality were observed across the DM subgroups.
- Severe autoimmune diabetes (SAID) and severe insulin-deficient diabetes (SIDD) subgroups showed increased odds of retinopathy compared to MARD (OR=2.38, P=0.02 and OR=3.34, P=0.001, respectively).
- Nephropathy risk did not differ significantly among the subgroups.
Conclusions:
- The mild age-related diabetes (MARD) subgroup may face a higher risk of cardiovascular mortality.
- Retinopathy risk is elevated in severe autoimmune diabetes (SAID) and severe insulin-deficient diabetes (SIDD) compared to MARD.
- Diabetes mellitus classification into specific subgroups is crucial for understanding differential mortality and complication risks.
Context:
Numerous studies have shown that cardiovascular disease (CVD) represents the most important cause of mortality among people with diabetes mellitus (DM). However, no studies have evaluated the risk of CVD-related mortality among different DM subgroups.
Objective:
We aimed to examine all-cause, CVD-related, and cancer-related mortality for different DM subgroups.
Design, Setting, Patients, And Interventions:
We included participants (age ≥ 20 years) from the National Health and Nutrition Examination Survey III (NHANES III) data set. We evaluated the risks of all-cause and cause-specific (CVD and cancer) mortality among 5 previously defined diabetes subgroups: severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD).
Primary Outcome Measure:
The hazard ratios (HRs) for all-cause and cause-specific (CVD and cancer) mortality were measured for each of the 5 DM subgroups. We also evaluated the odds ratios (ORs) for retinopathy and nephropathy in each subgroup.
Results:
A total of 712 adults were enrolled and the median follow-up time was 12.71 years (range, 0.25-18.08 years). The number of deaths in the 5 subgroups (SAID, SIDD, SIRD, MOD, and MARD) were 50, 75, 64, 7, and 18, respectively, and the number of CVD-related deaths in the 5 subgroups was 29, 30, 26, 2, and 11, respectively. Compared to the MOD subgroup, the adjusted HRs and 95% CIs of CVD-related mortality for the SAID, SIDD, SIRD, and MARD subgroups were 3.23 (95% CI, 0.77-13.61), 2.87 (95% CI, 0.68-12.06), 2.23 (95% CI, 0.53-9.50), and 4.75 (95% CI, 1.05-21.59), respectively (the HR for the MARD subgroup had a P value of .04). In addition, compared to the MARD subgroup, the adjusted ORs and 95% CIs for retinopathy in the SAID and SIDD groups were 2.38 (95% CI, 1.13-5.01, P = .02) and 3.34 (95% CI, 1.17-6.88, P = .001), respectively. The ORs for nephropathy were nonsignificant.
Conclusions:
Our study of patients from the NHANES III data set indicated that among the different DM subgroups, the MARD subgroup tended to have a higher CVD-related mortality than the MOD subgroup. The all-cause and cancer-related mortality rates were similar across the different diabetes subgroups. In addition, compared to the MARD subgroup, the SAID and SIDD subgroups had a higher retinopathy risk, but there was no difference in nephropathy among the subgroups.
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