Mortality patterns in Dutch diabetes outpatients.

Area of Science:

• Endocrinology
• Public Health
• Epidemiology

Background:

• Diabetes mellitus is a leading cause of mortality globally.
• Outpatient populations with diabetes experience higher complication rates compared to general practice.
• Limited research exists on specific mortality patterns within diabetes outpatient settings.

Purpose of the Study:

• To investigate mortality rates, causes of death, and associated predictors in Dutch outpatients with diabetes.
• To analyze mortality trends in relation to specific diabetes types (Type 1 and Type 2).
• To identify risk factors contributing to mortality in this population.

Main Methods:

• A cohort study utilizing data from the Dutch Paediatric and Adult Registry of Diabetes (DPARD) from 2016-2020.
• Linking DPARD data with Statistics Netherlands (CBS) for comprehensive mortality, ethnicity, and education information.
• Employing Cox proportional hazard regression to estimate all-cause and cardiovascular mortality rates.

Main Results:

• High mortality rates observed: 67.7 per 10,000 person-years for adult type 1 diabetes and 324.2 for type 2 diabetes.
• Malignancy was the primary cause of non-cardiovascular death.
• Mortality rates peaked during pandemic years (2018 influenza, 2020 COVID-19).
• Key predictors of all-cause mortality included age, smoking, and impaired renal function (eGFR <60 ml/min).
• Additional risk factors for type 2 diabetes mortality included male sex, low BMI, short diabetes duration, and hypertension.

Conclusions:

• Dutch outpatients with diabetes exhibit elevated mortality.
• Smoking and renal failure are significant mortality predictors in both diabetes types.
• Early detection and management of identified risk factors are crucial for improving clinical outcomes in diabetes care.