Associations of Mortality and Diabetes Complications in Patients With Type 1 and Type 2 Diabetes

Early Treatment Diabetic Retinopathy Study report no. 27

  1. Michael Cusick, MD12,
  2. Annal D. Meleth, BS12,
  3. Elvira Agrón, MA1,
  4. Marion R. Fisher, PHD3,
  5. George F. Reed, PHD1,
  6. Genell L. Knatterud, PHD4,
  7. Franca B. Barton, MSC5,
  8. Matthew D. Davis, MD3,
  9. Frederick L. Ferris III, MD1,
  10. Emily Y. Chew, MD1 and
  11. Early Treatment Diabetic Retinopathy Study (ETDRS) Research Group*
  1. 1National Eye Institute, National Institutes of Health, Bethesda, Maryland
  2. 2Howard Hughes Medical Institute, National Institutes of Health, Bethesda, Maryland
  3. 3Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin
  4. 4Maryland Medical Research Institute, Baltimore, Maryland
  5. 5EMMES, Rockville, Maryland
  1. Address correspondence and reprint requests to Emily Y. Chew, MD, National Institutes of Health, Building 10, CRC, Rm. 3-2531, 10 Center Dr., MSC-1204, Bethesda, MD 20892. E-mail: echew{at}nei.nih.gov

Abstract

OBJECTIVE—Diabetes is a leading cause of morbidity and mortality. The purpose of this study is to assess the associations between diabetes complications and mortality in the Early Treatment Diabetic Retinopathy Study (ETDRS).

RESEARCH DESIGN AND METHODS—We examined demographic, clinical, and laboratory characteristics of the 3,711 subjects enrolled in the ETDRS, a randomized controlled clinical trial designed to evaluate the role of laser photocoagulation and aspirin therapy for diabetic retinopathy. The outcome assessed was all-cause mortality. Multivariable Cox proportional hazards regression was used to assess associations between diabetes complications and mortality for type 1 and type 2 diabetes separately.

RESULTS—The 5-year estimates of all-cause mortality were 5.5 and 18.9% for patients with type 1 and type 2 diabetes, respectively. In patients with type 1 diabetes, amputation (hazard ratio [HR] 5.08 [95% CI 2.06–12.54]) and poor visual acuity (1.74 [1.10–2.75]) remained significantly associated with mortality, after adjusting for other diabetes complications and baseline characteristics. In patients with type 2 diabetes, macrovascular disease and worsening levels of nephropathy, neuropathy, retinopathy, and visual acuity are associated with progressively increasing risks of mortality, after controlling for other baseline risk factors.

CONCLUSIONS—Amputation is the strongest predictor for mortality in patients with type 1 diabetes. All complications independently predict mortality in patients with type 2 diabetes. There is an increased risk for mortality as the degree of each complication worsens. Additional studies are needed to investigate the effectiveness of tertiary prevention to decrease mortality in these patients.

Footnotes

  • *

    ↵* A list of the ETDRS investigators appears at the end of the ETDRS report no. 7 (Ophthalmology 98:741–756, 1991).

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted November 8, 2004.
    • Received September 16, 2004.
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  1. doi: 10.2337/diacare.28.3.617 Diabetes Care March 2005 vol. 28 no. 3 617-625
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