EXPLAINING THE DECLINE IN EARLY MORTALITY IN MEN AND WOMEN WITH TYPE 2 DIABETES. Population-based cohort study

Abstract

Objective: To test the hypothesis that changing utilisation of lipid-lowering, antihypertensive and oral hypoglycemic drugs may be associated with trends in all-cause mortality in men and women with type 2 diabetes.

Research design and methods: Cohort study in 197 general practices in the UK General Practice Research Database including 48,579 subjects with type 2 diabetes first diagnosed between 1996 and 2006. Measures included all-cause mortality; prescription of hypoglycemic, lipid lowering and antihypertensive drugs.

Results: From 1996 to 2006 incidence of type 2 diabetes increased and the mean age at diagnosis declined in women. Prescription of statins within 12 months of diagnosis increased (1996, women 4.9% men 5.1%; 2005, women 63.5%, men 71.0%), as did drugs acting on the renin-angiotensin system (1996, women 19.4%, men, 21.5%; 2005, women 45.5%, men 54.6%) and metformin (1996, women 19.1%, men 15.8%; 2005, women 45.5%, men 42.8%) while prescription of sulphonylureas declined. All-case mortality in the first 24 months following diabetes diagnosis declined in men from 47.9 per 1000 person years for subjects diagnosed in 1996 to 25.2 in 2006, and women from 37.4 in 1996 to 27.6 in 2006. In a multiple regression model adjusting for age and comorbidity, prescription of statins before or after diagnosis, renin-angiotensin system drugs before or after diagnosis and metformin after diagnosis were associated with lower mortality.

Conclusion: Widespread implementation of more effective prescribing to control lipids, blood glucose and blood pressure may have contributed to recent declines in early mortality in men and women with type 2 diabetes.