Causes of excess mortality in well adjusted type 2 diabetes mellitus patients. Results From a mortality follow-up in a cohort of disease management program enrolled patients

Andrea Werdecker, University of Marburg
Ulrich O. Mueller, Federal Institute for Population Research (BiB)

Prevention of Diabetes Mellitus Type 2 (T2DM), a global pandemics, is crucial for healthy aging in rich societies. Here, the majority of T2DM cases is diagnosed by screening lab tests with no clinical symptoms present. Most diagnosed T2DM cases (2/3 in Germany) are in managed care programs, well adjusted with systolic blood pressure (SBP) values and long-time-glucose (HbA1c) values considered normal, with oral medication and no insulin. Still, mortality in such well-adjusted patients is substantially higher than in subjects without the disease. Perhaps biomedical parameters considered “normal” in healthy subjects may not be optimal for diabetes patients: Here, the lower or the higher (whatever is better) such values, the better for survival – these were the SPRINT study results: the lower SBP by aggressive medication, the lower was all-cause mortality and cardiovascular morbidity. We have a cluster-randomized, controlled intervention trial with 4 waves, each six months apart, enclosing n=404 T2DM patients in a managed care program, aged 40-69 when recruited 2009-2010. The intervention - feedback of personalized 10years-risk profiles for T2DM typical complications: Heart Infarction, Stroke, Kidney Failure, Blindness, Foot Amputation – was ineffective. Therefore, for studying differential longevity, the study can be considered a uniform observation cohort. An exploratory mortality-follow-up in September 2015, tracing all original patients, will be repeated by the end of 2015. All-cause mortality (n=28+) was threefold as high as expected in the general population. Although numbers are too small for studying single causes of death, T2DM typical complications dominate. SBP, HbA1c, and certain lipid values seem to be strictly monotonic predictors of survival. We conclude: For maximizing survival, Diabetes Mellitus Type 2 patients should be managed not within “normal” parameter corridors, but by aggressively striving for optimal parameter values. This rule may also apply to other chronic conditions relevant for survival and healthy aging.