Factors Associated with Mortality Among People with Type 2 Diabetes. Entred Cohorts, France, 2002–2013.

Introduction: Mortality among people with diabetes remains high in France, as does their excess mortality compared to the general population. In this context, understanding the determinants of mortality among people with diabetes—a topic that has received little attention in France—is essential. The objective of our study was to investigate the determinants of mortality among people with type 2 diabetes. Methods: The study population consisted of people with type 2 diabetes who completed a self-administered questionnaire as part of the Entred 2001 or Entred 2007 surveys. Participants were followed through February 2013. Survival analyses were performed using a Cox model with age as the time scale. A subgroup analysis was conducted on individuals whose physician had completed a questionnaire. Results: Among the 7,218 individuals included, the mean ages at enrollment and at death were 65 and 72 years, respectively. The proportion of deaths was 21%. In multivariate analysis, the determinants of mortality were: non-morbid obesity (RR=1.21, 95% CI: [1.02–1.43]) and morbid obesity (RR=1.76 [1.43–2.18]), a diagnosis of diabetes based on symptoms (RR=1.19 [1.03–1.37]) rather than screening, and tobacco use (RR=1.49 [1.26–1.77]), as well as male gender (RR=1.76 [1.53–2.02]), belonging to the Entred 2007 cohort compared to Entred 2001 (RR=0.84 [0.74–0.95]), socioeconomic status (with an increased risk particularly among manual workers (RR=1.36 [1.11-1.67]) compared to managers), having a long-standing condition (RR=1.29 [1.08-1.54]), treatment with insulin alone (RR=1.45 [1.21–1.74]) or with insulin combined with one or more oral antidiabetics (RR=1.37 [1.12–1.68]) compared to treatment with a single oral antidiabetic, and severe foot or kidney complications (RR=1.97 [1.68–2.31]) and coronary complications (RR=1.39 [1.22–1.59]). Conclusion: Some of the identified determinants are largely modifiable. These results underscore the importance of prevention, which must involve tailored therapeutic education to modify the lifestyle of people with type 2 diabetes and improve the management of complications. This prevention must be tailored to the socioeconomic profile of the person with diabetes in order to reduce the social inequalities observed in diabetes-related mortality.

Author(s): Piffaretti C, Fagot Campagna A, Rey G, Antero Jacquemin J, Latouche A, Mandereau Bruno L, Fosse Edorh S

Publishing year: 2016

Pages: 681-90

Weekly Epidemiological Bulletin, 2016, n° 37-38, p. 681-90

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