Overview of the Disease

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia (high blood sugar levels) resulting from a deficiency in insulin secretion or insulin action, or both. There are two main types of diabetes:

• Type 1 occurs primarily in children or young adults (about 6% of diabetes cases);

• Type 2, which is the most common form (about 92%), occurs mainly in adults but can also develop as early as adolescence.

There are other forms of diabetes, such as gestational diabetes (which occurs during pregnancy and usually resolves after childbirth), or cases of diabetes resulting from specific medical conditions or genetic factors.

Type 2 diabetes can progress without symptoms for several years. Screening is performed on an empty stomach via a blood test to measure blood glucose levels. An abnormal result (above 1.26 g/L or 7 mmol/L) must be confirmed by a second test. Type 2 diabetes can be treated with diet alone, oral antidiabetic medication, and/or insulin injections. As the disease progresses, diabetes can lead to serious complications affecting the heart, blood vessels, eyes, kidneys, and nerves. However, good management of the disease can significantly reduce the risk of complications.

Key figures and results

Since 2002, Santé publique France has implemented an epidemiological surveillance system for diabetes aimed at providing information on the prevalence, severity, and progression of diabetes in France.

More than 3 million people in France are treated with medication (oral antidiabetics and/or insulin) for diabetes.

Overall mortality among people with diabetes aged 45 and older receiving medication decreased by 26% among men and 11% among women between the periods 01/2002–12/2006 and 08/2007–07/2012. This decrease is primarily due to the decline in mortality from cardiovascular diseases, major complications of diabetes.

Excess mortality relative to the general population remained high during the 2007–2012 period for both men (+34%) and women (+51%). Excess mortality decreased between the two periods for men (+53% during the 2002–2006 period) but remained stable for women (+57%). Unlike what is observed among men, excess mortality from cardiovascular disease did not decrease among women between the two periods (+68% over the 2002–2007 period versus +74% over the 2007–2012 period). It remained high for men over the most recent period (+41%).

Both men and women with diabetes aged 45 and older included in the Entred 2001 cohort have a 10-year excess mortality rate, compared to the general population, due to cardiovascular and renal diseases as well as certain cancer sites: pancreas, liver, and colorectal. Among women, excess mortality is observed for uterine cancer, and among men for bladder cancer and leukemia. Furthermore, excess mortality is higher for both sexes for diseases of the digestive system, infectious diseases, and respiratory diseases, including pneumonia. All of these results are consistent with those in the literature.

In addition to the well-known determinants of mortality—male sex and disease severity—the Entred cohorts have highlighted, among people with type 2 diabetes, an association between mortality and socioeconomic status, as well as with modifiable risk factors: obesity, morbid obesity, tobacco use, alcohol consumption, and delayed diagnosis.

Taken together, 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, particularly cardiovascular complications.

Learn more

• Diabetes-related mortality in France. Special issue. Bull Epidémiol Hebd 2016;37-38.

• Diabetes report.