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Diabetes mortality declines as prevalence rises: Danish study.

Declining mortality among diabetic patients may account in part for the rising prevalence of the disease, a finding that calls into question the existence of a "diabetic epidemic," according to Danish researchers.

"The increase in prevalence is largely the result of incidence in absolute numbers being higher than mortality in treated diabetics, rather than as a result of rising incidences," said Henrik Stovring, Ph.D., University of Southern Denmark, Odense, and his colleagues.

They analyzed prescription records for antidiabetic drugs in Fyn County, Denmark (population 470,000), between 1993 and 1999 (Lancet 362[9383]:537-38, 2003).

"We noted an increase in prevalence, nearly constant incidence, and a reduction in mortality," the researchers said. "Mortality also decreased relative to an overall decreasing trend in mortality in the general population."

The annual increase in the combined prevalence of type 1 and type 2 diabetes was 2.6% for women and 4.1% for men, based on logistic regression analysis. The incidence of diabetes increased by only 1.0% per year in women and by 1.5% in men. After adjustment for declining mortality in the general population, mortality among diabetic patients fell at an annual rate of 1.7% in women and 2.1% in men; for men and women combined, this decline in relative mortality was statistically significant.

The findings suggest that decreased mortality among treated diabetic patients plays a role in the higher prevalence. "Although our data do not allow a firm conclusion as to why prevalence is rising, we believe that the decrease in mortality should be taken into account."

In an editorial, Dr. Edwin A.M. Gale, Southmead Hospital, Bristol, England, cited reasons for caution about the findings (Lancet 362[9383]:503-04, 2003). The study could have counted cases twice, and it did not include diabetic patients treated with diet alone. Nor did the study differentiate between type 1 and 2 diabetes. Finally, "earlier use of oral hypoglycemic agents in diet-treated patients will also give a spurious impression of rising incidence, as will earlier diagnosis."
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Title Annotation:Clinical Rounds
Author:Wachter, Kerri
Publication:Internal Medicine News
Geographic Code:1USA
Date:Dec 1, 2003
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