Associations of Mortality and Diabetes Complications in Patients With Type 1 and Type 2 Diabetes: Early Treatment Diabetic Retinopathy Study report no. 27

• Published in: Diabetes care Vol. 28; no. 3; pp. 617 - 625
• Main Authors: Cusick, Michael, Meleth, Annal D, Agrón, Elvira, Fisher, Marion R, Reed, George F, Knatterud, Genell L, Barton, Franca B, Davis, Matthew D, Ferris, Frederick L, Chew, Emily Y
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.03.2005
• Subjects: Adult; Age Factors; Biological and medical sciences; Care and treatment; Complications and side effects; Continental Population Groups; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - mortality; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Diabetic Neuropathies - epidemiology; Diabetic Neuropathies - mortality; Diabetic retinopathy; Diabetic Retinopathy - epidemiology; Diabetic Retinopathy - mortality; Evaluation; Female; Health risk assessment; Humans; Male; Medical sciences; Medical treatment; Middle Aged; Morbidity; Mortality; Ophthalmology; Patients; Probability; Retinopathies; Risk factors; Sex Characteristics; Survival Analysis; United States; United States - epidemiology; Visual Acuity; United States; North America; America; Endocrinopathy; Type 2 diabetes; Human; Immunopathology; Prognosis; Retinopathy; Mortality; Cardiovascular disease; Metabolic diseases; Autoimmune disease; Epidemiology; Arteriopathy; Eye disease; Surgical amputation; Type 1 diabetes; Complication; Predictive factor; Public health
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.28.3.617

OBJECTIVE:--Diabetes is a leading cause of morbidity and mortality. The purpose of this study is to assess the associations between diabetes complications and mortality in the Early Treatment Diabetic Retinopathy Study (ETDRS). RESEARCH DESIGN AND METHODS--We examined demographic, clinical, and laboratory characteristics of the 3,711 subjects enrolled in the ETDRS, a randomized controlled clinical trial designed to evaluate the role of laser photocoagulation and aspirin therapy for diabetic retinopathy. The outcome assessed was all-cause mortality. Multivariable Cox proportional hazards regression was used to assess associations between diabetes complications and mortality for type 1 and type 2 diabetes separately. RESULTS:--The 5-year estimates of all-cause mortality were 5.5 and 18.9% for patients with type 1 and type 2 diabetes, respectively. In patients with type 1 diabetes, amputation (hazard ratio [HR] 5.08 [95% CI 2.06-12.54]) and poor visual acuity (1.74 [1.10-2.75]) remained significantly associated with mortality, after adjusting for other diabetes complications and baseline characteristics. In patients with type 2 diabetes, macrovascular disease and worsening levels of nephropathy, neuropathy, retinopathy, and visual acuity are associated with progressively increasing risks of mortality, after controlling for other baseline risk factors. CONCLUSIONS:--Amputation is the strongest predictor for mortality in patients with type 1 diabetes. All complications independently predict mortality in patients with type 2 diabetes. There is an increased risk for mortality as the degree of each complication worsens. Additional studies are needed to investigate the effectiveness of tertiary prevention to decrease mortality in these patients.