Endocrinology and Diabetology, Abdominal Center, Helsinki University Hospital and the Universities of Helsinki and Eastern Finland, Helsinki, Finland.
Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland.
Eur J Endocrinol. 2018 Oct 12;179(5):299-306. doi: 10.1530/EJE-18-0351.
To characterize the burden of external causes of death attributable to alcohol-related causes, accidents and suicide among diabetic patients in a large national cohort.
The population included diabetic individuals who had purchased and received reimbursement for at least one insulin prescription and/or one oral antidiabetic drug prescription between January 1997 and December 2010, and a non-diabetic reference population matched by sex, age and area. All new insulin users in this period were included, as well as 50% of new oral drug (OAD) users as a random sample. The data were collected by means of linkage from national registries. We analyzed the cohort data using Poisson regression models separately for each end-point and by gender (mortality rate ratio (MRR)). We subjected the case-cohort data to conditional logistic regression analysis based on exposure information within 1 year of the end-point event. The follow-up started on the date of the first diabetes medication prescription and ended on 31 December 2012 or on the date of death.
The study population comprised 434 629 individuals (226 372 men; diabetes population: 208 148 subjects, of whom 76% were treated only with OAD). The mean follow-up time was 7.1 years, during which there were 2832 deaths attributable to alcohol, 3187 to accidents and 853 to suicide. The diabetic subjects had higher mortality at almost all end-points, especially those treated with insulin: the adjusted MRRs for alcohol-related deaths were 1.71 for diabetic men treated with OAD and 6.92 for those on insulin; the respective MRRs for diabetic women were 2.10 and 10.60. There were more accident-related deaths among those treated with insulin (MRRs: 2.06 and 1.53 for men and women, respectively), and more suicides (MRR: 2.10 for men treated with insulin and 1.62 among women treated only with OAD). The results from the cohort study and the case-cohort study were rather similar. A time-dependent effect of diabetes was observed in alcohol-related mortality among men.
The findings from this large nationwide cohort indicate higher mortality attributable to suicide, alcoholrelated causes and accidents among diabetic patients than among the non-diabetic population. The results emphasize the importance of effective psychosocial interventions among high-risk diabetic patients.
在一个大型全国队列中，描述糖尿病患者因酒精相关原因、意外事故和自杀导致的死亡的外部原因负担。
该人群包括 1997 年 1 月至 2010 年 12 月期间至少购买并获得胰岛素处方和/或一种口服抗糖尿病药物处方报销的糖尿病患者，以及通过性别、年龄和地区匹配的非糖尿病参考人群。该时期的所有新胰岛素使用者，以及作为随机样本的 50%新口服药物（OAD）使用者均被纳入。数据通过国家登记处的链接收集。我们使用泊松回归模型分别对每个终点和性别（死亡率比（MRR））对队列数据进行了分析。我们根据终点事件发生前 1 年内的暴露信息，对病例队列数据进行了条件逻辑回归分析。随访从首次开具糖尿病药物处方开始，截止日期为 2012 年 12 月 31 日或死亡日期。
该研究人群包括 434629 人（226372 名男性；糖尿病患者人群：208148 例，其中 76%仅接受 OAD 治疗）。平均随访时间为 7.1 年，在此期间，归因于酒精的死亡有 2832 例，归因于事故的有 3187 例，归因于自杀的有 853 例。几乎所有终点都有更高的糖尿病患者死亡率，尤其是接受胰岛素治疗的患者：接受 OAD 治疗的糖尿病男性患者的酒精相关死亡的调整 MRR 为 1.71，接受胰岛素治疗的患者为 6.92；相应的女性糖尿病患者的 MRR 分别为 2.10 和 10.60。接受胰岛素治疗的患者发生事故相关死亡的人数更多（MRR：男性分别为 2.06 和 1.53，女性分别为 1.53），自杀人数也更多（MRR：男性接受胰岛素治疗的为 2.10，女性仅接受 OAD 治疗的为 1.62）。队列研究和病例队列研究的结果非常相似。男性中观察到酒精相关死亡率存在糖尿病的时间依赖性效应。
这项来自大型全国队列的研究结果表明，与非糖尿病人群相比，糖尿病患者因自杀、酒精相关原因和事故导致的死亡率更高。这些结果强调了对高风险糖尿病患者进行有效社会心理干预的重要性。
