Long-term diabetes--associated factors in survivorship and mortality.

Patients with long standing diabetes mellitus were analysed in order to identify associated factors in survivorship and mortality. Two population-based investigations were performed. In the Erfurt district all 20 years' survivors (208 patients, survival time up to 42 years) were studied longitudinally. Within the total diabetic population of the GDR all 40 years' survivors (159 patients, survival time up to 59 years) were investigated cross-sectionally in a multicentre study. During a 12-year follow-up a 2,6 fold excess mortality was registered. Although most patients in both studies were insulin-treated type-1 diabetics, death due to renal failure was observed only in 7%. In general the appearance of macroangiopathy was considerably postponed. Coronary heart disease represented the main cause of death (41.9%). Taking together both studies, to successfully overcome several decades of diabetes appears to be associated with age, age of onset, body weight, blood pressure, daily insulin dose, serum triglycerides, dietetic adherence and degree of compliance. In long-term diabetics, duration of illness exerts no prognostic influence. Some patients have survived for even half a century of diabetes despite additional atherogenic risk factors and bad compliance. Obviously, long-term diabetes is a multifactorial event including protective mechanisms yet unknown. Most long-term studies in diabetes so for have been based on case material from specialized centres (Oakley et al. 1974, Paz-Guevara et al. 1975, Dekkert et al. 1975) or have been performed without an epidemiologic background (Chazan et al. 1970, Ryan et al. 1970, Cochran et al. 1979). Due to unavoidable selection factors those studies do not provide representative samples of the diabetic population.(ABSTRACT TRUNCATED AT 250 WORDS)