Mortality trends and causes of death in diabetic patients.

Although national mortality statistics for diabetes mellitus are often quoted in the literature, problems with their validation need to be overcome. They are based upon the assignment of diabetes as the so-called "underlying cause of death", which has several limitations when applied to studies of diabetes mortality. The EURODIAB Sub-Area C study group has carried out simulation studies which indicate that European variations in physicians' certifying practices and national coding procedures could explain about 35% of the variation in published European mortality rates for diabetes. Some of these problems can be overcome by the use of a "multiple-cause" encoding procedure which is recommended for monitoring of the targets of the St Vincent Declaration Action Programme for Europe. Studies of specific causes of death in cohorts of subjects with insulin-dependent diabetes mellitus indicate that many of these premature deaths are potentially avoidable. The major cause of death in patients with non-insulin-dependent diabetes continues to be cardiovascular disease. Studies in England and Wales indicate the diabetic patients are not experiencing the same fall in cardiovascular mortality as that experienced by the general population.