Diabetes increases the likelihood of major cardiovascular events and death, but the increased risk is variable across patients depending on age at diabetes onset, duration of diabetes, glucose control, blood pressure control, lipid control, tobacco control, renal function, microvascular complication status, and other factors. The association of diabetes and increased mortality can be attenuated by cardiovascular risk factor control.[184]Raghavan S, Vassy JL, Ho YL, et al. Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults. J Am Heart Assoc. 2019 Feb 19;8(4):e011295.
https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011295
http://www.ncbi.nlm.nih.gov/pubmed/30776949?tool=bestpractice.com
A HbA1c of 6% to 6.9% (42 mmol/mol to 52 mmol/mol) is associated with the lowest mortality.[184]Raghavan S, Vassy JL, Ho YL, et al. Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults. J Am Heart Assoc. 2019 Feb 19;8(4):e011295.
https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011295
http://www.ncbi.nlm.nih.gov/pubmed/30776949?tool=bestpractice.com
Trends in data for complications in people with diabetes show a declining risk of cardiovascular disease (CVD) and CVD-associated mortality, particularly in high-income countries.[14]Harding JL, Pavkov ME, Magliano DJ, et al. Global trends in diabetes complications: a review of current evidence. Diabetologia. 2019 Jan 31;62(1):3-16.
https://spiral.imperial.ac.uk:8443/bitstream/10044/1/72664/2/Harding_Diabetologia_2018.pdf
http://www.ncbi.nlm.nih.gov/pubmed/30171279?tool=bestpractice.com
When type 2 diabetes is diagnosed at age 40, men lose an average of 5.8 years of life, and women lose an average of 6.8 years of life.[13]Gregg EW, Zhuo X, Cheng YJ, et al. Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985-2011: a modelling study. Lancet Diabetes Endocrinol. 2014 Nov;2(11):867-74.
http://www.ncbi.nlm.nih.gov/pubmed/25128274?tool=bestpractice.com
The overall excess mortality in those with type 2 diabetes is around 15% higher, but ranges from ≥60% higher in younger adults with poor glucose control and impaired renal function, to better than those without diabetes for those who are age 65 and over with good glucose control and no renal impairment.[72]Hansen MB, Jensen ML, Carstensen B. Causes of death among diabetic patients in Denmark. Diabetologia. 2012 Feb;55(2):294-302.
http://www.ncbi.nlm.nih.gov/pubmed/22127411?tool=bestpractice.com
[73]Tancredi M, Rosengren A, Svensson AM, et al. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015 Oct 29;373(18):1720-32.
https://www.nejm.org/doi/full/10.1056/NEJMoa1504347
http://www.ncbi.nlm.nih.gov/pubmed/26510021?tool=bestpractice.com
Cumulative prevalence of vision-threatening diabetic retinopathy in the US is about 4.4% among adults with type 2 diabetes, and appears to be higher for non-Latino black people compared with non-Latino white people (9.3% vs. 3.2%, respectively).[185]Zhang X, Saaddine JB, Chou CF, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010 Aug 11;304(6):649-56.
https://jamanetwork.com/journals/jama/fullarticle/186384
http://www.ncbi.nlm.nih.gov/pubmed/20699456?tool=bestpractice.com
Prevalence of end-stage renal disease (ESRD) is about 1% in those with type 2 diabetes (cross-sectional data), but cumulative prevalence of nephropathy and/or chronic kidney disease is much higher.[186]Centers for Disease Control (CDC). State-specific trends in chronic kidney failure - United States, 1990-2001. MMWR Morb Mortal Wkly Rep. 2004 Oct 8;53(39):918-20.
http://www.ncbi.nlm.nih.gov/pubmed/15470324?tool=bestpractice.com
Incidence rates of ESRD attributed to diabetes are declining; however, continued intervention to detect and manage diabetic kidney disease is required to limit the development of ESRD.[187]Burrows NR, Hora I, Geiss LS, et al. Incidence of end-stage renal disease attributed to diabetes among persons with diagnosed diabetes - United States and Puerto Rico, 2000-2014. MMWR Morb Mortal Wkly Rep. 2017 Nov 3;66(43):1165-70.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6643a2.htm
http://www.ncbi.nlm.nih.gov/pubmed/29095800?tool=bestpractice.com
Effective treatment requires a motivated and informed patient who actively takes responsibility for the care of his or her diabetes, and a healthcare provider team willing to frequently adjust medications to support comprehensive disease management over a long period of time.