disease disease
Geiss LS et al. In: Diabetes in America. 2nd ed. 1995; chap 11.
Mortality Due to Heart Disease in Men and Women with or without Diabetes (US)
American Diabetes Association. Economic Consequences of Diabetes Mellitus in the US in 1997. Alexandria, VA: American Diabetes Association, 1998:1-14.
Rate per 1000 person-years
Diabetes 20
17.0
15
14.2
10
6.8 7.6
5
Nondiabetes
Men, cohort 1* Men, cohort 2** Women, cohort 1* Women, cohort 2** 7.4
4.2 2.4 1.9
0
-16.6%
-20.4%
(P=0.12)
Survival Post-MI in Diabetic and Nondiabetic Men and Women: Minnesota Heart Survey
Survival etes
80
n=1628
60 Diabetes
n=228
40
WOMEN 100
No diabetes
80
n=568
60
Diabetes
40
n=156
0 0 20 40 60 80 Months Post-MI
0 0 20 40 60 80 Months Post-MI
Adapted from Sprafka JM et al. Diabetes Care 1991;14:537-543.
17
DM
Non-DM
4 Women
% of Deaths
Mortality in People with Diabetes Causes of Death
50
40
30
20
10
0
Ischemic Other Diabetes Cancer Stroke Infection Other heart heart
(P=0.46)
+10.7%
(P=0.76)
-43.8%
(P<0.001)
*Defined in 1971-1975, followed up through 1982-1984. **Defined in 1982-1984, followed up through 1992-1993. Gu K et al. JAMA 1999;281:1291-1297.
Cardiovascular Mortality in People with Diabetes
% of Deaths (Crude Rate)
60
MEN
WOMEN
28 d – 1 y
50
9.1
Hospitalization – 28 d
40
15.4
4.2
11.1
Out of Hospital
30
Age-adjusted CVD death rate per 10,000 person-years
140
120
No diabetes
Diabetes
100
80
60
40
20
0 None
One only Two only All three
*Serum cholesterol >200 mg/dl, smoking, SBP >120 mmHg Stamler J et al. Diabetes Care 1993;16:434-444
Mortality per 1000 person-years*
35 29.9
30
25
20
19.2
23.0
Diabetes No Diabetes
15
11.5
10
6.3
5
11.0
7.1 3.6
0
Men
Women
Men
Women
All heart disease Ischemic heart disease
*Age-adjusted Adapted from Gu K et al. Diabetes Care 1998;21:1138-1145.
Trends in Mortality Rates for Ischemic Heart Disease in NHANES Subjects with and without Diabetes*
Epidemiology of Insulin Resistance, Diabetes Mellitus, and Coronary Heart Disease
Steven Haffner, MD
Hospitalization Costs for Chronic Complications of Diabetes in the US
Ophthalmic Others disease
Renal disease
Neurologic disease
Peripheral vascular disease
Total costs 12 billion US $
CVD accounts for 64% of total costs
Cardiovascular disease
Framingham Study: DM and CHD Mortality 20-Year Follow-up
Annual CHD Deaths per 1000 Persons
18
16
17
14
12
10
8
6
8
4
2
0
Men
Kannel WB, McGee DL. JAMA 1979;241:2035-2038.
20
28.6
10
9.6 22.1
22.7 10.9
2.8 9.0 11.9
0 Diabetes No Diabetes Diabetes No Diabetes
Adapted from Miettinen H et al. Diabetes Care. 1998;21:69-75.
Influence of Multiple Risk Factors* on CVD Death Rates in Diabetic and Nondiabetic Men: MRFIT Screenees