The number of people with diabetes in the UK has increased substantially over past decades to almost 4 million with increasing costs to the health service. Diabetes increases the risk of disability and premature death. Additionally, diabetes increases the risk of developing, and subsequently dying from, several other conditions including heart disease, stroke, kidney disease, common cancers and dementia.
Death rates among those with common complications of diabetes such as heart disease and stroke have reduced substantially over the past four decades in the UK, increasing the number of years lived with diabetes leading to an increased risk of developing a wider range of complications. This can affect the quality of life in this patient group, and increase the demand upon health services.
This study aims to estimate trends in diabetes-related complications and mortality in patients with diabetes in England over the past 20 years and compare to the non-diabetes population. This research will inform the provision of health services, management and prevention of diabetes and diabetes-related complications.
Aim, Study, Design, key variables, analytical method
This study aims to estimate the trends in diabetes-related complications and cause of death in patients with diabetes in England 1998-2017 and compare with the non-diabetes population.
Study design
This study uses a historical open cohort study to develop an analytic, dynamic cohort to examine age-specific incidence and mortality rates and compare between the diabetes and non-diabetes population. We will estimate the trends in diabetes related complications and cause of death in patients with diabetes over a 20-year period and then compare incidence and mortality rates and rate ratios with the non-diabetes population.
The exposure of interest is diabetes (both type 1 and type 2 diabetes) and key outcomes of interest are diabetes-related complications, including microvascular and macrovascular disease, cancer and dementia and cause-specific mortality, including microvascular and macrovascular disease, cancer, dementia, chronic lower respiratory disease, chronic liver disease, respiratory failure including due to pneumonia, influenza, sepsis, intentional self-harm and accidents.
The primary cohort is those with diabetes (type 1 or type 2) in each of the 20-years in the study to identify diabetes-related complications and cause of death during follow up. We will additionally have a non-diabetes cohort to provide comparison (rate ratios) with the diabetes population.
The primary analytic method will be discrete Poisson regression with year, age at follow up and event status (for diabetes-related complication, not for mortality) as time dependent variables. Key outcome measures will include incidence rate, mortality rate, and rate ratios comparing the diabetes and non-diabetes populations.
Incidence of diabetes-related complications:
Acute Myocardial Infarction
Coronary artery bypass graft
Primary cutaneous intervention
Stroke (ischaemic and haemorrhagic)
Chronic Obstructive Pulmonary Disease
Nephropathy
End stage Renal disease
Non-traumatic lower extremity Amputation
Peripheral neuropathy
Retinopathy
Dementia
All cancer and site-specific cancer
Cause-specific mortality
Malignant neoplasm of liver and intrahepatic bile ducts
Malignant neoplasm of colon, rectosigmoid junction and rectum
Malignant neoplasms of digestive organs except liver and intrahepatic bile ducts or colorectal
Malignant neoplasms of lymphoid, haematopoietic and related tissue
Malignant neoplasm of trachea, bronchus and lung
Malignant neoplasm of prostate
Malignant neoplasm of breast
Malignant neoplasm of cervix
Malignant neoplasm of pancreas
Malignant neoplasm of endometrium
All other neoplasms
Respiratory
Diabetes
Acute Myocardial Infarction
Other ischaemic heart disease
Stroke (cerebrovascular)
Liver disease
Renal failure
Other circulatory
Intentional Injury - Self-harm
Unintentional Injury
Dementia and Alzheimers Disease
Jonathan Pearson-Stuttard - Chief Investigator - Imperial College London
Jonathan Pearson-Stuttard - Corresponding Applicant - Imperial College London
Ailsa McKay - Collaborator - Imperial College London
Edward Gregg - Collaborator - Imperial College London
Eszter P Vamos - Collaborator - Imperial College London
James Bennett - Collaborator - Imperial College London
Mahsa Mazidi - Collaborator - Imperial College London
Majid Ezzati - Collaborator - Imperial College London
Joshua Symons - Collaborator - NHS Digital ( HSCIC )
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation