Trends in diabetes-related complications and cause of death in patients with diabetes in England

Date of ISAC Approval: 
06/06/2019
Lay Summary: 
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.
Technical Summary: 
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.
Health Outcomes to be Measured: 
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 Alzheimer's Disease
Collaborators: 

Jonathan Pearson-Stuttard - Chief Investigator - Imperial College London
Dr Ailsa McKay - Collaborator - Imperial College London
Professor Edward Gregg - Collaborator - Imperial College London
Dr Eszter P Vamos - Collaborator - Imperial College London
Dr James Bennett - Collaborator - Imperial College London
Jonathan Pearson-Stuttard - Corresponding Applicant - Imperial College London
Mr Joshua Symons - Collaborator - NHS Digital (HSCIC)
Mahsa Mazidi - Collaborator - Imperial College London
Professor Majid Ezzati - Collaborator - Imperial College London

Linkages: 
HES Admitted;HES Admitted;HES Outpatient;HES Outpatient;ONS;ONS;Patient IMD;Patient IMD;Practice IMD (Standard);Practice IMD (Standard)