Causes of death and associated factors among patients with non-insulin-dependent diabetes mellitus in Taipei, Taiwan

A cohort of 766 patients with non-insulin-dependent diabetes mellitus (NIDD M) from a general teaching hospital in Taipei, Taiwan were followed prospec tively to assess survival experience and associated risk factors. Data were abstracted from the medical records and additional information was obtaine d from patients or their closest relatives using a structured questionnaire . Date and cause of death were determined from death certificates. Standard ized mortality ratios were calculated by the direct method. chi(2)-Square t est and Cox's proportional hazard analysis were used to control for potenti al confounders. During a median follow-up of 3.5 years (range 1 month to 4. 6 years), 131 deaths occurred. Of these, 29.8% were due to cardiopulmonary disease (ICD 401-429), 13.0% due to cerebrovascular disease (ICD 430-438), 13.0% due to acute diabetes metabolic complications (250.1, 250.2), and 11. 4% due to nephropathy (580-589). Adjusted for age, people with NIDDM had 2. 2 (95% CI 1.6-2.9) times the risk of death than members of the general popu lation, and cause-specific standardized mortality ratios were: CPD 4.6, nep hropathy 8.8, cerebrovascular disease 1.9, and neoplasm 0.7. Age, fasting p lasma glucose, hypertension, and proteinuria were positively and independen tly associated with all-cause mortality (P < 0.05 for each). Thus, NIDDM pa tients have higher mortality rates than the general population in Taiwan, a nd age, fasting plasma glucose, hypertension, and proteinuria are associate d with this excess risk. Proper application of available interventions may control these factors with a consequent reduction in mortality. Particular attention is needed to prevent deaths from the acute metabolic complication s of diabetes. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.