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Comment & Response
March 2015

Mortality Trends in Diabetes Mellitus

Author Affiliations
  • 1Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
  • 2Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
  • 3Diabetes Center, Isala Clinics, Zwolle, the Netherlands
JAMA Intern Med. 2015;175(3):469. doi:10.1001/jamainternmed.2014.7985

To the Editor In this journal, Butala et al1 reported that patients with diabetes had a considerable reduction of in-hospital mortality and even a complete reversal in risk of mortality in an urban US medical center over the last decade.1

Until recently, relative mortality rates in diabetes mellitus were reported to be approximately twice to 4 times as high compared with individuals without diabetes, which were mostly associated with an increased risk of cardiovascular disease. Along the same line as the data of Butala et al,1 the Framingham Heart Study showed a markedly decreased incidence rate for cardiovascular disease in patients with diabetes of almost 50%, probably due to improvement of diabetes care during the years.2 The primary end point in the study of Butala et al1 was in-hospital mortality; unfortunately, causes of death were not specified. Some years ago, we reported that mortality rates in patients with type 2 diabetes mellitus treated for a longer period in a shared care environment in the Netherlands were comparable to that of the general population. Therefore, these findings resulted in comparable life duration outcomes of patients with diabetes and the general population.3 Results of other analyses in the described population point specifically toward improved cardiovascular outcome. Still, a history of cardiovascular disease or the presence of albuminuria was still associated with an increased risk of mortality. Therefore, it would be interesting to be informed regarding possible (changes in) causes of death in the study of Butala et al.1

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