Don’t Take Diabetes Lightly ‒ It Can Even Lead To Suicide

There is a general attitude that diabetes is a treatable disease, that's it's no big deal, that you just take medicine and you have a normal life.

The truth is diabetics have a 2.5 increased rate of death, meaning people with diabetes are 80 percent more likely to die prematurely than those without the disease.

A new British analysis ‒ published in the March 3 issue of the New England Journal of Medicine ‒ confirms that diabetes is associated with higher mortality.

And it's not just diabetes that's killing them. Besides dying from vascular problems caused by diabetes, people with the blood sugar disease are also more likely to die prematurely from many other causes, including cancer, infections, falls, liver disease, mental disorders and even suicide.

Although all the reasons that result in the greater risk of death among diabetics aren't known, high blood sugar and inflammation are key players. These can decrease the body's ability to fight off infections and even cancer.

A team lead by John Danesh, a professor of epidemiology and medicine at the University of Cambridge in the UK analyzed deaths among 820,900 people who took part in 97 studies. Among those in these studies, 123,205 died.

The risk of premature death was closely associated with blood sugar levels, with an excess risk of death at blood glucose fasting levels exceeding 100 milligrams per deciliter. There was no excess risk of death at fasting levels of 70 to 100 mg per dL, the researchers found.

The risk of dying from vascular disease, not surprisingly, was much higher in people with diabetes. But people with diabetes were also at increased risk for death from liver and kidney disease, pneumonia, other infectious diseases and chronic obstructive pulmonary disease, among other ills.

Danesh's team also found that people with diabetes were 25 percent more likely to die from cancer, with scientists finding a moderate association between the disease and death from liver cancer, pancreatic cancer, ovarian cancer, colorectal cancer, and lung, bladder or breast cancer. They were also 70 percent more likely to die from falls than people without diabetes.

In addition, diabetics were 64 percent more likely to die from mental disorders and 58 percent more likely to die from suicide, mostly because they were more likely to be depressed. Indeed, another study showed that management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression - the two are linked not only behaviorally but biologically. (See my post 'Diabetes, Depression Can be a Two-Way Street' here.)

Broken down, the hazard ratios for people with diabetes vs. people without diabetes were:
   * 2.32 for death from vascular causes
   * 1.80 for death from any cause
   * 1.73 for death from other causes
   * 1.25 for death from cancer

Summing up, the study authors write: "These findings highlight the need to better understand and prevent the multi-system consequences of diabetes."

The challenge before researchers therefore is to continue to find a cure and to prevent diabetes ‒ it cannot just be managed with drugs.

Diabetics Who Suffer No Complications To Be Studied

What the current research provides is an admission that the fundamental mechanisms that create the environment for the development of diabetes complications are still very much unknown.

When one is diagnosed with diabetes, the patient is prepared to prevent and avoid the complications from the disease. There have been so many studies and research on diabetes complications. Now, researchers are looking at the problem from a different perspective since they have found diabetics who do not develop complications.

Now the question is, why don’t these diabetics develop complications? A new research is now being conducted to find out. This is called the PROLONG study and is focused on the nearly fifteen percent of all diabetics that live life complications free. The study is headed by Valeriya Lyssenko and Peter Nilsson from Lund University Diabetes Center.

What the current research provides is an admission that the fundamental mechanisms that create the environment for the development of diabetes complications are still very much unknown.

One aspect of the disease though that is very well documented is the damage that the disease wreaks on an individual’s blood vessels. Diabetes does not kill the individual but the complications often do. Among the top of the list of complications is cardiovascular disease, as diabetics have three times of the risk compared to non-diabetics. Smaller blood vessels are damaged. Nearly seventy percent of patients would have suffered from kidney damage leading to end stage renal failure. Many others suffer from eye complications with nearly two percent of these diabetics going blind eventually.

“The blood vessels and other organs of the body become sugar coated and stiff. It is reminiscent of premature biological ageing”, says Peter Nilsson.

The pilot study is being conducted in Skåne, Sweden and is projected to study diabetes patients for the next thirty years. They would be comparing complication developments in patients in specific timelines and observe those that do not develop complications during the whole duration.

Participants would be answering inquiries about their lifestyle and how the disease affects them. Also part of the study would be genetic testing, blood sampling and history reviews. The researchers believe that thirty years would be the turning point for a diabetic since the absence of complications beforehand would not develop complications during the remainder of their lives.

“If we can identify factors protecting these individuals from devastating complications, then it might be possible to develop drugs that can do the same thing,” said Valeriya Lyssenko, who will lead the study. “Clearly they are different and we want to find out what it is that protects them.”