Study: Excess Mortality in Diabetic Patients

Here is a link to a Finnish papers discussing deaths rates in diabetic patients. This is the underlying paper that is behind all of the non-technical write-ups bombarding the internet today.


Thanks for posting @Chris
These findings aren’t exactly cheery but in some ways I find them slightly more positive than those studies which show excess risk from things like cardiovascular disease. Because ultimately, risk of suicide, accidents and alcohol use are very modifiable risk factors, and it’s actually possible to know pretty well which individuals are at most risk and can potentially intervene. And the intervention isn’t just more of the same – better BG control. It’s kind of refreshing, weirdly, to think of interventions other than insulin and BG management that can help those with diabetes.

Not to say that those risk factors are easy of course. They’re definitely not. But still.

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I agree, the results are not surprising to me, and they are actionable as you mention.

Interestingly, one of the biggest side effects of heart disease is also depression, and it treatable in much the same way. i.e. identify and intervene to help the person. This is an area that our health system in the US doesn’t excel in, but fortunately, involved firends/families can help identify and ask the person to get help.

A great reminder to keep a healthy family and/or friend network alive.

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@Chris, this is a great article, thanks so much for posting it!

Here is a part of the summary I found interesting:

The diabetic subjects had higher mortality at almost all end-points, especially those treated with insulin: the adjusted MRRs for alcohol-related deaths were 1.71 for diabetic men treated with Oral Antidiabetic Drug [T2s] and 6.92 for those on insulin; the respective MRRs for diabetic women were 2.10 and 10.60. There were more accident-related deaths among those treated with insulin (MRRs: 2.06 and 1.53 for men and women, respectively), and more suicides (MRR: 2.10 for men treated with insulin and 1.62 among women treated only with OAD). The results from the cohort study and the case-cohort study were rather similar. A time-dependent effect of diabetes was observed in alcohol-related mortality among men.

The MRR (Mortality Rate ratio) indicates how much mortality is seen in the population in question compared to the average. So, for instance for diabetic men treated with insulin, there were 692% deaths than for non-diabetic men per unit of population compared to 100% for a normal population unit.

So, in summary, what they saw was approximatively:

  • 600% more deaths due to alcohol among insulin-dependent diabetic males (compared to normal population unit)
  • 900% more deaths due to alcohol among insulin-dependent diabetic females
  • 100% more accidental deaths among insulin-dependent diabetic males
  • 50% more accidental deaths among insulin-dependent diabetic females
  • 100% more suicide deaths among insulin-dependent diabetic males

The percentages are much lower among non-insulin-dependent PWDs, yet not negligible.


Nice summary Michel. Sobering really, you could do everything possible for their health by keeping A1c in range and then depression gets them…

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It is a really valid consideration. I’ve often been frustrated that people with diabetes seem to view the world and be viewed by the world entirely through the narrow lens laser focused on blood sugars. As if they’re less complex or complete people because they have blood sugar issues. In reality though they’re complete human beings, with all the stresses, heartaches, triumphs, victories, defeats etc as anyone else has—- plus the constant never ending challenge of managing their blood sugar. It’s easy to lose sight of that.


Did any of you hear from your endos early in the diagnosis/treatment about the psychological impact of the disease?

Sadly I think this is mostly over-looked.

You really can’t stress about the daily issues of the disease. That becomes maddening. You have to play the long game emotionally. Burnout is a real issue.


Nope, not, never, not one little bit! And I was a mental wreck for quite a while after DX and then on a horrible glucose roller coaster for quite a while as I recovered from DKA. Thank goodness for the DOC and for my yoga practice!


we were really lucky to hear about it through D-camp and we went within a few months of diagnosis. But honestly, hearing about other peoples’ experiences makes me a little nervous about the future for Samson. So many of the people I met at D-camp seemed to really struggle for a good long while before getting more on track. It’s hard.

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I know it is different for everyone, but my experience might be close to what Samson will feel, because I was diagnosed at a similar age.

I think it is probably harder to get diagnosed at an older age - as a teenager or adult.

I think it is much easier to get it younger. You don’t really have as much of an adjustment. It’s just a more normal part of life. You grow up watching what you eat, no big deal. As opposed to growing up eating whatever you want and then having to change.

At some point he will have to come to grips with it. Who knows when that will happen. Maybe as a teenager, or young adult, but eventually when the “permanence” of it sinks in, it can be a little tough at first. Once you get past that, it’s much better.

When I was 5, I would gladly take my insulin every day because I thought it would cure me! And then eventually I started to figure out that it wasn’t going anywhere, and it was a bit tough.

But coming to grips with it, and not looking at all the “cure” stuff all the time made it easier for me.

As I have expressed before, I compare it to someone who is in prison. And they have know they have no chance of parole, so rather than getting their hopes up every year at the parole hearing, they just focus on owning their cell block. And eventually you end up being in charge - not only of your cell block, but you own the prison cafeteria, the prison yard, the game room, the workout room, everything. You end up running the entire prison, the prison guards (endos :slight_smile:) do whatever you tell them to do! You can do whatever you want.

Maybe this doesn’t work for everyone, but that’s how I look at it.


I think this is really critical. When I feel support from loved ones, diabetes feels much easier. I’m not talking about support with my diabetes. I’m talking about feeling unconditional love from family and close friends.

It’s very obvious that the parents on this forum are incredibly supportive of their children. Your children may never realize how significant that is because it’ll always be there, but that support is invaluable.


I did. I was at Joslin (the original one) and there, pediatric cases routinely get referred to see their in house psychologists. We met with her as a family, and I saw individually. We probably would have done ok without her, but she definitely helped a lot. It should be a standard part of care IMO, for any newly diagnosed diabetic, especially kids/families.

Also, funny enough, my supervisor for family therapy in my residency year was a supervisee of that psychologist in her training—we both raved about how awesome she is when we realized the overlap.


I agree !

However, when diagnosed in the ‘old days’, diabetes care was a relatively small disruption in my case. Single injection in morning, no candy/sweets, more doctor appts than siblings, awakened in middle of night to be force fed orange juice when I was “sweaty”. This remained the same for me, age 5 through college !

As years went on, I was gradually introduced to new things, BG testing (visual), BG meters (2 min test time), NPH/Reg, exchange diet, A1Cs, faster insulins/MDI, carb counting, insulin pumps, CGMS, all over a period of 25 years after college. Today, the new diabetic needs to learn all this in a short time.

It would seem to also be easier if one is diagnosed, and already familiar with someone else with diabetes, or goes to camp or support groups as soon as possible after diagnosis. When’s the last time a doctor recommended that as part of treatment ?

In my experience, the general public focus is on “not having sweets”, rather than actually knowing blood sugar is key factor. Leads to confusion when diabetic says they "need’ sugar to treat a low, and the uneducated think its not good for us.


Our staff did in fact highly recommend my son go to Diabetes camp that summer. They even had a few spots reserved for their patients that were diagnosed after normal signup had closed.

Best decision we ever made.


Nope. Unless “You’ll be dead by thirty” counts.

None of my endos over 48 years have ever brought it up, nor my family doctors. But my longtime CDE is acutely aware of the need for individuals to find their own healthy, workable balance between living a “normal” life and being focused on diabetes 24/7/365.


That beats “you’ll be blind with no legs in 20 years”.

I had a few doctors give threats like that to inspire me.


I don’t know. I was diagnosed at 19 and never really had any big problem.

I think the main thing psychologically is just accepting it. Learn how to deal with it and then put it in the background.

Of course many are not as physically lucky as I am. That’s where the DOC comes in. It’s all about learning the ropes and then put it on automatic.

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I don’t remember being told directly. But I was given a book called Children Have DIabetes, Too, and it talked a lot about the psychological impact of diagnosis and management.

I never went to diabetes camp. I did, however, have contact with other kids who had diabetes through a local support group and family diabetes education sessions at Children’s Hospital. A local friend of mine from school was also diagnosed several years after I was.