Diabetes is more common and has a much larger effect on mortality in Mexico than in major high-income countries according to a study published Nov. 16 in the New England Journal of Medicine. The study found that cases of diabetes in Mexico – a middle-income country with high levels of obesity, high rates of diabetes, and poor glycemic control – are associated with significantly worse prognoses than cases in higher-income countries.

Researchers analyzed data from approximately 50,000 men and 100,000 women ages 35 years and older in Mexico City, Mexico, between 1998 and 2004. Diabetes was accepted as the underlying cause of death only when the deaths were directly due to acute diabetic crises. Estimates of rate ratios were made for deaths among participants who had diabetes at recruitment vs. those who did not. Data from participants who had chronic diseases other than diabetes were excluded from the main analysis.

Overall findings showed diabetes accounting for at least one-third of deaths for individuals ages 35 to 74. After adjusting for other risk factors, the rate of death from any cause between 35 and 74 years of age was approximately four times higher among participants with diabetes than those without diabetes. In contrast, meta-analyses of prospective studies from mostly high-income countries showed that persons with diabetes had less than twice the rate of death from any cause as those without diabetes.

Additionally, by 60 to 74 years of age, approximately 24 percent of participants received a medical diagnosis of diabetes, as compared with approximately seven percent in the United Kingdom and approximately 15 percent in the U.S. Researchers also noted that eight percent of all deaths among study participants previously diagnosed with diabetes were due to acute diabetic crises, as compared with less than one percent of deaths among persons with diabetes in the U.S. In contrast to previous studies, rate ratios for deaths from any cause were similar in men and women, which could be a reflection of similar glycemic control and duration of diabetes.

“A probable explanation for our more marked rate ratios for deaths from any cause is inadequate medical care, including poor glycemic control,” the authors said. “More than one third of participants with diabetes diagnosed before recruitment had a baseline glycated hemoglobin level of greater than 10 percent, as compared with only approximately five percent of persons with diagnosed diabetes in cohorts from high-income countries.”

Mexico recently introduced its National Strategy for Overweight, Obesity and Diabetes, a comprehensive program that includes health education, improved opportunities for exercise, the taxation of sugary drinks and high-calorie foods, and earlier identification and monitoring of diabetes and other risk factors. However, moving forward, the authors suggest improved and more aggressive health care delivery targeted toward reducing instances of diabetes and its related diseases.

Keywords: Cause of Death, Chronic Disease, Developing Countries, Diabetes Mellitus, Lipoatrophic, Exercise, Health Education, Glycated Hemoglobin A, Mexico, Obesity, Overweight, Prognosis, Prospective Studies, Risk Factors

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