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Studies on proportion of death certificates mentioning diabetes in diabetic patients

Studies on proportion of death certificates mentioning diabetes in diabetic patients

Journal of the Japan Diabetes Society 34(3): 213-218

To determine the accuracy of the stated cause of death in diabetic patients, we analyzed 503 death certificates of diabetic patients who were followed up for 9.4 years on average at Osaka Medical Center for Adult Diseases (Osaka, Japan) and died during the observation period. Of the certificates examined, only 213 (42.4%) mentioned diabetes, either as the underlying cause or a contributory condition. The proportion mentioning diabetes was related to the underlying cause of death; it was 18.7% for malignant neoplasms, 40.5% for cerebrovascular disease and 46.9% for disease of the heart, and a high 81.8% for renal disease. The proportion was higher in females (48.7%) than males (39.5%), and a significant difference was observed between the sexes in the proportion for heart disease. The proportion was not significantly related to year of death or age at death. However, it was related to fasting glucose level and type of treatment: 37.8% and 54.4% for patients with FPG < 200 mg/dl and .gtoreq.200 mg/dl, respectively, and 24.1% for those treated with diet therapy, 51.4% for oral hypoglycemic agents and 80.7% for insulin. As a result, it was found that the proportion mentioning diabetes on the death certificate was related to the accompanying complications and severity of diabetes. Based on these results, the actual number of deaths of diabetic patients was estimated to be at least 6.4 times higher than that appearing in mortality statistics, since diabetes as the underlying cause of death was found in 36.8% of all certificates mentioning diabetes in our previous study in Osaka, which corresponded to 42.4% of the observed number of deaths of diabetic patients in the present study.

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