Diabetes accounts for more than one in 10 deaths among the bulk of the population in England, it has been claimed.

In most cases the disease kills indirectly by leading to strokes, heart attacks or kidney failure. Often it is not recorded on death certificates. For this reason the number of deaths attributable to diabetes has consistently been underestimated, say experts.

The new figures compiled by the charity Diabetes UK indicate that the disease is responsible for 11.6% of deaths among 20 to 79-year-olds in England. They were calculated by combining research evidence, diabetes prevalence estimates and population and mortality data.

Adults under 80 with diabetes were twice as likely to die as those without the condition, said the charity. It predicted that if current trends continued, one in eight deaths in the same age group would be attributable to diabetes by 2010.

Douglas Smallwood, chief executive of Diabetes UK, said: “These new figures are truly alarming and confirm that diabetes is one of the biggest health challenges facing the UK today. There are currently 2.3 million people diagnosed with diabetes and more than half a million people are unaware they have the condition.

“Good self-management, awareness, and improved access to specialist diabetes care services are crucial if we are to curb this growing health crisis and see a reduction in the number of people dying from diabetes and complications attributed to the condition.”

The vast majority of people with diabetes have the “type 2″ version of the disease, which is associated with unhealthy lifestyles and obesity. Primary Care Trusts (PCTs) with the highest percentage of diabetes-attributable deaths were in areas with a higher than average proportion of people over the age of 40.

They also tended to have large numbers of older people of Asian and Afro-Caribbean origin who are at greater risk of type 2 diabetes. Poverty was another characteristic of regions with a high diabetes death rate.

The percentage of diabetes-attributable deaths varied between 9% in affluent Buckinghamshire to 17% in deprived Newham, east London. Around 80% of people with diabetes die as a result of heart and artery disease. High blood sugar levels can damage blood vessels, resulting in a stroke or heart attack.

Diabetes is also the main cause of end-stage renal failure, an irreversible decline in kidney function. The disease is directly responsible for death on relatively rare occasions.

Developing diabetes before age 65 and greater severity of diabetes may be important in the development of mild cognitive impairment among individuals in their 70s and 80s, researchers from the Mayo Clinic in Rochester, Minnesota, report.

The term “mild cognitive impairment” describes a transitional stage between normal aging and dementia, the researchers explain in a report published today. Previous studies have shown a link between mild cognitive difficulties and diabetes. Poor control of blood sugar over time may lead to loss of brain cells, and diabetes increases the risk of cardiovascular disease and stroke, which also may increase the risk of cognitive impairment.

Dr. Rosebud O. Roberts and colleagues studied 1,969 people who were between 70 and 89 years old and free of dementia in 2004. A total of 356 of them were diabetic.

According to the team, rates of diabetes were similar among the 329 individuals with mild cognitive impairment (20.1 percent) and the 1,640 individuals without mild cognitive impairment (17.7 percent).

However, mild cognitive impairment was associated with developing diabetes before age 65, having diabetes for 10 years or longer, being treated with insulin and having diabetes complications.

Severe diabetes mellitus is more likely to be associated with chronic high blood sugar, which, in turn, increases the likelihood of disease in the small blood vessels of the brain and may contribute to brain cell damage and cognitive impairment, the investigators suggest.

That individuals with the eye disease known as diabetic retinopathy were twice as likely to have mild cognitive impairment supports the theory that diabetes-related damage to blood vessels in the brain may contribute to the development of cognitive problems, they say.

SOURCE: Archives of Neurology, August 11, 2008.