Australians with diabetes are increasingly dying from conditions not usually linked to diabetes, like dementia

A new paper looking at the causes of death among Australians with type 1 and type 2 diabetes highlights dementia and falls are increasing, while deaths from heart disease are declining.

The significant increase in in the proportion of deaths among people with diabetes due to dementia in Australia (a rise of more than 5 percentage points from 2002 to 2019), was mirrored in the United Kingdom, which saw deaths from dementia jump 14 percentage points between 2001 and 2018.

What's more, these findings can only partly be explained by increased life expectancies of people with diabetes and the increased likelihood of developing and dying from age-related diseases. The study also showed a trend in increasing deaths due to dementia in younger ages under 65 years, implicating additional factors that are not age-related.

The study of more than 1.3 million Australians with diabetes by researchers at the Baker Heart and Diabetes Institute shows the causes of death are diversifying, signifying individuals with diabetes, health care practitioners and government need to be more mindful of dementia, falls and even Parkinson's disease, not just traditional complications like heart disease.

Heart disease, however, continues to rank very highly as one of the biggest killers of people with diabetes. It was the leading cause of death for men and women with type 1 diabetes in Australia during this period, as well as women with type 2 diabetes. While cancer has replaced heart disease as the leading cause of death in men with type 2 diabetes.

The study, published in Diabetic Medicine, examined the records of individuals with type 1 or type 2 diabetes who were registered on the National Diabetes Services Scheme between 2002 and 2019.

Researchers say the findings reflect a more diverse range of diabetes complications are at play than has traditionally been acknowledged, something that is being mirrored in the U.S. and the U.K.

Mounting evidence suggests an increased risk of both vascular dementia and Alzheimer's disease among those with diabetes, and a burden of cognitive diseases in younger people with diabetes under 65 years of age.

But in some good news, the findings also likely reflect the great improvements in management of heart disease. The decline in heart disease as a cause of death coincided with an increase in the use of cholesterol-lowering medications, particularly for those with type 2 diabetes, supporting this as a likely factor.

Head of Clinical Diabetes and Epidemiology, Professor Jonathan Shaw says while the study likely reflects improvements in the management of cardiovascular disease, which is really positive news, it also highlights the increasing challenge of dementia, in line with other global studies.

"This suggests people maybe surviving longer, allowing age-related diseases to develop but that dementia and falls need to be well and truly on the radar when it comes to screening and prevention of these conditions as part of diabetes management," Professor Shaw says.

In 2020 the Institute released a report called The dark shadow of type 2 diabetes which shone a light on the far-reaching and lesser-known complications of diabetes. It revealed Australians living with type 2 diabetes have a 60 percent higher chance of developing dementia than those without diabetes and are twice as likely to develop some types of cancer.

"Diabetes increases the risk of numerous other diseases that most people may not understand are linked," Professor Shaw says. "It is important that this message is clear when it comes to prevention, treatment and health care resourcing."