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Main arrow Archive of previous Issues arrow ╣5 2012 (27) arrow The problem of diabetes mellitus recording while diagnostics of death causes
The problem of diabetes mellitus recording while diagnostics of death causes Print
Tuesday, 11 December 2012

D.O. Roschin1, T.P. Sabgayda2, G.N.Evdokushkina2
1Federal hospital of Russian Academy of Sciences, Troitsk, Moscow region
2Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow

Summary. Russia enters the ôbig tenö of nations with greatest number of diabetes mellitus, while mortality from it ranges rather low in official statistics. That indicates an evident under-registration of diabetes mellitus as a cause of death. The aim of this study is to analyze the frequency of diabetes indications while death causes diagnostics.

Two approaches were applied. First, three ôscience-orientedö towns of Moscow region (Chernogolovka, Pushkino, and Troitsk) were screened through this study, and a comparison of death certificates (Form No.106/ˇ-08) with medical records of dead patients of the only in-patient facilities of those towns was performed. Second, death certificates (Form No.106/ˇ-98) from the regions of Tver, Tula, and Kaluga were also enrolled in this study, and the subclauses a), b), c) of the clause N18 of those death certificates (Form No.106/ˇ-98) were investigated into. The morbidity and mortality from diabetes mellitus in 1994-2010 were investigated into for those three regions. Microsoft Office Access 2003 and Microsoft Office Excel 2003 software were used for data processing.

In case of in-hospital mortality, about one quarter of the dead patients had had diabetes mellitus in medical records, while it had never been officially proclaimed among causes of death, save one case with diabetes mellitus stated as underlying cause of death. Mostly, while death causes diagnostics clinical approach in applied. Lack of determination in persons who establish cause of death to give an evaluation of population health results in perception of diabetes mellitus as a background disease and not as a primary cause of disorders of organs and systems functioning leading to lethal outcomes from causes of different classes.

The mathematical frequency of inclusion of diabetes mellitus in causes of death in issued medical certificates of death surveyed into in this study was one order of magnitude less than it had been in overall morbidity with diabetes mellitus of the adult population.

In the regions of Tver and Kaluga where morbidity and mortality in diabetes mellitus were similar to the all-Russia indicators, diabetes mellitus was very rarely mentioned in death certificates, namely: in 1.3% and 1.9% of issued certificates, respectively, while in the region of Tula where morbidity was higher, it was mentioned in 2.5% certificates.

Distribution of number of records indication presence of diabetes mellitus in death certificates doesnĺt coincide with the frequency of diabetes complications. Apart from endocrine diseases the most often such records were found in cases of deaths from diseases of the skin and subcutaneous tissue and from diseases of the musculoskeletal system and connective tissue. In case of diseases of the skin and subcutaneous tissue, respiratory and digestive diseases input of diabetes-associated deaths in females is by 1.2-1.9 times higher than in males; in case of infections, Ill-defined and unknown causes of mortality and traumas and poisonings ľ by more than 8 times.

The problem of diabetes mellitus still has no adequate social perception as concerns health status of the population, and a vicious circle is formed when underestimation of social and medical implications of diabetes mellitus evokes not a rare inclination of a corresponding official to skip it in medical certificates of death being issued. This leads to a lack of attention of public health authorities to the problems of prevention of diabetes mellitus and enhancement of medical care quality for patients with diabetes mellitus. The whole situation makes for underestimation of diabetes mellitus for the state of health of the population, experts of public health also being mystified as concerns this problem. The first obligatory step for breaking the vicious circle is compulsory registration of diabetes mellitus while death causes diagnostics.

Keywords. Problem of diabetes mellitus in public health; coding of causes of death; perception of diabetes problem; mortality in diabetes mellitus; in-hospital lethality of patients with diabetes mellitus; evaluation of completeness of revelation of mortality from diabetes mellitus; diabetes mellitus-related mortality; filling-in of medical death certificates.


  1. Ametov A.S., Karpova Ye.V., Ivanova Ye.V. Sovremennyye podkhody k upravleniyu sakharnym diabetom 2-go tipa (obzor) [The current approaches to management of type 2 diabetes mellitus (review)]. Terapevticheskiy arkhiv 2009;81; (10):20-27.
  2. Dedov I.I. Shestakova M.V. Sakharnyy diabet [Diabetes mellitus]. M.:Universum Pablishing. 2003; 282 p.
  3. Doskina Ye.V. Prichiny neudach v kompensatsii patsiyentov s sakharnym diabetom 2 tipa. Rol postprandialnoy glikemii [The reasons of failures in compensation of patients with type 2 diabetes mellitus. The role of postprandial glycemia]. Sakharnyy diabet 2010;(1):129-132.
  4. Mazovetskiy A.G., Velikov V.K. Sakharnyy diabet [Diabetes mellitus]. M.: Meditsina; 1987. 284 p.
  5. Maslova O.V., Suntsov Yu.I. Epidemiologiya sakharnogo diabeta i mikrososudistykh oslozhneniy [Epidemiology of diabetes mellitus and microvascular complications]. Sakharnyy diabet 2011;(3):6-12.
  6. Nikolayev N.A. Optimizatsiya terapii bolnykh IBS v sochetanii s arterialnoy gipertoniyey [Optimization of therapy for patients with ischemic heart diseases combined with arterial hypertension]. Sakharnyy diabet 2008;(1):20-25.
  7. Prikaz ministerstva zdravookhraneniya i sotsialnogo razvitiya Rossiyskoy Federatsii ot 26 dekabrya 2008 g. N 782n "Ob utverzhdenii i poryadke vedeniya meditsinskoy dokumentatsii, udostoveryayushchey sluchai rozhdeniya i smerti" [ôOn approving the procedure for maintenance of the medical records certifying birth and mortality casesö, the Order of the Ministry of Health Social Development of the RF of 2008, December 26, N782Ý]. [Internet]. 1998 [cited 2012 Aug 3]. Available from: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=law;n=20628
  8. Shestakova M.V. Kommentarii endokrinologa k rekomendatsiyam po sakharnomu diabetu, prediabetu i serdechno-sosudistym zabolevaniyam esc-easd 2007 [Endocrinologistĺs comments to recommendations for diabetes mellitus, pre-diabetes, and cardiovascular diseases esc-easd 2007]. Sakharnyy diabet 2008;(1):97-99
  9. Shestakova M.V., Suntsov Yu.I., Dedov I.I. Diabeticheskaya nefropatiya: sostoyaniye problemy v mire i v Rossii [Diabetic nephropathy: state of the problem in the world and in Russia]. Sakharnyy diabet 2001;(3):2-5.
  10. Dailey G. Overall mortality in diabetes mellitus: where do we stand today? Diabetes Technol Ther. 2011;13 (Suppl 1):S65-S74.
  11. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254-1264.
  12. Gomez-Huelgas R, Mancera-Romero J, Bernal-Lopez MR, Jansen-Chaparro S, Baca-Osorio AJ, Toledo E, Perez-Gonzalez R, Guijarro-Merino R, Tinahones FJ, Martinez-Gonzalez MA. Prevalence of cardiovascular risk factors in an urban adult population from southern Spain. IMAP Study. Int J Clin Pract. 2011 Jan;65(1):35-40.
  13. Kim JH, Kim DJ, Jang HC, Choi SH. Epidemiology of micro- and macrovascular complications of type 2 diabetes in Korea. Diabetes Metab J. 2011;35(6):571-577.
  14. Laakso M., Lehto S. Epidemiology of risk factors for cardiovascular disease in diabetes and impaired glucose tolerance. Atherosclerosis 1998 Apr;137 Suppl:S65-S73.
  15. Lehto S, Ronnemaa T, Haffner SM, Pyorala K, Kallio V, Laakso M. Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with NIDDM. Diabetes 1997;46(8):1354-1359.
  16. Morrish N.J., Wang S.L., Stevens L.K., Fuller J.H., Keen H: Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001;44 (Suppl. 2):S14 ľS21.
  17. Rhodes ET, Prosser LA, Hoerger TJ, Lieu T, Ludwig DS, Laffel LM. Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus. Diabet Med. 2012;29(4):453-463.
  18. Roglic G., Unwin N., Bennett P.H., Mathers C., Tuomilehto J., Nag S., Connolly V., King H. The Burden of Mortality Attributable to Diabetes. Realistic estimates for the year 2000. Diabetes Care 2005;28(9):2130ľ2135.
  19. WHO. The global burden of disease: 2004 update. Geneva: World Health Organization. 2008. 150 p. [Internet] 2004 [cited 2012 Aug 3]. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf
  20. Wild S., Roglic G., Green A., Sicree R., King H. Global Prevalence of Diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27(5):1047ľ1053.
  21. World Health Organization: The world health report 2003 - shaping the future. Geneva, World Health Organization. 2003. 193 p. [Internet]. 2003 [cited 2012 Aug 3]. Available from: http://www.who.int/whr/2003/en/whr03_en.pdf

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