Mortality rates in people with type 1 diabetes have fallen in recent years but rose for people with type 2 diabetes, according to data from the Australian Institute of Health and Welfare (AIHW).

The report, which examined 156,000 deaths between 2009 and 2014 among 1.3 million Australians with diabetes, found mortality gaps remain for both patient groups compared to the general population.

Death rates for people with type 1 diabetes were almost twice as high as the general population and 1.6 times as high in people with type 2 diabetes.

Professor Jonathan Shaw, deputy director (Clinical and Population Health) of the Baker Heart and Diabetes Institute and Australian Diabetes Society National Council member, told the limbic the slight rise in type 2 diabetes deaths was driven mainly by people aged 85 years and over.

“We would have concluded mortality was at least stable if a cut-off was applied at 80 years.”

He said independence, quality of life, and the risk of disability and cognitive impairment were often more important issues than longevity to older people.

“We shouldn’t be thinking we’re not treating aggressively enough. If you’re aged 50 years, it’s desperately sad if you were to die in the next 10 years, but maybe not if you’re aged 75 years.”

The report also found cardiovascular deaths were reducing in people with type 1 diabetes but remained stable in type 2 diabetes while rates in the general population were falling at a faster rate.

It estimated there were 1,264 excess deaths due to type 1 diabetes during 2012-2014 and 7,094 excess deaths due to type 2 diabetes. Life expectancy was about 12 years shorter with type 1 diabetes and five to 12 years shorter with type 2 diabetes.

Professor Shaw said there was still significant room for further improvement.

“Clearly there is more work to be done and usually what that means is doing what has been proven to work such as adequate treatment of blood pressure and cholesterol.”

“While that’s very easy to say, not surprisingly it’s a hard ask when trying to persuade someone to take their third, fourth, fifth or tenth drug, and a system that addresses that only by writing out a prescription is one that is only going to be modestly successful.”

“This all needs to be seen not just in the context of individual doctors and individual patients but getting this kind of improvement usually mean addressing systems.”

“How can systems be organised such that care is delivered better? What are the weaknesses; where are the gaps that people are falling through in the delivery of healthcare?  How many people are not seeing a doctor enough or not being given enough support for what is often a complex management regimen?”