Trends in complications, morbidity and cause of death in diabetes patients in England (360G-Wellcome-220574_Z_20_Z)

Diabetes is a leading cause of mortality and morbidity in England, with significant impact upon individual patients, and the NHS. Its significance is expected to increase in coming decades due to population ageing and obesity prevalence. Diabetes is associated with several sequelae including heart disease, stroke, and limb amputations, and more recently several cancers and dementia. Work in the US has identified an aggregate reduction in diabetes complications, particularly in vascular complications, with patients experiencing a more diverse range of complications with a growing proportional impact of non-CVD causes. How incidence of complications and mortality has changed over the past two decades in England is unclear. This research fellowships primary aim is to estimate trends in complications and outcomes in patients with type 2 diabetes in England 1998-2018. I will integrate large national datasets including the CPRD, a UK primary care database, linked to Hospital Episode Statistics, the National Cancer Registration and Analysis Service and death records and. Specifically, this fellowship will: 1. estimate trends in age-specific cause of death in patients with diabetes; 2. estimate trends in age-specific incidence of diabetes-related complications and health service-usage; 3. estimate trends in age-specific cancer incidence, survival and mortality in patients with diabetes.