A Meta-Analysis of the Relative Risk of Mortality for Type 1 Diabetes Patients Compared to the General Population: Exploring Temporal Changes in Relative Mortality

Abstract

AimsType 1 diabetes has been associated with an elevated relative risk (RR) of mortality compared to the general population. To review published studies on the RR of mortality of Type 1 diabetes patients compared to the general population, we conducted a meta-analysis and examined the temporal changes in the RR of mortality over time.MethodsSystematic review of studies reporting RR of mortality for Type 1 diabetes compared to the general population. We conducted meta-analyses using a DerSimonian and Laird random effects model to obtain the average effect and the distribution of RR estimates. Sub-group meta-analyses and multivariate meta-regression analysis was performed to examine heterogeneity. Summary RR with 95% CIs was calculated using a random-effects model.Results26 studies with a total of 88 subpopulations were included in the meta-analysis and overall RR of mortality was 3.82 (95% CI 3.41, 3.4.29) compared to the general population. Observations using data prior to 1971 had a much larger estimated RR (5.80 (95% CI 4.20, 8.01)) when compared to: data between; 1971 and 1980 (5.06 (95% CI 3.44, 7.45)); 1981–90 (3.59 (95% CI 3.15, 4.09)); and those after 1990 (3.11 (95% CI 2.47, 3.91)); suggesting mortality of Type 1 diabetes patients when compared to the general population have been improving over time. Similarly, females (4.54 (95% CI 3.79–5.45)) had a larger RR estimate when compared to males (3.25 (95% CI 2.82–3.73) and the meta-regression found evidence for temporal trends and sex (p<0.01) accounting for heterogeneity between studies.ConclusionsType 1 diabetes patients’ mortality has declined at a faster rate than the general population. However, the largest relative improvements have occurred prior to 1990. Emphasis on intensive blood glucose control alongside blood pressure control and statin therapy may translate into further reductions in mortality in coming years.

Parity and mortality in cases of childhood‐onset diabetes mellitus

“…In our study, women with prepubertal onset (as defined by age <10 years) had a higher mortality than those with a later onset. In a Finnish population-based cohort study from 2011 [6], the standardized mortality ratios were highest in the earliest age-at-onset groups (diabetes onset at the age of 0-4, 5-9 and 10-14 years) and lower in the later age-at-onset groups, a result more in line with ours.…”

“…In this study the mortality (both crude mortality and standardized mortality ratio) among people with T1D was higher than in non-diabetic controls, as expected from previous studies [1][2][3][4][5][6]. The mortality rates of men, both with and without diabetes, were higher than those of women, respectively, but women with diabetes had higher standardized mortality ratios than men with diabetes; hence in relative terms, diabetes affected mortality more in women than in men.…”

“…The mortality rates of men, both with and without diabetes, were higher than those of women, respectively, but women with diabetes had higher standardized mortality ratios than men with diabetes; hence in relative terms, diabetes affected mortality more in women than in men. Such a sex difference has also been detected in other studies , but the reasons for it are not well understood.…”

Efficacy and safety of dapagliflozin in Japanese patients with inadequately controlled type 1 diabetes (DEPICT‐5): 52‐week results from a randomized, open‐label, phase III clinical trial

“…2,3 As such, individuals with T1DM have a two-to threefold risk of developing cardiovascular disease with glycaemic variability, as well as increased overall mortality compared with the general population. [4][5][6] Furthermore, insulin-related hypoglycaemia is a common event, with 11.8% of patients with T1DM experiencing at least one episode of severe hypoglycaemia every year. 7 Reduced insulin sensitivity together with poor glycaemic control and insulin-related weight gain probably contributes to insulin therapy resistance in patients with T1DM.…”

Recent trends in life expectancy for people with type 1 diabetes in Sweden

“…Previous studies have estimated the impact of type 1 diabetes on mortality and LE and compared these with variables in the general population [1,[8][9][10][11][12][13][14]. There is some evidence that survival of people with type 1 diabetes relative to the general population has improved since the 1940s [6] and has continued to improve in recent years [15].…”