Mortality in type 1 diabetes diagnosed in childhood in Northern Ireland during 1989-2012: A population-based cohort study

Abstract

Objective: To investigate long-term mortality rates and causes of death in individuals diagnosed with type 1 diabetes before the age of 15 years during the period 1989-2012 or known to paediatric diabetes teams in 1989, in Northern Ireland.Methods: A cohort of 3129 patients from the Northern Ireland Childhood Diabetes Register was linked to death registrations and underlying causes, coded according to ICD-9 or ICD-10.Standardized mortality ratios (SMRs) were calculated as the ratio of observed to expected deaths by sex, attained age, time since diagnosis, calendar period, and cause of death.Results: Subjects were followed to December 31, 2012 giving 39 764 person-years of follow-up (median 12.1 years). In total, 59 subjects had died (1.5 per 1000 person-years) compared with 19.9 deaths expected, an SMR of 296 (95% confidence interval (CI) 229-382).Women had a significantly higher excess risk of mortality than men with SMRs of 535 (95% CI 361-764) and 203 (95% CI 136-291), respectively. Over half of the deaths (56%) were judged to be related or possibly related to diabetes with most of these due to acute (n = 24) or late (n = 6) complications.Conclusions: Subjects with type 1 diabetes diagnosed less than 15 years of age had 3 times the mortality risk of the general population. Over half of the deaths were related to acute or chronic complications of diabetes. K E Y W O R D Smortality, standardized mortality ratio, type 1 diabetes

Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004–2017

“…High SMRs at young ages in diabetes have been reported in other countries, but changes in absolute and relative mortality rates compared with the background population over time vary between studies. Studies in Australia (2000–2011), Finland (1970–1999) and Denmark (2002–2011) identified reductions in both absolute and relative mortality rates, whereas analyses in Sweden (1998–2011), Wales and Northern Ireland (1989–2012) found no improvement in relative mortality [ 2 , 5 – 7 , 12 – 14 ].…”

“…For example, we reported that 40-45% of the overall loss in life expectancy of 11 and 13 years in men and women with type 1 diabetes, respectively, was attributable to deaths occurring below age 50 [1]. Whether there have been any improvements in the prevention of these early deaths in type 1 diabetes in recent years is uncertain, as all recent studies have been very small or have had relatively short follow-up times, with the largest study including 3192 individuals [6][7][8][9]. Thus, the scope for further improvements in life expectancy by preventing such deaths is also unknown.…”

Poor metabolic control in childhood strongly correlates to diabetes‐related premature death in persons <30 years of age—A population‐based cohort study

“…A Swedish register study between the years 1977 and 2000 found an average SMR of 2.15 in young patients with type 1 diabetes . A more recent Norwegian study presented an average SMR of 3.6 from 1973 to 2012 (n = 7884), the same as a Finnish study of childhood‐onset (<15 years) diabetes covering the period 1970 to 2007 (n = 17 306), and a study from northern Ireland from 1989 to 2012 calculated an average SMR of 2.96 . In Denmark, a cohort of 720 children was followed from 1987 to 2014, rendering an SMR of 4.8, where HbA1c in 1989 was found to be the only predictor for increased risk of death .…”

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

“…In population studies, the mortality rate from DKA in children is 0.15% to 0.30% [194][195][196] and may be decreasing. 196,197 The Centers for Disease 198 and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA. 199,200 Cerebral injury is the major cause of mortality and morbidity 195,201 and cerebral edema accounts for 60% to 90% of all DKA deaths.…”

“…A number of possible reasons have been proposed for the reduction in diabetes‐related deaths in children, including improved diabetes care and treatment, increased awareness of diabetes symptoms, possibly resulting in earlier recognition and treatment, and advances in education regarding diabetes and management of DKA. However, recent data show that DKA is still the leading cause of death in subjects with T1D diagnosed less than 15 years of age and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA …”