Causes of death defined in young adults with type I diabetes
medwireNews: Mortality rates are high among adolescents and young adults with type I diabetes, with more than half caused by acute or chronic complications, researchers report.
“Both acute and chronic complications cause substantial premature mortality, implying a continuous need for improved diabetes care,” say Vibeke Gagnum (Oslo University Hospital, Norway) and colleagues.
Most notably, the researchers found that 15.0% of all deaths and 21.8% of those occurring within 20 years of diabetes diagnosis were associated with alcohol, which they report is about five to seven times higher than the rate of alcohol-associated deaths for the general population of Norway.
“Our study suggests that increased awareness of alcohol-related death should be encouraged in clinics providing health care to this group of patients,” the team highlights in Diabetes Care.
They monitored 719 patients diagnosed with type I diabetes at the age of 15 to 29 years over an average 29.6-year period, during which 20.6% died.
The overall mortality rate was 6.96 per 1000 person–years, which was between four and five times higher than the rate for the general population. Cumulative mortality by years since diagnosis was 6.0% at 10 years, 12.2% at 20 years, and 18.4% at 30 years.
Younger patients, aged 15–34 years, were around seven times more likely to die than people of a similar age in the general population. The difference reduced with age, with the difference four times higher for patients aged 45–65 years.
The most common causes of death, determined from a Norwegian death and renal register and reviewed by a clinical committee, were chronic complications (including from renal failure and cardiovascular causes) in 31.8% and acute complications (including diabetic ketoacidosis and hypoglycemia) in 20.3%, followed by violent death in 19.6%, cancer in 12.8%, and other causes in 14.2%.
In younger patients, however, violent death and acute complications were the most common causes. “This leads us to speculate about increased risk behavior in young adults with type I diabetes,” the team comments.
They add that, in support of this, the risks of violent death and suicide were both around three times higher for young patients with type I diabetes than would normally be expected for this age group.
End-stage renal disease as a result of diabetic nephropathy developed in just 4.6% of patients at an incidence rate of 1.57 per 1000 person–years and at a low cumulative incidence of 4.8% at 30 years. But when present it increased the likelihood of death 8.7-fold, resulting in death within 10 years of being diagnosed in half of patients.
By Lucy Piper
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