Poor childhood glycemic control flags early mortality risk
medwireNews: People who die in young adulthood from acute complications of type 1 diabetes are characterized by poor glycemic control during childhood, report Swedish researchers.
Overall, people with diabetes were nearly three times more likely to die before the age of 30 years than those without, report John Samuelsson (Ryhov County Hospital, Jönköping) and study co-authors.
The standardized mortality ratios versus the general Swedish population were 2.0 for males and 4.4 for females, with the age of 25–29 years representing the highest-risk period (6.0 for both sexes), although the absolute number of deaths was highest among those aged 20–24 years.
On linking a national pediatric diabetes register and a death register, the team found that 68 of 12,652 people with type 1 diabetes in childhood had died before the age of 30 years. Diabetes was the main cause of death for 38% of these people, with acute complications the cause for 32%; coma was listed as the specific cause for the majority, which the researchers note could refer to either ketoacidosis or hypoglycemia.
The average glycated hemoglobin (HbA1c) level during inclusion in the pediatric registry was 74 mmol/mol (8.9%) in the people who died of diabetic causes versus 62 mmol/mol (7.8%) in those still alive, which was a significant difference. The level in people who died of other causes (eg, cardiovascular, neurologic, traffic accident) was 64 mmol/mol (8.0%).
The pattern was consistent in males, at 77 versus 61 mmol/mol (9.2 vs 7.7%) for those who died of diabetes versus those still alive, but it lost statistical significance in females, although HbA1c was numerally higher, at 69 versus 63 mmol/mol (8.5 vs 7.9%). This was also the case for the last recorded HbA1c value.
Average HbA1c remained significantly associated with the risk for death due to diabetes after accounting for age, sex, and year of diagnosis. A more recent year of diagnosis also increased the risk for death from diabetes, but age at diagnosis had no effect.
The researchers note that they did not have HbA1c values for the study participants after they left pediatric care. “Future similar studies should include adult HbA1c data in order to control for the impact of glycemic control in adulthood and assess the time-dependent HbA1c related risk for mortality,” they say.
Of the 68 deaths, eight occurred between the ages of 10 and 14 years, 18 at 15–19 years, 30 at 20–24 years, and 12 at 25–29 years.
“Most deaths occur after referral to adult diabetes care, which is why this might be a problem that is overlooked by the pediatric diabetes team,” write Samuelsson and team in Pediatric Diabetes.
“The transition to adult diabetes care is a sensitive period. There is need for a well-structured transition care and it is important not to lose subjects from follow up.”
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