Community study quantifies excess mortality in type 1 diabetes
medwireNews: Australian adults with type 1 diabetes die almost 7 years earlier, on average, than their non-diabetic peers, with cardiovascular disease (CVD) the most common cause of death, observational data presented at the virtual 56th EASD Annual Meeting show.
Timothy Davis, from the University of Western Australia in Fremantle, reported that almost half (45.5%) of the deaths among people with type 1 diabetes were due to CVD compared with just one-third (32.7%) in people without diabetes.
He also noted that one in eight of the CVD deaths were among participants younger than 55 years of age, compared with none among people in the control group.
Davis said that these findings “highlight the risk of premature death and the need for optimal CVD risk reduction in people with [type 1 diabetes].”
The analysis included data for 121 people with type 1 diabetes who were participants in the longitudinal observational Fremantle Diabetes Study Phase I and for 484 controls without known diabetes who were matched by age, sex, and postcode. The mean age of the participants was 43.1 years and 59% were men. For those with diabetes, the mean age at diagnosis was 29.5 years and the median disease duration was 12 years.
During a mean 20.7 years (12,541 person–years) of follow-up the risk for death was a significant three times higher among the people with diabetes relative to those without, even after adjustment for age, sex, and comorbidity (excluding diabetes-related complications).
Specifically, 45.5% of participants with diabetes and 18.2% of controls died during follow-up, giving mortality rates of 25.7 and 8.5 per 1000 person–years, respectively.
Davis said that the highest rates of excess mortality in the diabetes group were observed among individuals aged 35–44 years, with a significant mortality rate ratio of 22.4 versus the control group. This fell with increasing age to a nonsignificant 2.00 and 1.75 for individuals age 75–84 and 85–94 years, respectively.
There were no deaths among individuals younger than 35 years of age with diabetes and three deaths, due to suicide or drug misuse, among those without.
Davis also reported that the mean age at death was 6.6 years younger among the people with diabetes relative to the controls. He pointed out that this is less than previous estimates of at least 10 years life expectancy loss among people with type 1 diabetes and “likely reflected the older age at diagnosis in the [current] cohort relative to other studies.”
He concluded: “CVD as the major cause of death, including at a relatively young age, is a concern and further justifies appropriately intensive risk management of glycemia and other nonglycemic cardiovascular risk factors in adults with type 1 diabetes.”
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