Excess mortality problem is not shrinking in young people with type 1 diabetes
medwireNews: Absolute mortality rates are falling among younger people with type 1 diabetes, but excess mortality relative to the general population remains high and unchanged, show Scottish national registry data presented at the virtual 56th EASD Annual Meeting.
The most common causes of death among the 27,935 individuals (mean age 30.6 years, 44% women) included in the study were circulatory disease and diabetic ketoacidosis or coma (DKAoC).
But while circulatory disease mortality rates improved significantly between 2004 and 2017, no such improvement was seen for DKAoC, Joseph O’Reilly, from the University of Edinburgh in the UK, reported.
He said the data show that “[s]trategies to both improve the prediction and prevention of out of hospital acute diabetes deaths and to improve circulatory disease prevention are still needed.”
During a mean 9 years of follow-up there were 1138 deaths among the study participants who were all younger than 50 years of age.
O’Reilly and team found that the incidence rate ratio (IRR) for death per calendar year was 0.983, after adjustment for age, sex, diabetes duration, and level of social deprivation, which was equivalent to a significant 1.7% annual reduction in mortality.
In spite of this, the researchers found that people with diabetes were three to four times more likely to die during the study period relative to the general population, and this excess was largely unchanged with time.
Specifically, the standardized mortality ratio (SMR) for men with type 1 diabetes was 3.10 in 2004 and 3.60 in 2017. For women, the SMRs were 4.09 and 4.16, respectively.
O’Reilly commented that “the consistent SMR observed alongside the reduction in mortality rates is indicative of a paired reduction in mortality rate in both the general population and the population of individuals with type 1 diabetes.”
Looking at the causes of death, O’Reilly reported excess mortality across almost all body systems, with widespread differences between men and women, particularly for circulatory diseases, where the SMR was 11.78 in women and 5.57 in men.
Circulatory diseases accounted for 27.6% of the deaths in the diabetes cohort overall, but the rate fell by a significant 5.4% per year (IRR=0.946) between 2004 and 2017.
DKAoC was the cause of death in 20.8% of cases, the majority (79.3%) of which occurred outside of hospital, and this rate did not change significantly with time. DKAoC was the most common cause of death among younger participants (<30 years) and was also associated with social deprivation. The researchers found that individuals in the highest deprivation quintile were 11.3 times more likely to die from DKAoC than those in the lowest quintile.
O’Reilly said that, consequently, his team “are now working to identify risk factors for DKA hospital admission and DKA mortality using this large data set.”
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