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Causes of death in childhood‐onset Type 1 diabetes: long‐term follow‐up
Author(s) -
Gagnum V.,
Stene L. C.,
Jenssen T. G.,
Berteussen L. M.,
Sandvik L.,
Joner G.,
Njølstad P. R.,
Skrivarhaug T.
Publication year - 2017
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13114
Subject(s) - medicine , cause of death , hazard ratio , diabetes mellitus , population , pediatrics , autopsy , type 2 diabetes , national death index , disease , medical record , standardized mortality ratio , epidemiology , confidence interval , endocrinology , environmental health
Aims To assess the causes of death and cause‐specific standardized mortality ratios in two nationwide, population‐based cohorts diagnosed with Type 1 diabetes during the periods 1973–1982 and 1989–2012, and to evaluate changes in causes of death during the follow‐up period. Methods People with Type 1 diabetes who were aged < 15 years at diagnosis were identified in the Norwegian Childhood Diabetes Registry and followed from diagnosis until death, emigration or September 2013 ( n = 7871). We assessed causes of death by linking data to the nationwide Cause of Death Registry and through a review committee that evaluated medical records, autopsy reports and death certificates. Results During a mean (range) follow‐up of 16.8 (0–40.7) years, 241 individuals (3.1%) died, representing 132 143 person‐years. The leading cause of death before the age of 30 years was acute complications (41/119, 34.5%). After the age of 30 years cardiovascular disease was predominant (41/122, 33.6%), although death attributable to acute complications was still important in this age group (22/122, 18.0%). A total of 5% of deaths were caused by ‘dead‐in‐bed’ syndrome. The standardized mortality ratio was elevated for cardiovascular disease [11.9 (95% CI 8.6–16.4)] and violent death [1.7 (95% CI 1.3–2.1)] in both sexes combined, but was elevated for suicide only in women [2.5 (95% CI 1.2–5.3)]. The risk of death from acute complications was approximately half in women compared with men [hazard ratio 0.43 (95% CI 0.25–0.76)], and did not change with more recent year of diagnosis [hazard ratio 1.02 (0.98–1.05)]. Conclusions There was no change in mortality attributable to acute complications during the study period. To reduce premature mortality in people with childhood‐onset diabetes focus should be on prevention of acute complications. Male gender implied increased risk.