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Markedly increased incidence of critical illness in adults with Type 1 diabetes
Author(s) -
Marrie R. A.,
Sellers E. A. C.,
Chen H.,
Fransoo R.,
Bernstein C. N.,
Hitchon C. A.,
Peschken C. A.,
Garland A.
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.13404
Subject(s) - medicine , hazard ratio , intensive care unit , incidence (geometry) , population , diabetes mellitus , type 2 diabetes , proportional hazards model , diabetic ketoacidosis , cohort , rate ratio , cohort study , type 1 diabetes , pediatrics , confidence interval , endocrinology , environmental health , physics , optics
Aims To compare the incidence of and mortality after intensive care unit admission in adults with paediatric‐onset Type 1 diabetes vs the general population. Methods Using population‐based administrative data from Manitoba, Canada, we identified 814 cases of paediatric‐onset Type 1 diabetes, and 3579 general population controls matched on age, sex and region of residence. We estimated the incidence of intensive care unit admission in adulthood, and compared the findings between populations using incidence rate ratios and multivariable Cox proportional hazards regression, adjusting for age, sex, comorbidity and socio‐economic status. We estimated age‐ and sex‐standardized mortality rates after intensive care unit admission. Results Between January 2000 and October 2009, the average annual incidence of intensive care unit admission among prevalent cohorts was 910 per 100 000 in the Type 1 diabetes population, and 106 per 100 000 in matched controls, an eightfold increased risk (incidence rate ratio 8.6; 95% CI 5.5, 14.0). The adjusted risk of intensive care unit admission was elevated to a greater extent among women with Type 1 diabetes compared with matched women (hazard ratio 14.7; 95% CI 7.2, 29.4) than among men with Type 1 diabetes compared with matched men (hazard ratio 4.92; 95% CI 10.3, 2.36) The most common reasons for admission in the diabetes cohort were diabetic ketoacidosis, infection and ischaemic heart disease. At 30%, 5‐year mortality was higher in the diabetes cohort than in the matched cohort (relative risk 5.7; 95% CI 1.2, 8.9). Conclusions Compared with the general population, the risk of intensive care unit admission was higher in adults with paediatric‐onset Type 1 diabetes, and mortality after admission was also higher.