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. 2010 Dec;59(12):3216-22.
doi: 10.2337/db10-0862. Epub 2010 Aug 25.

Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes

Aaron M Secrest  1 , Dorothy J Becker, Sheryl F Kelsey, Ronald E Laporte, Trevor J Orchard
Affiliations

Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes

Aaron M Secrest et al. Diabetes. 2010 Dec.

Abstract

Objective: Little is known concerning the primary cause(s) of mortality in type 1 diabetes responsible for the excess mortality seen in this population.

Research design and methods: The Allegheny County (Pennsylvania) childhood-onset (age < 18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965 to 1979 was used to explore patterns in cause-specific mortality. Cause of death was determined by a mortality classification committee of at least three physician epidemiologists, based on the death certificate and additional records surrounding the death.

Results: Vital status for 1,043 (97%) participants was ascertained as of 1 January 2008, revealing 279 (26.0%) deaths overall (141 females and 138 males). Within the first 10 years after diagnosis, the leading cause of death was acute diabetes complications (73.6%), while during the next 10 years, deaths were nearly evenly attributed to acute (15%), cardiovascular (22%), renal (20%), or infectious (18%) causes. After 20 years' duration, chronic diabetes complications (cardiovascular, renal, or infectious) accounted for >70% of all deaths, with cardiovascular disease as the leading cause of death (40%). Women (P < 0.05) and African Americans (P < 0.001) have significantly higher diabetes-related mortality rates than men and Caucasians, respectively. Standardized mortality ratios (SMRs) for non-diabetes-related causes do not significantly differ from the general population (violent deaths: SMR 1.2, 95% CI 0.6-1.8; cancer: SMR 1.2, 0.5-2.0).

Conclusions: The excess mortality seen in type 1 diabetes is almost entirely related to diabetes and its comorbidities but varies by duration of diabetes and particularly affects women and African Americans.

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Figures

FIG. 1.
FIG. 1.
Distribution of underlying causes of death within 10-year intervals of type 1 diabetes duration. Ten deaths where the cause of death was unknown were excluded.
FIG. 2.
FIG. 2.
Total contribution (underlying and/or secondary cause of death) of major diabetes complications to deaths in type 1 diabetes. Proportions of death in each diabetes duration interval where the following complications either caused or contributed to death are shown: acute complications (A), end-stage renal disease (ESRD) (B), and CVD (C).
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