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Observational Study
. 2016 Aug;39(8):1378-83.
doi: 10.2337/dc15-2399. Epub 2016 Jul 13.

Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population

Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
Observational Study

Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population

Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group. Diabetes Care. 2016 Aug.

Abstract

Objective: Historically, mortality in type 1 diabetes has exceeded that in the general population. We compared mortality in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study cohort to that of the current general U.S.

Research design and methods: The DCCT (1983-1993) compared intensive versus conventional therapy, with HbA1c levels of ∼7 vs. 9%, respectively, over an average of 6.5 years of treatment. EDIC is the observational follow-up study of the DCCT (1994 to the present). Vital status was ascertained for 97.5% of the original DCCT cohort (n = 1,441) after a mean of 27 years follow-up. Expected mortality during DCCT/EDIC was estimated using the current age-, sex-, and race-specific risks in the general U.S. population, and the observed versus expected mortality compared using standardized mortality ratios (SMRs) and Poisson regression models.

Results: Mortality in the DCCT intensive therapy group was nonsignificantly lower than that in the general U.S. population (SMR = 0.88 [95% CI 0.67, 1.16]), whereas mortality in the DCCT conventional therapy group was significantly greater than that in the general population (SMR = 1.31 [95% CI 1.05, 1.65]). The SMR increased with increasing mean HbA1c, and above an HbA1c of 9%, the rate of increase in SMR among females was greater than that among males.

Conclusions: Overall mortality in the combined DCCT/EDIC cohort was similar to that of the general population but was higher in the DCCT conventional therapy group. Mortality increased significantly with increasing mean HbA1c, more so among females than males, especially for HbA1c >9%.

Trial registration: ClinicalTrials.gov NCT00360815 NCT00360893.

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Figures

Figure 1
Figure 1
The RMR for the mortality in the combined DCCT/EDIC cohort relative to the age-, sex-, and race-specific risk in the general population as a function of the updated time-dependent mean HbA1c during the DCCT and EDIC from a Poisson regression model. The horizontal dashed line at an RMR of 1.0 represents no difference in risk relative to the general population.
Figure 2
Figure 2
The RMR for the mortality in the combined DCCT/EDIC cohort relative to the age-, sex-, and race-specific risk in the general population as a function of the updated time-dependent mean HbA1c during the DCCT and EDIC separately for males and females.
See this image and copyright information in PMC

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References

    1. Borch-Johnsen K, Kreiner S, Deckert T. Mortality of type 1 (insulin-dependent) diabetes mellitus in Denmark: a study of relative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologia 1986;29:767–772 - PubMed
    1. Harjutsalo V, Forsblom C, Groop PH. Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. BMJ 2011;343:d5364. - PMC - PubMed
    1. Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G. Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia 2006;49:298–305 - PubMed
    1. Soedamah-Muthu SS, Fuller JH, Mulnier HE, Raleigh VS, Lawrenson RA, Colhoun HM. All-cause mortality rates in patients with type 1 diabetes mellitus compared with a non-diabetic population from the UK general practice research database, 1992-1999. Diabetologia 2006;49:660–666 - PubMed
    1. Shankar A, Klein R, Klein BEK, Moss SE. Association between glycosylated hemoglobin level and cardiovascular and all-cause mortality in type 1 diabetes. Am J Epidemiol 2007;166:393–402 - PubMed

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