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. 2020 Aug;63(8):1626-1636.
doi: 10.1007/s00125-020-05173-w. Epub 2020 May 26.

Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004-2017

Joseph E O'Reilly  1 , Luke A K Blackbourn  1 , Thomas M Caparrotta  1 , Anita Jeyam  1 , Brian Kennon  2 , Graham P Leese  3 , Robert S Lindsay  4 , Rory J McCrimmon  5 , Stuart J McGurnaghan  1 , Paul M McKeigue  6 , John A McKnight  7 , John R Petrie  4 , Sam Philip  8 , Naveed Sattar  4 , Sarah H Wild  6 , Helen M Colhoun  9   10 ; Scottish Diabetes Research Network Epidemiology Group
Affiliations

Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004-2017

Joseph E O'Reilly et al. Diabetologia. 2020 Aug.

Abstract

Aims/hypothesis: We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes.

Methods: Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs).

Results: There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002).

Conclusions/interpretation: Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia. Graphical abstract.

Keywords: DKA; Epidemiology; Mortality; Type 1 diabetes.

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Figures

None
Graphical abstract
Fig. 1
Fig. 1
(a) Crude mortality rate and (b) SMR across the study period, stratified by sex. Points and bars for each year are slightly staggered to enhance visibility. Error bars show 95% CI. F, female; M, male
Fig. 2
Fig. 2
SMR by SIMD quintile and sex (2008–2013 only). The horizontal dotted line marks an SMR of 1. Error bars show 95% CI. F, female; M, male
Fig. 3
Fig. 3
Underlying cause of death by age band. DM, type 1 diabetes mellitus
Fig. 4
Fig. 4
SMR stratified by specific cause and sex. Vertical dotted lines mark an SMR of 1. Error bars show 95% CI. Calculation of SMR was restricted to individuals aged <45 and to the period 2004–2016 owing to the restricted availability of data. (a) Certain infectious and parasitic diseases, (b) diseases of the circulatory system, (c) diseases of the digestive system, (d) diseases of the genitourinary system, (e) diseases of the nervous system, (f) diseases of the respiratory system, (g) external causes of mortality, (h) mental and behavioural disorders, (i) neoplasms. F, female; M, male
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References

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