Mortality in type 1 diabetes
Pro Research Analysisby 
Searched over 200M research papers
Mortality Trends in Type 1 Diabetes
Recent research shows that mortality rates in people with type 1 diabetes have declined over the past decades in many countries, including Australia, Denmark, Latvia, Scotland, Spain, the USA, Japan, and Sweden. The annual reduction in mortality rates ranges from about 2% to nearly 6% per year, with improvements seen across different age groups and both sexes. However, while overall mortality is decreasing, the risk of death for people with type 1 diabetes remains higher than for the general population, especially for women and those diagnosed at a younger age 138.
Age at Onset and Excess Mortality Risk
The age at which type 1 diabetes is diagnosed plays a major role in long-term survival. People diagnosed before age 10 face the highest excess risk of death and cardiovascular disease, losing up to 17.7 life-years for women and 14.2 for men compared to the general population. The risk of cardiovascular complications, such as heart attacks and strokes, is also much higher in those with early-onset diabetes. The excess risk decreases with later age at diagnosis but remains significantly elevated compared to people without diabetes .
Causes of Death in Type 1 Diabetes
The main causes of death in type 1 diabetes vary by age and duration of the disease. In children and young adults, acute complications like diabetic ketoacidosis, sudden unexplained deaths (often found deceased in bed), and accidents are common. As the duration of diabetes increases, especially beyond 30 years, chronic complications such as end-stage renal disease and cardiovascular disease become the leading causes of death 289. Poor glycemic control (high HbA1c levels) is a major factor in early mortality, particularly in youth-onset cases .
Cardiovascular Disease and Mortality Risk
Type 1 diabetes is associated with a much higher risk of cardiovascular disease and early death compared to both the general population and people with type 2 diabetes. This increased risk is seen across different populations, including Asian and European cohorts. The risk of heart failure, heart attacks, and atrial fibrillation is significantly higher in people with type 1 diabetes, and the risk is even greater than in those with type 2 diabetes 57.
Key Risk Factors for Mortality
The most important predictors of mortality and cardiovascular outcomes in type 1 diabetes are poor glycemic control (high HbA1c), albuminuria (protein in urine), longer duration of diabetes, high systolic blood pressure, and elevated LDL cholesterol. Smoking and overweight/obesity also contribute to higher risk. Maintaining lower levels of HbA1c, blood pressure, and LDL cholesterol is associated with a significantly lower risk of death and cardiovascular events 710.
Impact of Intensive Therapy and Adiposity
Intensive insulin therapy, which leads to better glycemic control, can reduce mortality to levels similar to the general population. However, higher HbA1c levels are linked to increased mortality, especially in women. The relationship between body weight and mortality in type 1 diabetes now resembles that of the general population, with underweight individuals at the highest risk of death. Weight gain during follow-up may be protective, but obesity is only a significant risk factor when accompanied by increased waist circumference 46.
Geographic and Temporal Differences
While mortality rates have improved globally, the degree of improvement and the relative risk compared to the general population vary by country and over time. For example, in Japan, mortality rates and standardized mortality ratios have decreased over the decades, but remain higher for those with onset after puberty. In India, high mortality is still observed in youth-onset type 1 diabetes, mainly due to poor glycemic control and complications like kidney disease and infections 89.
Conclusion
Mortality in type 1 diabetes has declined in recent years, but people with the condition still face a higher risk of death, especially from cardiovascular disease and acute complications. Early age at onset, poor glycemic control, and other modifiable risk factors like high blood pressure, cholesterol, and smoking are key contributors to this excess risk. Continued improvements in diabetes management and risk factor control are essential to further reduce mortality in this population.
Sources and full results
Most relevant research papers on this topic
Mortality trends in type 1 diabetes: a multicountry analysis of six population-based cohorts
All-cause mortality in people with type 1 diabetes has declined in recent years, but improvements in mortality relative to the non-diabetic population are less consistent across different countries.
Mortality in childhood-onset type 1 diabetes: a population-based study.
Young type 1 diabetic patients experience significant excess mortality, with a large proportion of unexplained deaths in bed, but no clear excess death rate caused by suicide or traffic accidents.
Excess mortality and cardiovascular disease in type 1 diabetes in relation to age at onset: a nationwide study of 27,195 young adults with diabetes
Age at onset of type 1 diabetes is an important determinant of survival and cardiovascular outcomes, with higher excess risk in women.
Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population
Overall mortality in type 1 diabetes patients in the DCCT/EDIC study cohort was similar to the general population, but higher in the conventional therapy group, with mortality increasing significantly with increasing HbA1c levels.
DOI