Mortality rates in type 1 diabetes
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Trends in Mortality Rates in Type 1 Diabetes
Recent research shows that mortality rates in people with type 1 diabetes have declined over the past few decades across multiple countries and populations. Studies from Australia, Denmark, Latvia, Scotland, Spain, and the USA all report a consistent decrease in age- and sex-standardized all-cause mortality rates from 2000 to 2016, with annual reductions ranging from about 2% to nearly 6% per year 239. This trend is also seen in long-term studies from the UK and the US, where improvements in diabetes care have contributed to better survival rates 147.
Excess Mortality Compared to the General Population
Despite these improvements, people with type 1 diabetes still face a much higher risk of death compared to those without diabetes. In the UK, the annual mortality rate for people with type 1 diabetes was 8.0 per 1,000 person-years, compared to 2.4 per 1,000 in the non-diabetic population, resulting in a hazard ratio of 3.7 . Similar findings are reported in Sweden and other countries, with standardized mortality ratios (SMRs) indicating that people with type 1 diabetes have two to five times the risk of death compared to the general population 269.
Impact of Age at Onset and Duration of Diabetes
The age at which type 1 diabetes is diagnosed plays a significant role in mortality risk. Those diagnosed before age 10 have the highest excess risk, with hazard ratios for all-cause mortality over four times higher than the general population, and even greater risks for cardiovascular mortality and complications . Early-onset type 1 diabetes can result in a loss of up to 17.7 life-years for women and 14.2 for men . The duration and burden of diabetes-related complications, such as kidney disease and cardiovascular disease, also strongly influence mortality rates, with the highest risk seen soon after the onset of these complications .
Sex Differences in Mortality
Women with type 1 diabetes experience a greater excess risk of death compared to men. Meta-analyses show that women have about 40% higher excess risk of all-cause mortality and up to twice the excess risk of fatal and nonfatal vascular events compared to men with type 1 diabetes 24610. This difference is especially pronounced for cardiovascular and renal disease outcomes.
Causes of Death in Type 1 Diabetes
Cardiovascular disease is the leading cause of death among people with type 1 diabetes, particularly in adults 3469. In younger patients, diabetic ketoacidosis is a major cause of death, while unexplained deaths during sleep are also reported . The risk of death from non-cardiovascular causes, such as accidents or suicide, does not appear to be significantly higher than in the general population .
Effect of Improved Diabetes Management
Advances in diabetes care, including better blood glucose monitoring, HbA1c testing, and improved blood pressure management, have contributed to the observed decline in mortality rates 17. Intensive diabetes management, as shown in the DCCT/EDIC study, can reduce mortality to levels similar to the general population, especially when HbA1c is well controlled .
Conclusion
While mortality rates in type 1 diabetes have improved significantly in recent decades, people with the condition still face a much higher risk of death than those without diabetes. Early age at onset, female sex, and the presence of complications like kidney or cardiovascular disease further increase this risk. Continued improvements in diabetes management and a focus on preventing complications 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. The Allegheny County (Pennsylvania) Registry 1965-1999.
Long-term survival in type 1 diabetes patients has improved in recent years, likely due to advances in HbA1 testing, home blood glucose monitoring, and improved blood pressure therapy in the 1980s.
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.
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
UK mortality rates in the past decade continue to be significantly higher in patients with type 1 diabetes than in those without diabetes.
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.
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