Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010
Open accessAbstract
IMPORTANCE: Type 1 diabetes has historically been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have occurred in the past 3 decades. Contemporary estimates of the effect of type 1 diabetes on life expectancy are needed. OBJECTIVE: To examine current life expectancy in people with and without type 1 diabetes in Scotland. We also examined whether any loss of life expectancy in patients with type 1 diabetes is confined to those who develop kidney disease. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort of all individuals alive in Scotland with type 1 diabetes who were aged 20 years or older from 2008 through 2010 and were in a nationwide register (n=24,691 contributing 67,712 person-years and 1043 deaths). MAIN OUTCOMES AND MEASURES: Differences in life expectancy between those with and those without type 1 diabetes and the percentage of the difference due to various causes. RESULTS: Life expectancy at an attained age of 20 years was an additional 46.2 years among men with type 1 diabetes and 57.3 years among men without it, an estimated loss in life expectancy with diabetes of 11.1 years (95% CI, 10.1-12.1). Life expectancy from age 20 years was an additional 48.1 years among women with type 1 diabetes and 61.0 years among women without it, an estimated loss with diabetes of 12.9 years (95% CI, 11.7-14.1). Even among those with type 1 diabetes with an estimated glomerular filtration rate of 90 mL/min/1.73 m2 or higher, life expectancy was reduced (49.0 years in men, 53.1 years in women) giving an estimated loss from age 20 years of 8.3 years (95% CI, 6.5-10.1) for men and 7.9 years (95% CI, 5.5-10.3) for women. Overall, the largest percentage of the estimated loss in life expectancy was related to ischemic heart disease (36% in men, 31% in women) but death from diabetic coma or ketoacidosis was associated with the largest percentage of the estimated loss occurring before age 50 years (29.4% in men, 21.7% in women). CONCLUSIONS AND RELEVANCE: Estimated life expectancy for patients with type 1 diabetes in Scotland based on data from 2008 through 2010 indicated an estimated loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women compared with the general population without type 1 diabetes.
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Cardiovascular disease is still the leading cause of early illness and death in type 1 diabetes; data indicate a life expectancy 8-13 years shorter than healthy people.
“Cardiovascular disease remains the major cause of premature morbidity and mortality, with data119,120 suggesting an 8–13-year shorter life expectancy for people with type 1 diabetes than for healthy individuals.”
From Type 1 diabetes (2018) · cites this paper as [120]
The Results (Deaths by Cause; Examination of the Life Expectancy Differential by Age and Cause) identify ischemic heart disease as the most commonly reported cause of death and circulatory disease as the largest contributor to lost life expectancy. The Abstract (Results) reports losses of about 8 years in a preserved-kidney-function subgroup and 11–13 years overall. The paper does not establish cardiovascular disease as a leading cause of morbidity, and its comparator is the general population without type 1 diabetes, not specifically healthy individuals. (LLM, conf=0.87)
Experimental — accuracy not yet measuredDue in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population over 65 years of age is growing.
“Due in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population of these people over 65 years of age is growing (121-123).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [121]
The Discussion reports greater life expectancy in this Scottish cohort than in earlier cohorts, but says the populations may not be comparable and that the study cannot directly assess improvement over time. It does not establish that modern diabetes management caused longer lives or that the population with type 1 diabetes over age 65 is growing. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDue in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population of these people over 65 years of age is growing.
“Due in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population of these people over 65 years of age is growing (136-138).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [136]
The Abstract (Importance) notes major advances in type 1 diabetes treatment, and the Discussion reports higher life expectancy than earlier estimates from other populations. But the Discussion says the study cannot directly establish improvement over time, and our copy does not link any improvement to treatment or show that the population over age 65 is growing. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn Scotland, mortality rates in 2008-2010 increased from 31.9 and 24.2 per 1,000 person-years in men and women with type 1 diabetes mellitus aged 60-64 years to 142.7 in men and 171.3 in women aged ≥80 years.
“In Scotland, mortality rates in 2008–2010 increased from 31.9 and 24.2 per 1,000 person-years in men and women, respectively, with T1DM who were aged 60–64 years to 142.7 in men and 171.3 in women aged ≥80 years39.”
From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [39]
The Methods (Statistical Methods; page unavailable) say the paper calculated mortality rates by age and sex for the Scottish type 1 diabetes cohort in 2008–2010. The passages in our copy do not give the four claimed rates for ages 60–64 and ≥80, so the numerical comparison is not verified. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn Scotland, reductions in life expectancy for people with type 1 diabetes mellitus aged 60-64 years were 5.6 years and 7.1 years for men and women, respectively.
“In Scotland, reductions in life expectancy for people with T1DM aged 60–64 years were 5.6 years and 7.1 years for men and women, respectively39.”
From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [39]
The Results section (‘Abridged Life Table’; page unavailable) says the study estimated life-expectancy losses by attained age and that the losses declined with age. However, the passages available from our copy do not give the claimed 5.6- and 7.1-year losses for ages 60–64; searches for that age interval and both figures did not retrieve them. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Due in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population of people over 65 years with type 1 diabetes is growing.
“Due in part to the success of modern diabetes management, people with type 1 diabetes are living longer, and the population of people over 65 years with type 1 diabetes is growing (154–156).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [154]
The Discussion compares the Scottish cohort with earlier studies and reports a higher estimated life expectancy, but says it cannot directly assess whether life expectancy has improved because it lacks historical data for the same population. The paper notes advances in treatment, but does not establish that they caused longer survival or that the population over 65 with type 1 diabetes is growing. No page numbers are available in our copy. (LLM, conf=0.84)
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- Authors
- Livingstone, S. J., Levin, D., Looker, H. C., Lindsay, R. S., Wild, S. H., Joss, N., Leese, G., Leslie, P., McCrimmon, R. J., Metcalfe, W., McKnight, J. A., Morris, A. D., Pearson, D. W. M., Petrie, J. R., Philip, S., Sattar, N. A., Traynor, J. P., & Colhoun, H. M.
- Affiliations
- University of Dundee (GB)
- University of Glasgow (GB)
- University of Edinburgh (GB)
- Raigmore Hospital (GB)
- Borders General Hospital (GB)
- Scottish Renal Registry, Paisley, Scotland
- Western General Hospital (GB)
- NHS Grampian (GB)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2015-01-06
- Volume
- 313
- Issue
- 1
- Pages
- 37
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4426486
- OpenAlex
- W1965748339
- Cited by
- 621
- References
- 19
- Citations by year
- 2026: 39 · 2025: 46 · 2024: 49 · 2023: 55 · 2022: 66 · 2021: 64 · 2020: 59 · 2019: 62 · 2018: 51 · 2017: 39 · 2016: 48 · 2015: 42 · 2013: 1
- FWCI
- 52.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- Funders
- Wellcome Trust (086113)
- Diabetes UK (10/0004010)
- Medical Research Council (MR/M501633/1, MR/K007017/1)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, life expectancy, life expectancy loss, kidney disease, estimated glomerular filtration rate, ischemic heart disease, diabetic ketoacidosis, diabetic coma, sex differences, causes of death, Scotland, life expectancy at age 65
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cause of Death, Diabetes Mellitus, Type 1, Diabetic Coma, Female, Humans, Life Expectancy, Male, Middle Aged, Prospective Studies, Scotland, Sex Factors, Myocardial Ischemia, Young Adult
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