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Cited by 183Diabetes Management and ResearchDiabetes and associated disordersDiabetes Management and Education

Acute Complications and Drug Misuse Are Important Causes of Death for Children and Young Adults With Type 1 Diabetes

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Feltbower, Richard G., Bodansky, H. Jonathan, Patterson, Christopher C., Parslow, Roger C., Stephenson, Carolyn R., Reynolds, Catherine, McKinney, Patricia A.·2008·Diabetes Care
DOI 10.2337/dc07-2029
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Abstract

OBJECTIVE—To examine mortality rates and causes of death among subjects diagnosed with type 1 diabetes aged ≤29 years. RESEARCH DESIGN AND METHODS— Subjects with type 1 diabetes from a population-based register in Yorkshire, U.K., diagnosed between 1978 and 2004 were linked to the U.K. National Health Service Central Register for death notifications. Deaths were coded using ICD-9 (1979–2000) and ICD-10 (2001–2005). Standardized mortality ratios (SMRs) were calculated using expected numbers of deaths from U.K. mortality rates by cause of death and age at diagnosis. RESULTS—A total of 4,246 individuals were followed up, providing 50,471 person-years of follow-up. Mean follow-up length was 12.8 years for individuals aged 0–14 years and 8.3 for those aged 15–29 years. Overall, 108 patients died, of whom 77 (71%) were male. A total of 74 (1.7/1,000 person-years) deaths occurred in inidividuals aged 0–14 years and 34 (4.6/1,000 person-years) in those aged 15–29 years. The SMR was 4.7 (95% CI 3.8–5.6) overall, similar for males and females, but higher for individuals aged 15–29 years (SMR 6.2 [95% CI 4.3–8.6]) compared with those aged 0–14 years (4.2 [3.3–5.3]). The SMR rose with increasing disease duration. A total of 47 of 108 deaths (44%) occurred from diabetes complications, 32 of which were acute and 15 chronic. Twenty-two percent (n = 24) of deaths were attributed to accidents or violence (SMR 2.1 [95% CI 1.4–3.2]), including six suicides. Sixteen percent of all deaths were related to drug misuse (including insulin but excluding tobacco and alcohol) (SMR 6.4 [95% CI 3.7–10.2]). CONCLUSIONS—Subjects with type 1 diabetes diagnosed under 30 years of age had a 4.7-fold excess mortality risk. Nearly half of the deaths were due to acute or chronic complications of diabetes. Drug misuse–related deaths may be an emerging trend in this population warranting further investigation.

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  • Diabetic ketoacidosis accounts for 13-19% of type 1 diabetes-related mortality.

    “and accounts for 13–19% of type 1 diabetes-related mortality.105,110,111”

    From Type 1 diabetes (2018) · cites this paper as [110]

    The Results report 14 deaths from diabetic ketoacidosis, and Table 3 reports 108 deaths from all causes—about 13%. This supports the lower end of the cited range in this Yorkshire cohort, but the paper does not establish the 19% figure or the full range. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Hypoglycaemic events are associated with 4-10% of type 1 diabetes-related deaths.

    “and are associated with 4–10% of type 1 diabetes-related deaths.110–112”

    From Type 1 diabetes (2018) · cites this paper as [110]

  • In four series, 4%, 6%, 7%, and 10% of deaths of patients with type 1 diabetes were caused by hypoglycemia.

    “four recent reports of mortality rates in series of patients indicate that 4% (27), 6% (28), 7% (29), and 10% (30) of deaths of patients with type 1 diabetes were caused by hypoglycemia.”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [29]

  • Four recent reports of mortality rates in series of patients indicate that 4%, 6%, 7%, and 10% of deaths of patients with type 1 diabetes were caused by hypoglycemia.

    “In addition to case reports of hypoglycemic deaths in patients with type 1 and type 2 diabetes, four recent reports of mortality rates in series of patients indicate that 4% (27), 6% (28), 7% (29), and 10% (30) of deaths of patients with type 1 diabetes were caused by hypoglycemia.”

    From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [29]

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Authors
Feltbower, R. G., Bodansky, H. J., Patterson, C. C., Parslow, R. C., Stephenson, C. R., Reynolds, C., & McKinney, P. A.
Affiliations
  • University of Leeds (GB)
  • Leeds General Infirmary (GB)
  • Queen's University Belfast (GB)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2008-05-01
Volume
31
Issue
5
Pages
922-926
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc07-2029
OpenAlex
W2102203530
Cited by
183
References
29
Citations by year
2026: 2 · 2025: 1 · 2024: 9 · 2023: 8 · 2022: 6 · 2021: 10 · 2020: 8 · 2019: 9 · 2018: 12 · 2017: 11 · 2016: 17 · 2015: 23 · 2014: 15 · 2013: 18 · 2012: 13
FWCI
4.83
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute for Health and Care Research
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, mortality, causes of death, acute complications, drug abuse, insulin misuse, suicide, children and young adults, standardized mortality ratio, disease duration, chronic complications, diabetes complications
MeSH terms
Accidents, Adolescent, Adult, Cause of Death, Child, Child, Preschool, Diabetes Mellitus, Type 1, Female, Humans, Hypoglycemic Agents, Male, Violence

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