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Childhood, young adult onset type 1 diabetes increases mortality risk
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The risks for all-cause mortality and mortality from cardiovascular causes, sepsis, renal failure, respiratory disorders and cancer are significantly higher among adults with insulin-treated diabetes diagnosed before age 30 years compared with adults without diabetes, study data show.
“Mortality rates in the prime working years are still very high for persons with type 1 diabetes diagnosed in childhood and early young adulthood, particularly among poor and underserved African Americans and whites, largely due to complications of kidney and cardiovascular disease,” Baqiyyah Conway, PhD, assistant professor of epidemiology and biostatistics and community health in the department of epidemiology at the University of Texas Health Science Center, told Endocrine Today.
Conway and colleagues evaluated data from the Southern Community Cohort Study on 62,266 adults without diabetes (mean age, 51.6 years; 57.9% women; 31.1% white; 65% black), 162 with childhood-onset type 1 diabetes (diagnosed before age 20 years; mean age, 50.2 years; 69.1% women; 35.4% white; 62.1% black) and 313 with young-adulthood-onset type 1 diabetes (diagnosis between ages 20 to 29 years; mean age, 49.7 years; 64.9% women; 23.6% white; 73.9% black) to estimate overall and cause-specific mortality. Follow-up was a mean of 9.5 years. Participants with diabetes were treated with insulin.
During follow-up, mortality occurred in 39.5% of participants with childhood-onset diabetes, 38.3% in those with young-adult-onset diabetes and 12.9% in those without diabetes.
Compared with participants without diabetes, participants with childhood-onset and young-adult-onset diabetes had higher mortality rates for all-causes (childhood, HR = 4.3; 95% CI, 3.3-5.5; young adult, HR = 4.9; 95% CI, 4-5.8), ischemic heart disease (childhood, HR = 5.7; 95% CI, 3.5-9.4; young adult, HR = 7.9; 95% CI, 5.6-11), heart failure (childhood, HR = 7.3; 95% CI, 4.2-12.7; young adult, HR = 5.4; 95% CI, 3.3-8.9), sepsis (childhood, HR = 10.3; 95% CI, 6.1-17.3; young adult, HR = 8.8; 95% CI, 5.7-13.5), renal failure (childhood, HR = 15.1; 95% CI, 8.6-26.5; young adult, HR = 18.2; 95% CI, 12.3-27.1), respiratory disorders (childhood, HR = 3.9; 95% CI, 2.3-6.7; young adult, HR = 5.3; 95% CI, 3.74-7.7), suicide/homicide/accidents (childhood, HR = 2.3; 95% CI, 0.72-7; young adult, HR = 5.8; 95% CI, 3.4-10.2) and cancer (childhood, HR = 2.1; 95% CI, 0.98-4.4; young adult, HR = 1.2; 95% CI, 0.55-2.5).
“Renal disease has declined greatly in type 1 diabetes over the past several decades, but we still found renal disease mortality rates among whites that were 33 to 50 times higher than their non-diabetic peers, and among blacks that were eight to 15 times higher compared to their non-diabetic peers,” Conway said. “Hence, continued heightened monitoring of kidney function and disease among indigent populations within type 1 diabetes is still needed. Our data also suggest that duration of diabetes (ie, years lived with the disease) is not as important for mortality as commonly thought, as we found no real differences in mortality rates whether diabetes was diagnosed in childhood or young adulthood. Careful control of cardiovascular and renal disease risk factors appear to be what matter, which may be particularly challenging in low-income populations.” – by Amber Cox
For more information:
Baqiyyah Conway, PhD, can be reached at baqiyyah.conway@uthct.edu.
Disclosures: The authors report no relevant financial disclosures.
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