Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004-2017

Scottish Diabet Res Network Epidem

doi:10.1007/s00125-020-05173-w

Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004-2017

Scottish Diabet Res Network Epidem

School of Medicine, Medical Sciences & Nutrition

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Abstract

Aims/hypothesis We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes. Methods Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs). Results There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002). Conclusions/interpretation Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia.

Original language	English
Pages (from-to)	1626-1636
Number of pages	11
Journal	Diabetologia
Volume	63
Early online date	26 May 2020
DOIs	https://doi.org/10.1007/s00125-020-05173-w
Publication status	Published - Aug 2020

Bibliographical note

Acknowledgements

We thank the SDRN Epidemiology Group: J. Chalmers (Diabetes Centre, Victoria Hospital, Kirkcaldy, UK), C. Fischbacher (Information Services Division, NHS National Services Scotland, Edinburgh, UK), B. Kennon (Queen Elizabeth University Hospital, Glasgow, UK), G. Leese (Ninewells Hospital, Dundee, UK), R. Lindsay (British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK), J. McKnight (Western General Hospital, NHS, UK), J. Petrie (Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK), R. McCrimmon (Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK), S. Philip (Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, UK), D. McAllister (Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK), E. Pearson (Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK) and S. Wild (Usher Institute, University of Edinburgh, Edinburgh, UK).

The SDRN Epidemiology Group resource was originally set up under Ethics ref. 11/AL/0225, PAC 33/11 now running under PBPP ref. 1617-0147.

Funding
This study was supported by funding from Diabetes UK (17/0005627).

Keywords

DKA
Epidemiology
Mortality
Type 1 diabetes
ALL-CAUSE MORTALITY
CARDIOVASCULAR-DISEASE
GLYCEMIC CONTROL
LIFE EXPECTANCY
COHORT
RISK

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

@article{0e1725ffb0564cd9846c0e63cdcb12a5,

title = "Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004-2017",

abstract = "Aims/hypothesis We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes. Methods Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs). Results There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002). Conclusions/interpretation Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia.",

keywords = "DKA, Epidemiology, Mortality, Type 1 diabetes, ALL-CAUSE MORTALITY, CARDIOVASCULAR-DISEASE, GLYCEMIC CONTROL, LIFE EXPECTANCY, COHORT, RISK",

author = "O'Reilly, {Joseph E.} and Blackbourn, {Luke A. K.} and Caparrotta, {Thomas M.} and Anita Jeyam and Brian Kennon and Leese, {Graham P.} and Lindsay, {Robert S.} and McCrimmon, {Rory J.} and McGurnaghan, {Stuart J.} and McKeigue, {Paul M.} and McKnight, {John A.} and Petrie, {John R.} and Sam Philip and Naveed Sattar and Wild, {Sarah H.} and Colhoun, {Helen M.} and {Scottish Diabet Res Network Epidem}",

note = "Acknowledgements We thank the SDRN Epidemiology Group: J. Chalmers (Diabetes Centre, Victoria Hospital, Kirkcaldy, UK), C. Fischbacher (Information Services Division, NHS National Services Scotland, Edinburgh, UK), B. Kennon (Queen Elizabeth University Hospital, Glasgow, UK), G. Leese (Ninewells Hospital, Dundee, UK), R. Lindsay (British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK), J. McKnight (Western General Hospital, NHS, UK), J. Petrie (Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK), R. McCrimmon (Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK), S. Philip (Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, UK), D. McAllister (Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK), E. Pearson (Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK) and S. Wild (Usher Institute, University of Edinburgh, Edinburgh, UK). The SDRN Epidemiology Group resource was originally set up under Ethics ref. 11/AL/0225, PAC 33/11 now running under PBPP ref. 1617-0147. Funding This study was supported by funding from Diabetes UK (17/0005627).",

year = "2020",

month = aug,

doi = "10.1007/s00125-020-05173-w",

language = "English",

volume = "63",

pages = "1626--1636",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer ",

}

TY - JOUR

T1 - Time trends in deaths before age 50 years in people with type 1 diabetes

T2 - a nationwide analysis from Scotland 2004-2017

AU - O'Reilly, Joseph E.

AU - Blackbourn, Luke A. K.

AU - Caparrotta, Thomas M.

AU - Jeyam, Anita

AU - Kennon, Brian

AU - Leese, Graham P.

AU - Lindsay, Robert S.

AU - McCrimmon, Rory J.

AU - McGurnaghan, Stuart J.

AU - McKeigue, Paul M.

AU - McKnight, John A.

AU - Petrie, John R.

AU - Philip, Sam

AU - Sattar, Naveed

AU - Wild, Sarah H.

AU - Colhoun, Helen M.

AU - Scottish Diabet Res Network Epidem

N1 - Acknowledgements We thank the SDRN Epidemiology Group: J. Chalmers (Diabetes Centre, Victoria Hospital, Kirkcaldy, UK), C. Fischbacher (Information Services Division, NHS National Services Scotland, Edinburgh, UK), B. Kennon (Queen Elizabeth University Hospital, Glasgow, UK), G. Leese (Ninewells Hospital, Dundee, UK), R. Lindsay (British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK), J. McKnight (Western General Hospital, NHS, UK), J. Petrie (Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK), R. McCrimmon (Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK), S. Philip (Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, UK), D. McAllister (Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK), E. Pearson (Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK) and S. Wild (Usher Institute, University of Edinburgh, Edinburgh, UK). The SDRN Epidemiology Group resource was originally set up under Ethics ref. 11/AL/0225, PAC 33/11 now running under PBPP ref. 1617-0147. Funding This study was supported by funding from Diabetes UK (17/0005627).

PY - 2020/8

Y1 - 2020/8

N2 - Aims/hypothesis We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes. Methods Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs). Results There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002). Conclusions/interpretation Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia.

AB - Aims/hypothesis We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes. Methods Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs). Results There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002). Conclusions/interpretation Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia.

KW - DKA

KW - Epidemiology

KW - Mortality

KW - Type 1 diabetes

KW - ALL-CAUSE MORTALITY

KW - CARDIOVASCULAR-DISEASE

KW - GLYCEMIC CONTROL

KW - LIFE EXPECTANCY

KW - COHORT

KW - RISK

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U2 - 10.1007/s00125-020-05173-w

DO - 10.1007/s00125-020-05173-w

M3 - Article

C2 - 32451572

SN - 0012-186X

VL - 63

SP - 1626

EP - 1636

JO - Diabetologia

JF - Diabetologia

ER -

Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004-2017

Abstract

Bibliographical note

Keywords

UN SDGs

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