HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nishimura, R. Articles by Orchard, T. J. Search for Related Content PubMed PubMed Citation Articles by Nishimura, R. Articles by Orchard, T. J. Social Bookmarking                What's this?

Mortality Trends in Type 1 Diabetes

The Allegheny County (Pennsylvania) Registry 1965–1999

¹ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
² Department of Internal Medicine, Division of Diabetes and Endocrinology, Jikei University School of Medicine, Tokyo, Japan
³ Children’s Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania

OBJECTIVES—To investigate long-term mortality and its temporal trends as of 1 January 1999 among the 1,075 patients with type 1 diabetes (onset age <18 years, diagnosed between 1965 and 1979) who comprise the Allegheny County population-based registry.

RESEARCH DESIGN AND METHODS—Overall, sex- and race-specific mortality rates per person-year of follow-up were determined. Standardized mortality ratios were also calculated. Survival analyses and Cox proportional hazard model were also used. Temporal trends were examined by dividing the cohort into three groups by year of diagnosis (1965–1969, 1970–1974, and 1975–1979).

RESULTS—Living status of 972 cases was ascertained as of January 1, 1999 (ascertainment rate 90.4%). The mean duration of diabetes was 25.2 ± 5.8 (SD) years. Overall, 170 deaths were observed. The crude mortality rate was 627 per 100,000 person-years (95% CI 532–728) and standardized mortality ratio was 519 (440–602). Life-analyses by the Kaplan-Meier method indicated cumulative survival rates of 98.0% at 10 years, 92.1% at 20 years, and 79.6% at 30 years duration of diabetes. There was a significant improvement in the survival rate between the cohort diagnosed during 1965–1969 and that diagnosed during 1975–1979 by the log-rank test (P = 0.03). Mortality was higher in African-Americans than in Caucasians, but there were no differences seen by sex. The improvement in recent years was seen in both ethnic groups and sexes.

CONCLUSIONS—An improvement in long-term survival was observed in the more recently diagnosed cohort. This improvement is consistent with the introduction of HbA₁ testing, home blood glucose monitoring, and improved blood pressure therapy in the 1980s.

Abbreviations: DERI, Diabetes Epidemiology Research International • SMR, standardized mortality ratio

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				S. Fourlanos, M. D. Varney, B. D. Tait, G. Morahan, M. C. Honeyman, P. G. Colman, and L. C. Harrison The Rising Incidence of Type 1 Diabetes Is Accounted for by Cases With Lower-Risk Human Leukocyte Antigen Genotypes Diabetes Care, August 1, 2008; 31(8): 1546 - 1549. [Abstract] [Full Text] [PDF]

				R. G. Feltbower, H. J. Bodansky, C. C. Patterson, R. C. Parslow, C. R. Stephenson, C. Reynolds, and P. A. McKinney Acute Complications and Drug Misuse Are Important Causes of Death for Children and Young Adults With Type 1 Diabetes: Results from the Yorkshire Register of Diabetes in Children and Young Adults Diabetes Care, May 1, 2008; 31(5): 922 - 926. [Abstract] [Full Text] [PDF]

				T. H. Lipman, A. F. Jawad, K. M. Murphy, A. Tuttle, R. L. Thompson, S. J. Ratcliffe, and L. E. Levitt Katz Incidence of Type 1 Diabetes in Philadelphia Is Higher in Black Than White Children From 1995 to 1999: Epidemic or misclassification? Diabetes Care, November 1, 2006; 29(11): 2391 - 2395. [Abstract] [Full Text] [PDF]

				M. Stadler, M. Auinger, C. Anderwald, T. Kastenbauer, R. Kramar, C. Feinbock, K. Irsigler, F. Kronenberg, and R. Prager Long-Term Mortality and Incidence of Renal Dialysis and Transplantation in Type 1 Diabetes Mellitus J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3814 - 3820. [Abstract] [Full Text] [PDF]

				J. C. Zgibor, G. A. Piatt, K. Ruppert, T. J. Orchard, and M. S. Roberts Deficiencies of Cardiovascular Risk Prediction Models for Type 1 Diabetes Diabetes Care, August 1, 2006; 29(8): 1860 - 1865. [Abstract] [Full Text] [PDF]

				G. Pambianco, T. Costacou, D. Ellis, D. J. Becker, R. Klein, and T. J. Orchard The 30-year natural history of type 1 diabetes complications: the pittsburgh epidemiology of diabetes complications study experience. Diabetes, May 1, 2006; 55(5): 1463 - 1469. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden Insulin Treatment and Type 1 Diabetes Topics Diabetes Care, April 1, 2006; 29(4): 936 - 944. [Full Text] [PDF]

				L. C. Lanting, I. M.A. Joung, J. P. Mackenbach, S. W.J. Lamberts, and A. H. Bootsma Ethnic Differences in Mortality, End-Stage Complications, and Quality of Care Among Diabetic Patients: A review Diabetes Care, September 1, 2005; 28(9): 2280 - 2288. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden Transplantation and Islet Topics Diabetes Care, January 1, 2005; 28(1): 213 - 219. [Full Text] [PDF]

				D. M. Harlan Gene-Altered Islets for Transplant: Giant Leap or Small Step? Endocrinology, February 1, 2004; 145(2): 463 - 466. [Full Text] [PDF]

				J. M. Venstrom, M. A. McBride, K. I. Rother, B. Hirshberg, T. J. Orchard, and D. M. Harlan Survival After Pancreas Transplantation in Patients With Diabetes and Preserved Kidney Function JAMA, December 3, 2003; 290(21): 2817 - 2823. [Abstract] [Full Text] [PDF]

				B. Hirshberg, K. I. Rother, B. J. Digon III, J. Lee, J. L. Gaglia, K. Hines, E. J. Read, R. Chang, B. J. Wood, and D. M. Harlan Benefits and Risks of Solitary Islet Transplantation for Type 1 Diabetes Using Steroid-Sparing Immunosuppression: The National Institutes of Health experience Diabetes Care, December 1, 2003; 26(12): 3288 - 3295. [Abstract] [Full Text] [PDF]

				K. Weinger and J. Rosenzweig Treatment of hypertension reduces risk of complications in type 2 diabetes Evid. Based Nurs., October 1, 2003; 6(4): 109 - 109. [Full Text] [PDF]

				K. S. Bryden, D. B. Dunger, R. A. Mayou, R. C. Peveler, and H. A. W. Neil Poor Prognosis of Young Adults With Type 1 Diabetes: A longitudinal study Diabetes Care, April 1, 2003; 26(4): 1052 - 1057. [Abstract] [Full Text] [PDF]

				R. F. Redberg, P. Greenland, V. Fuster, K. Pyorala, S. N. Blair, A. R. Folsom, A. B. Newman, D. H. O'Leary, T. J. Orchard, B. Psaty, et al. Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group III: Risk Assessment in Persons With Diabetes Circulation, May 7, 2002; 105 (18): e144 - e152. [Full Text] [PDF]

				D. Daneman Diabetes-Related Mortality: A pediatrician's view Diabetes Care, May 1, 2001; 24(5): 801 - 802. [Full Text]

				K. Heald, T. Jay, and R. Downing Human islet transplantation: expectation versus reality The British Journal of Diabetes & Vascular Disease, March 1, 2001; 1(2): 128 - 130. [Abstract] [PDF]