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Diabetes-Related Mortality

A pediatrician’s view

Division of Endocrinology, the Hospital for Sick Children, Toronto, Ontario, Canada

Individuals with newly diagnosed type 1 diabetes or members of their families invariably ask questions about the morbidity and mortality associated with this new disorder they must contend with. Some younger children are frightened that the "di" in diabetes means that they will die soon. Teens often use as an excuse for their noncompliance the view that they are going to die young and that nothing they do will alter that course.

What are the facts? And, are they already out-of-date, given recent improvements in diabetes care? Feudtner (1) called type 1 diabetes " a disease in motion," citing its "transmutation" from a uniformly lethal condition in the preinsulin era to its present status as a serious chronic disorder based on its long-term morbidity and mortality.

Diabetes-related mortality should be separated in two: deaths occurring early in the course, invariably associated with diabetic ketoacidosis (DKA) or hypoglycemia, and those resulting from long-term micro- and macrovascular complications. The article in this issue of Diabetes Care by Nishimura et al. (2) reports long-term mortality in nearly 1,000 type 1 diabetic patients diagnosed before age 18 years in Allegheny County, Pennsylvania, between 1965 and 1979. They found a significant improvement in survival in the more recently diagnosed individuals and concluded that this improvement likely stems from better glycemic and blood pressure control resulting from the availability of blood glucose monitoring, HbA_1c assays, and newer antihypertensive agents.

In life table analyses provided by Nishimura et al. (2) the cumulative survival was 98% at 10 years and 79.6% at 30 years. Recently, Matsushima . . . [Full Text of this Article]

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