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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 People.

¹Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, United Kingdom
²The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX
³ Department of Epidemiology & Public Health, Mulhouse Building, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BJ

r.g.feltbower{at}leeds.ac.uk

ABSTRACT

Objective: To examine mortality rates and causes of death amongst subjects diagnosed with T1D aged 0-29 years.

Research Design And Methods: T1D subjects from a population-based Register in Yorkshire, UK diagnosed between 1978-2004 were linked to the UK National Health Service Central Register for death notifications. Deaths were coded using ICD-9 (1979-2000) and ICD-10 (2001-2005). Standardized mortality ratios (SMR) were calculated using expected numbers of deaths from UK mortality rates by cause of death and age at diagnosis.

Results: 4246 individuals were followed-up providing 50,471 person years of follow-up. Mean follow-up length was 12.8 years for 0-14 and 8.3 years for 15-29 year olds. Overall 108 patients died, of whom 77 (71%) were male. 74 (1.7/1000 pyrs) deaths occurred in the 0-14s and 34 (4.6/1000 pyrs) in the 15-29 year olds. The SMR was 4.7 (95% CI 3.8-5.6) overall, similar for males and females, but higher for 15-29s (6.2; 4.3-8.6) compared to 0-14s (4.2; 3.3-5.3). The SMR rose with increasing disease duration. 47/108 deaths (44%) occurred from diabetes complications: 32 acute and 15 chronic. 22% (n=24) of deaths were attributed to accidents or violence (SMR 2.1; 95% CI 1.4-3.2), including 6 suicides. 16% of all deaths were related to drug misuse (including insulin but excluding tobacco and alcohol): SMR=6.4 (3.7-10.2).

Conclusions: T1D subjects diagnosed under 30 years had a 4.7-fold excess mortality risk. Nearly half 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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