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Original Research
Unnatural Deaths in a National Cohort of People Diagnosed With Diabetes
Roger T. Webb, Paul Lichtenstein, Marie Dahlin, Navneet Kapur, Jonas F. Ludvigsson, Bo Runeson
Diabetes Care 2014 May; DC_140005. https://doi.org/10.2337/dc14-0005
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Abstract

OBJECTIVE To examine risk of unnatural death among people diagnosed with diabetes irrespective of disease type.

RESEARCH DESIGN AND METHODS We conducted a matched cohort study of the entire Swedish population using interlinked national registers. From the National Diabetes Register we identified 252,191 people diagnosed with diabetes (type 1 or 2) during 1996–2009. Each cohort member was matched for age, sex, and county of birth to five unaffected individuals randomly sampled from the Total Population Register. Mortality was examined with complete ascertainment, and risk ratios RRs for all unnatural deaths and for specific causes (suicide, accident, homicide, and iatrogenic effects) were estimated using conditional fixed-effects Poisson regression.

RESULTS Risk of any unnatural death was elevated versus the general population: 77.3 versus 32.1 per 10,000 (RR 2.2 [95% CI 2.1–2.4]), and these deaths occurred at a younger age in the diabetes cohort. Risk was increased for suicide (RR 3.4 [95% CI 3.0–3.8]), accident (RR 2.0 [95% CI 1.9–2.1]), homicide (RR 3.1 [95% CI 1.6–6.1]), and iatrogenic effects (RR 2.4 [95% CI 1.9–3.2]). It was greatly elevated for fatal poisoning from a variety of agents, including psychotropic drugs and “other and unspecified medication,” as well as narcotics, alcohol, and carbon monoxide. Almost 9% of all fatal poisoning cases in the diabetes cohort were identified as overdoses of insulin or oral hypoglycemic drugs.

CONCLUSIONS Various causes of unnatural death, in particular deliberate and accidental poisonings, occur more frequently among diabetic patients. Before preventive strategies can be implemented, a deeper understanding of the risk factors and causal mechanisms explaining the marked elevations in risk is needed.

  • Received January 2, 2014.
  • Accepted April 18, 2014.
  • © 2014 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Diabetes Care: 44 (2)

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February 2021
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Unnatural Deaths in a National Cohort of People Diagnosed With Diabetes
Roger T. Webb, Paul Lichtenstein, Marie Dahlin, Navneet Kapur, Jonas F. Ludvigsson, Bo Runeson
Diabetes Care May 2014, DC_140005; DOI: 10.2337/dc14-0005

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Unnatural Deaths in a National Cohort of People Diagnosed With Diabetes
Roger T. Webb, Paul Lichtenstein, Marie Dahlin, Navneet Kapur, Jonas F. Ludvigsson, Bo Runeson
Diabetes Care May 2014, DC_140005; DOI: 10.2337/dc14-0005
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© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.