Time Trends in Deaths Before Age 50 Years in People with Type 1 Diabetes: a nationwide analysis from Scotland 2004–2017

Joseph E. O’Reilly; Luke Blackbourn; Tom Caparrotta; Anita Jeyam; Brian Kennon; Graham P. Leese; Robert S. Lindsay; Rory J. McCrimmon; Stuart J. McGurnaghan; Paul M. McKeigue; John A.  McKnight; John R. Petrie; Sam Philip; Naveed Sattar; Sarah H. Wild; Helen M. Colhoun; Scottish Diabetes Research Network Epidemiology Group

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

Joseph E. O’Reilly, Luke Blackbourn, Tom Caparrotta, Anita Jeyam, Brian Kennon, Graham P. Leese, Robert S. Lindsay, Rory J. McCrimmon, Stuart J. McGurnaghan, Paul M. McKeigue, John A. McKnight, John R. Petrie, Sam Philip, Naveed Sattar, Sarah H. Wild, Helen M. Colhoun (Lead / Corresponding author), Scottish Diabetes Research Network Epidemiology Group

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

76 Downloads (Pure)

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. [Figure not available: see fulltext.].

Original language	English
Pages (from-to)	1626-1636
Number of pages	11
Journal	Diabetologia
Volume	63
Issue number	8
Early online date	26 May 2020
DOIs	https://doi.org/10.1007/s00125-020-05173-w
Publication status	Published - 1 Aug 2020

Keywords

DKA
Epidemiology
Mortality
Type 1 diabetes

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism

UN SDGs

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

Access to Document

10.1007/s00125-020-05173-wLicence: CC BY

Final Published VersionFinal published version, 845 KBLicence: CC BY

Cite this

O’Reilly, J. E., Blackbourn, L., Caparrotta, T., Jeyam, A., Kennon, B., Leese, G. P., Lindsay, R. S., McCrimmon, R. J., McGurnaghan, S. J., McKeigue, P. M., McKnight, J. A., Petrie, J. R., Philip, S., Sattar, N., Wild, S. H., Colhoun, H. M., & Scottish Diabetes Research Network Epidemiology Group (2020). Time Trends in Deaths Before Age 50 Years in People with Type 1 Diabetes: a nationwide analysis from Scotland 2004–2017. Diabetologia, 63(8), 1626-1636. https://doi.org/10.1007/s00125-020-05173-w

@article{fc22b5a4a17a47cab14de1c5ec059ba2,

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. [Figure not available: see fulltext.].",

keywords = "DKA, Epidemiology, Mortality, Type 1 diabetes",

author = "O{\textquoteright}Reilly, {Joseph E.} and Luke Blackbourn and Tom Caparrotta 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 Diabetes Research Network Epidemiology Group}",

note = "Funding - Diabetes UK (17/0005627) ",

year = "2020",

month = aug,

day = "1",

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

language = "English",

volume = "63",

pages = "1626--1636",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "8",

}

O’Reilly, JE, Blackbourn, L, Caparrotta, T, Jeyam, A, Kennon, B, Leese, GP, Lindsay, RS, McCrimmon, RJ, McGurnaghan, SJ, McKeigue, PM, McKnight, JA, Petrie, JR, Philip, S, Sattar, N, Wild, SH, Colhoun, HM & Scottish Diabetes Research Network Epidemiology Group 2020, 'Time Trends in Deaths Before Age 50 Years in People with Type 1 Diabetes: a nationwide analysis from Scotland 2004–2017', Diabetologia, vol. 63, no. 8, pp. 1626-1636. https://doi.org/10.1007/s00125-020-05173-w

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

AU - Caparrotta, Tom

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 Diabetes Research Network Epidemiology Group

N1 - Funding - Diabetes UK (17/0005627)

PY - 2020/8/1

Y1 - 2020/8/1

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. [Figure not available: see fulltext.].

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. [Figure not available: see fulltext.].

KW - DKA

KW - Epidemiology

KW - Mortality

KW - Type 1 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85085288621&partnerID=8YFLogxK

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

IS - 8

ER -

Time Trends in Deaths Before Age 50 Years in People with Type 1 Diabetes: a nationwide analysis from Scotland 2004–2017

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this