Takeaway
- 13.8-fold excess in ischaemic heart disease (IHD) deaths in individuals with early-onset type 1 diabetes compared with the general population.
- Deaths began to emerge in the early 20s.
Why this matters
- Death certification analysis without clinical validation underestimates IHD deaths in this population.
- The increasing evidence for cardiovascular risk factors developing during adolescence suggests that a targeted approach is needed to reduce the risk for IHD death in patients with early-onset type 1 diabetes.
Key results
- During a median follow-up of 17.7 years, 156 deaths were recorded.
- Median age at death was 28.2 years (range, 6.5-48.9 years).
- Prior to validation of death certificates, 9 deaths were classed as IHD.
- After validation, 14 deaths were attributed to type 1 diabetes with IHD.
- Deaths began to emerge noticeably in the 20-24 years age group.
- The youngest death occurred at 21.9 years.
- After validation, median age at death was 35.1 years (range, 21.9-47.9 years).
- Standardised mortality ratio (SMR) was 13.8 (95% CI, 8.2-23.4).
- SMR for time since diagnosis was highest between 10 and 19 year, at 116.1 (95% CI, 48.3-278.9).
Study design
- Cohort study of 4382 individuals with 83,097 person-years of follow-up using data from the Yorkshire Register of type 1 Diabetes in Children and Young People (YRDCYP) linked to clinically validated death certification data for those diagnosed under 15 years.
- Funding: YRDCYP receives funding from the Yorkshire and Humber Paediatric Diabetes network via Leeds Teaching Hospitals NHS Trust.
Limitations
- Exclusion of individuals with late-onset type 1 diabetes.
References
References