Poor metabolic control in childhood strongly correlates to diabetes‐related premature death in persons <30 years of age—A population‐based cohort study

Abstract

Background/objective: The importance of metabolic control in childhood regarding excess risk of death in young persons has not been well studied. This registry-based study aimed to investigate mortality rates and cause of death related to metabolic control in young persons (≤29 years) in Sweden with type 1 diabetes.Methods: All 12 652 subjects registered in the Swedish pediatric diabetes quality register, from 2006 to 2014, were included. Data were merged with the Swedish Cause of Death Register. Standardized mortality rates were calculated using the official Swedish population register.Results: Of 68 deaths identified, 38.2% of the deaths were registered as being due to diabetes whereof the major cause of death was acute complications. Overall standardized mortality ratio was 2.7 (2.1-3.4, 95% CI). Subjects who died from diabetes had a mean HbA1c of 74 ± 19 mmol/mol (8.9 ± 1.7%) during childhood vs 62 ± 12 mmol/mol (7.8 ± 1.1%) in those still alive (P < .001). Conclusions:In this nationwide cohort of young subjects with type 1 diabetes, there was a high mortality rate compared to the general population. Mean HbA1c in childhood was significantly higher in those who died from diabetes, compared to subjects who were still alive.To decrease mortality in young persons with type 1 diabetes it is essential not only to achieve but also to maintain a good metabolic control during childhood and adolescence.

Time trend in excess mortality in children with type 1 diabetes from 1987 to 2016 in mainland France

“…[8][9][10]12 Mortality rates by age groups are rarely reported, 8 and mortality data from the 2010s are scarce. 14,[16][17][18] Moreover, few studies covered a long enough period to analyze calendar time trends in mortality and showed either a decline, 5,7 stability, 12 or even an increase 11 in mortality rates during the studied period.…”

Glycated Hemoglobin (HbA1c) Concentrations Among Children and Adolescents With Diabetes in Middle- and Low-Income Countries, 2010–2019: A Retrospective Chart Review and Systematic Review of Literature

“…In addition to the DCCT/EDIC and UKPDS study that demonstrated long-term health benefits of strict glycemic control in adults with DM (8,9), studies in children also showed that tighter glycemic control (represented by lower HbA1c) is associated with less premature death and increased life expectancy (7,28). In addition, a lower HbA1c concentration is also associated with improved quality of life and less diabetic complications (29,30).…”

“…Recent population-based studies have shown that in countries with high-income, the average loss of life expectancy in patients with T1DM is about 12-15 years owing to diabetesrelated complications (5,6). The childhood-onset DM is associated with premature death, especially among patients with higher glycated hemoglobin (HbA1c) concentrations (7).…”

Perinatal risk factors for type 1 diabetes in children and adolescents

“…However, even with insulin treatment T1D is a severe, chronic disease that can result in serious long-term micro-and macrovascular complications, i.e., blindness, cardiovascular disease, renal disease and footand leg amputation [22][23][24][25][26] . Patients with T1D have a reduced life expectancy because of these complications and due to the possibility of suffering acute diabetes coma [27][28][29] . In addition, people with T1D have increased risk of developing other autoimmune disorders such as celiac disease, vitiligo and hypo-or hyperthyroidism 19 .…”