Alcohol-Related Deaths Up in Those With Type 1 Diabetes

Jim Kling

September 09, 2011

September 9, 2011 — Survival rates in patients with early-onset type 1 diabetes have improved in recent years, whereas survival in patients with late-onset type 1 diabetes has become worse since the 1980s. The trend appears to be a result of increases in drug- and alcohol-related deaths in patients with late-onset type 1 diabetes. The results were reported in a study published online September 8 in the British Medical Journal.

Advances in the care of type 1 diabetes have been made in recent years, but patients continue to suffer from increased mortality because of acute and chronic complications.

In theory, later age of onset of type 1 diabetes may be associated with decreased mortality. Those with onset after age 15 have lower risk for diabetic nephropathy and end-stage renal disease compared with patients with onset during adolescence. "Better long term survival could thus be expected in people diagnosed as having diabetes after adolescence," the researchers state. "However, most of the studies of mortality have been done in patients with onset of diabetes in childhood or the age at onset has not been the focus of the analyses."

To explore the effect of age of onset on mortality, Valma Harjutsalo, PhD, from Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Biomedicum Helsinki, Finland, and colleagues conducted a population based nationwide cohort study in Finland of early-onset (age, 0 - 14 years) and late-onset (age, 15 - 29 years) type 1 diabetes. The study included 17,306 patients overall, who were diagnosed between 1970 and 1999.

During an accumulated 370,733 person years, 1338 deaths occurred, for an all-cause mortality rate of 361/100,000 person years (95% confidence interval [CI], 342 - 382). The early-onset group had a standardized mortality ratio of 3.6 (95% CI, 3.3 - 3.9) compared with 2.8 (95% CI, 2.6 - 3.0) in the late-onset group. Standardized mortality ratios in women were higher than in men (5.5 [95% CI, 4.8 - 6.3] vs 3.0 [95% CI, 2.7 - 3.4] in the early-onset cohort; 3.6 [95% CI, 3.3 - 3.9] vs 2.6 [95% CI, 2.4 - 2.8] in the late-onset cohort).

There was an overall improvement in mortality rates over time in the early-onset cohort. The researchers looked at the standardized mortality ratio after 20 years postdiagnosis. The ratio was 3.5 (95% CI, 2.7 - 4.4) in patients diagnosed between 1970 and 1974 and decreased to 1.9 (95% CI, 1.2 - 2.9) in patients diagnosed between 1985 and 1989. The reverse was true in the late-onset group: It increased from 1.4 (95% CI, 1.0 - 1.8) in those diagnosed between 1970 and 1974 to 2.9 (95% CI, 2.2 - 3.7) in the 1985 to 1989 group.

The researchers also found that alcohol and drugs were common causes of mortality, especially in the late-onset cohort. The late-onset cohort also experienced an increase from 6.0 deaths (95% CI, 3.2 - 10.3) per 10,000 person years in patients diagnosed between 1970 and 1974 to 15.5 deaths (95% CI, 10.7 - 21.7) in patients with late-onset diabetes diagnosed between 1985 and 1989 (P < .001). Of those deaths, 39% were attributable to drugs or alcohol.

The findings highlight "the importance of permanent and long lasting patient-doctor-nurse relationships, close supervision, and guidance on the short term and long term effects of alcohol in young people with type 1 diabetes, especially in our alcohol permissive cultures," the authors write.

The study was supported by grants from the Folkhälsan Research Foundation, Wilhelm and Else Stockmann Foundation, and Livoch Hälsa Foundation. The authors have disclosed no relevant financial relationships.

BMJ. Published online September 8, 2011. Full text

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