Drug Use, Suicide Found in Type 1 Diabetes Organ Donors

Miriam E Tucker

July 17, 2017

High rates of suicide and illicit substance abuse have been found among deceased individuals with type 1 diabetes who acted as organ donors for research purposes, reinforcing the need for psychosocial screening in the type 1 diabetes population.

The data, from the JDRF-sponsored Network for Pancreatic Organ Donors with Diabetes (nPOD) program, were published online July 5 in Diabetes Care by pediatric endocrinology fellow Laura M Jacobsen, MD, of the University of Florida, Gainesville, and colleagues.

While acknowledging that organ donors may not reflect the general population with type 1 diabetes, Dr Jacobsen and colleagues say that the findings nevertheless highlight the need for addressing the emotional and psychological burdens associated with the condition.

"Greater attention needs to be paid to the behavioral aspects of diabetes. The odds of depression in type 1 diabetes are twice that of a control population," principal investigator Desmond Schatz, MD, professor of pediatrics and medical director, diabetes center, at the College of Medicine, University of Florida, told Medscape Medical News.

"Depression may occur secondary to the hardships of managing diabetes. As such, this may lead to illicit drug use and even suicide," added Dr Schatz.

The authors point to the inclusion in the American Diabetes Association 2017 guidelines of recommendations to screen for depression and diabetes-specific distress and for referral to mental healthcare providers — preferably those with type 1 diabetes–specific expertise — when signs of "depression, difficulty coping, disordered eating, drug use, or other self-harm behaviors are identified."

Database Includes Information on Cause of Death

The study data come from terminal hospitalization records for the first 100 organ donors with type 1 diabetes in the nPOD program, which collects, processes, and distributes pancreatic and other disease-relevant tissues to investigators worldwide for research purposes. The database includes medical record information about cause of death and drug use.

The donors were 45% female and 79% white, with a mean age of 28 years at death and mean diabetes duration of 16 years. Anoxia was the most commonly listed cause of death (n = 57), precipitated by a variety of events including drug overdose, myocardial infarction, pulmonary embolism, or cerebral edema.

Of the deaths due to anoxia, 26% coincided with a history of illicit substance abuse, and a majority of those had positive toxicology upon arrival to medical care.

Of 79 donors in whom bicarbonate or pH levels were available, acidosis (pH < 7.3 or HCO3 - < 15 mEq/L) was present in 71% (n = 56). Those with acidosis were younger than those without (27 vs 33 years; P < .05) and had a shorter diabetes duration (14 vs 20 years; P < .05).

The presence of acidosis is significant and likely contributed to the cause of death, Dr Jacobsen explained, noting, "This is especially important in diabetes where diabetic ketoacidosis most likely contributed to their demise. We only used the term 'acidosis' because we cannot definitively say whether diabetic ketoacidosis was present without having ketones tested, and that is not commonly reported or done in an emergency situation or resuscitation."

Overall, 32% of donors reported or tested positive for illegal drugs (excluding marijuana). Cocaine was the most common, and multidrug use was also common.

Alcohol use was reported in 35% of donors, and marijuana use in 27%.

Documented suicide was found in 8%, with an average age at death of 21 years and average diabetes duration of 9 years. Methods included intentional insulin overdose in two and self-inflicted gunshot wound to the head in three. Of the eight who committed suicide, three were younger than 18 years. The youngest — a girl who intentionally overdosed her insulin — was just 11 years.

The research was supported by nPOD, a collaborative type 1 diabetes research project sponsored by JDRF. The authors have reported no further relevant financial relationships.

Diabetes Care. Published online July 5, 2017. Article

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