Excess mortality in incident cases of diabetes mellitus aged 15 to 34 years at diagnosis : a population-based study (DISS) in Sweden

• Published in: Diabetologia Vol. 49; no. 4; pp. 653 - 659
• Main Authors: WAERNBAUM, I, BLOHME, G, ÖSTMAN, J, SUNDKVIST, G, E RIKSSON, J. W, ARNQVIST, H. J, BOLINDER, J, NYSTRÖM, L
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-04-2006; Springer Nature B.V
• Subjects: Adolescent; Adult; Age Distribution; Age groups; Biological and medical sciences; Cause of Death; Clinical Medicine; cohort; Death Certificates; Demography; Diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - etiology; Diabetes Mellitus - mortality; Diabetes Mellitus/diagnosis/etiology/mortality; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinology; Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Hospitals; Humans; Internal medicine; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Metabolism; Middle Aged; Mortality; Patients; Public health; Risk Factors; Sex Characteristics; Survival analysis; Survival Rate; Sweden - epidemiology; Time Factors; type 1 diabetes; type 2 diabetes; Young adults; Sweden; Europe; Endocrinopathy; Type 2 diabetes; Immunopathology; Cohort; Type 1 diabetes; Mortality; Autoimmune disease; Metabolic diseases; Diagnosis; Cause of death
• ISSN: 0012-186X; 1432-0428; 1432-0428
• DOI: 10.1007/s00125-005-0135-x

The objective of the study was to analyse the mortality, survival and cause of death patterns in incident cases of diabetes in the 15-34-year age group that were reported to the nationwide prospective Diabetes Incidence Study in Sweden (DISS).
During the study period 1983-1999, 6,771 incident cases were reported. Identification of deaths was made by linking the records to the nationwide Cause of Death Register.
With an average follow-up of 8.5 years, resulting in 59,231 person-years, 159 deaths were identified. Diabetes was reported as the underlying cause of death in 51 patients (32%), and as a contributing cause of death in another 42 patients (26%). The standardised mortality ratio (SMR) was significantly elevated (RR=2.4; 95% CI: 2.0-2.8). The SMR was higher for patients classified by the reporting physician as having type 2 diabetes at diagnosis than for those classified as type 1 diabetic (2.9 and 1.8, respectively). Survival analysis showed significant differences in survival curves between males and females (p=0.0003) as well as between cases with different types of diabetes (p=0.005). This pattern was also reflected in the Cox regression model showing significantly increased hazard for males vs females (p=0.0002), and for type 2 vs type 1 (p=0.015) when controlling for age.
This study shows a two-fold excess mortality in patients with type 1 diabetes and a three-fold excess mortality in patients with type 2 diabetes. Thus, despite advances in treatment, diabetes still carries an increased mortality in young adults, even in a country with a good economic and educational patient status and easy access to health care.