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Causes of death in children with insulin dependent diabetes 1990-96
J A Edge1, M E Ford-Adams, D B Dunger
1Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. julie.edge@paediatrics.ox.ac.uk
Insights
Children with insulin-dependent diabetes (IDDM) face higher mortality rates. Key causes include diabetic ketoacidosis and cerebral edema, with neglected IDDM contributing to deaths in young men.
Area of Science:
- Pediatric Endocrinology
- Diabetes Mellitus Research
- Public Health Surveillance
Background:
- Mortality rates for children with insulin-dependent diabetes (IDDM) in the UK were previously unknown.
- Causes of death in pediatric IDDM cases were not well-documented.
Purpose of the Study:
- To ascertain the mortality rate in children diagnosed with IDDM.
- To identify the specific causes of death among pediatric IDDM patients.
Main Methods:
- Utilized death records from the Office of National Statistics (England and Wales) and General Register Office (Scotland) for ages under 20 (1990-1996).
- Gathered additional details on causes of death from coroners, pathologists, and attending clinicians.
Main Results:
- Identified 116 deaths, with 83 directly attributed to diabetes.
- The standardized mortality ratio was 2.3, significantly higher in the 1-4 year age group (9.2).
- Hyperglycemia/diabetic ketoacidosis (DKA) caused 69 deaths, hypoglycemia 7. Cerebral edema was a primary cause in young children; neglected IDDM contributed to deaths in young males.
Conclusions:
- Children with IDDM exhibit increased mortality compared to the general population.
- Cerebral edema is a major factor in hospital deaths among young children with IDDM.
- A significant number of young men die at home due to neglected IDDM, suggesting a need for improved early diagnosis and supervision.
Background:
Mortality rates in children with insulin dependent diabetes (IDDM) in the UK are unknown and the causes of death not well documented.
Aim:
To determine the mortality rate and causes of death in children with IDDM.
Methods:
The Office of National Statistics (England and Wales) and the General Register Office (Scotland) notified all deaths under 20 years of age from 1990 to 1996 with diabetes on the certificate. Further details were provided by coroners, pathologists, and clinicians.
Results:
116 deaths were notified and 83 were caused by diabetes. The standardised mortality ratio was 2.3 (95% confidence interval (CI), 1.9 to 2.9), being highest in the age group 1-4 years, at 9.2 (95% CI, 5.4 to 14.7). Of the 83 diabetic deaths, hyperglycaemia/diabetic ketoacidosis (DKA) was implicated in 69 and hypoglycaemia in 7. Cerebral oedema was the most common cause of death in young children (25 of 36 diabetes related deaths in children under 12 years of age). 34 young people (10-19 years; 24 male) were either found dead at home (n = 26) or moribund on arrival at hospital (n = 8). In 24 of these, it appeared that DKA was the cause of death, in four hypoglycaemia was likely. Nine of these were found "dead in bed".
Conclusions:
Children with IDDM have a higher mortality than the general population. Cerebral oedema accounts for most hospital deaths in young children. There are a large number of young men dying at home from neglected IDDM. Early diagnosis of IDDM in children and closer supervision of young people might prevent some of these deaths.