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Mortality and diabetes from a population based register in Yorkshire 1978-93
D P Warner1, P A McKinney, G R Law
1Diabetes Centre, General Infirmary, Leeds, UK.
Insights
Children with insulin-dependent diabetes mellitus (IDDM) face increased mortality, especially during the transition to adulthood. Poor diabetic control and related complications were key factors identified before death in this UK-based study.
Area of Science:
- Pediatric Endocrinology
- Diabetes Research
- Public Health
Background:
- Insulin-dependent diabetes mellitus (IDDM) is a chronic condition in children.
- Understanding long-term mortality risks is crucial for improving care.
- Previous studies may not fully capture risks in contemporary cohorts.
Purpose of the Study:
- To investigate the mortality rates of children diagnosed with IDDM.
- To identify common factors contributing to deaths in this pediatric population.
- To assess mortality trends in relation to age and diabetic control.
Main Methods:
- A population-based cohort study was conducted.
- Children diagnosed with IDDM in Yorkshire were followed up throughout the UK.
- Data from the Yorkshire Children's Diabetes Register (1978-93) were linked to the NHS Central Register for mortality ascertainment.
Main Results:
- A total of 26 deaths were identified among 1854 children, with a follow-up of 17,350 person-years.
- The standardized mortality ratio (SMR) for all causes was significantly increased (247), particularly in the 15-19 year age group (SMR 442).
- Diabetes or its complications accounted for 58% of deaths; poor diabetic control was a common factor noted before death.
Conclusions:
- IDDM continues to be associated with increased mortality in young people.
- The transition age range (15-19 years) shows a particularly elevated risk.
- Improved management of diabetic control is essential to reduce premature mortality in pediatric IDDM patients.
Objective:
To investigate mortality of children diagnosed with insulin dependent diabetes mellitus (IDDM) and to identify common factors before death.
Design:
Follow up of a population based cohort of children diagnosed with IDDM to ascertain deaths.
Setting:
Children were diagnosed in Yorkshire but followed up throughout the United Kingdom.
Subjects:
From the Yorkshire Children's Diabetes Register details of 1854 children aged 0-16 years (1978-93) were submitted to the NHS Central Register.
Main Outcome Measure:
Notification and causes of death.
Results:
98.3% of cases were traced and 26 deaths identified. Follow up ranged from 1-18 years (median 9.3 years), providing 17,350 person-years of IDDM. Fifteen deaths (58%) were attributed to diabetes or its complications; 11 (42%) were unrelated and included one suicide. For mortality from all causes, the standardised mortality ratio (SMR) of 247 (95% confidence interval (CI) 163 to 362) was significantly increased for those under 34 years. The largest number of deaths (n = 10) occurred in the 15-19 year age range, with an SMR of 442 (95% CI 209 to 802). Case note examination showed a clear tendency towards poor diabetic control, and worries over control were expressed before death by health care professionals.
Conclusions:
Despite advances in treatment, IDDM still carries an increased mortality for young people, particularly in the "transition" age range.