American Diabetes Association Scientific Sessions

American Diabetes Association Scientific Sessions

Issue: July 2011
July 01, 2011
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Life expectancy improving for people with type 1 diabetes

Issue: July 2011
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ADA 71st Scientific Sessions

SAN DIEGO — The life expectancy for people with childhood-onset type 1 diabetes has improved dramatically since 1950, and the survival gap between type 1 diabetes and the general US population is diminishing, according to results of a 30-year, long-term, prospective study.

“Type 1 diabetes mortality rates have decreased over time, but formal life expectancy estimates for those diagnosed with type 1 diabetes in the US are lacking,” Trevor J. Orchard, MD, professor of epidemiology, pediatrics and medicine at University of Pittsburgh, said in a press release.

To estimate the all-cause mortality and life expectancy of type 1 diabetes, researchers examined data from the Pittsburgh Epidemiology of Diabetes Complication (EDC) study, a long-term study of childhood-onset type 1 diabetes, which began in 1986. Participants in the study, who were an average age of 28 years when entering the study and 44 years at its completion, were diagnosed with type 1 diabetes between 1950 and 1980. The researchers compared two cohorts based on year of diabetes diagnosis: 390 people diagnosed in 1950-1964 and 543 people diagnosed in 1965-1980.

For those diagnosed with diabetes between 1965 and 1980, the life expectancy was approximately 15 years longer than for those diagnosed between 1950 and 1964 (53.4 years vs. 68.8 years). The 1965-1980 diagnosis cohort life expectancy was approximately 4 years less than that estimated of the US general population at that time (72.4 years), while the 1950-1964 diagnosis cohort had a life expectancy approximately 18 years less than the general population (71.5 years).

“The estimated 15-year life expectancy improvement between the two groups persisted regardless of gender or pubertal status at diagnosis,” Orchard said in the press release.

The 30-year mortality rate of participants diagnosed with type 1 diabetes from 1965 to 1980 was 11.6% — a significant decline from the 35.6% 30-year mortality of those diagnosed between 1950 and 1964, according to the researchers.

While people with type 1 diabetes are still living approximately 4 years less than those without the disease, the survival gap is shrinking, Rachel G. Miller, MS, and colleagues concluded.

For more information:

  • Miller RG. 78-OR. Presented at: American Diabetes Association’s 71st Scientific Sessions; June 24-28, 2011; San Diego, Calif.

Disclosure: The researchers report no relevant financial disclosures.

PERSPECTIVE

The Pittsburgh Epidemiology of Diabetes Complication study is a long-term follow-up of type 1 diabetes diagnosed before age 17 years between 1950 and 1980, seen within 12 months of diagnosis at the Children's Hospital of Pittsburgh. Baseline evaluation for this study was done between 1986 and 1988. This valuable database has taught us much about trends in diabetes management and outcomes, including the frequency of microvascular and macrovascular complications and mortality data. The finding that life expectancy has improved in those diagnosed between 1965 and 1980 compared to those diagnosed between 1950 and 1964 is not surprising, given the changes in diabetes management that occurred with the advent of self blood glucose and HbA1c monitoring around 1980 and the consequent ability to improve blood glucose management that led to the Diabetes Control and Complications Trial findings in the mid-80s indicating that lower HbA1c values were associated with a lower rate of microvascular complications. Orchard et al have confirmed this finding, demonstrating that the duration and degree of hyperglycemia predict the timing of the development of microvascular complications. The cohort diagnosed later had tools to improve glycemia that the earlier cohort lacked. Not only did they have the ability to self monitor blood glucose values, they had the ability to make insulin adjustments based on more physiologic insulin replacement with insulin pumps and with insulin analogues. Further, endocrinologists became more aggressive about diagnosing and treating hyperlipidemia and hypertension, largely with angiotensin-converting enzyme inhibitors and statins, both of which should have a salutary effect on the vascular complications of diabetes. Although the incidence of microvascular disease has decreased markedly, mortality from coronary artery disease has not diminished significantly. Changes in arterial function and stiffness can already be seen in children and adolescents with diabetes; thus, it is possible that even those diagnosed between 1965 and 1980 might not have had the full benefit of the more recent aggressive interventions for lipid and BP control and life expectancy will continue to demonstrate improvement in those diagnosed since 1980.

– Janet Silverstein, MD
Endocrine Today Editorial Board member

Disclosure: Dr. Silverstein reports no relevant financial disclosures.

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