January 27, 2020
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High childhood HbA1c increases premature death risk in type 1 diabetes

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John Samuelsson

Young adults with type 1 diabetes were nearly three times more likely to die before age 30 years if they had poor metabolic control during childhood, according to findings from a Swedish registry-based study.

“The mortality for young adults with type 1 diabetes in Sweden was clearly elevated,” John Samuelsson, MD, a doctoral student in the department of clinical and experimental medicine, division of children’s and women’s health, Linköping University, Sweden, told Healio. “In this young cohort, the main reason for death due to diabetes was acute complications from the disease. For these adults, HbA1c was significantly elevated in childhood.”

Samuelsson and colleagues analyzed data from 12,652 young adults aged 29 years or younger using information from the Swedish Pediatric Diabetes Quality Register from 2006 to 2014. Researchers merged data with the Swedish Cause of Death Register and calculated standardized mortality rates (SMRs) using Statistics Sweden, the official Swedish population register.

Researchers identified 68 deaths between 2006 and 2014 (36 men), with 38.2% registered as due to acute complications of diabetes, such as hypoglycemia or diabetic ketoacidosis.

Diabetes child 2019 
Young adults with type 1 diabetes were nearly three times more likely to die before age 30 years if they had poor metabolic control during childhood.
Source: Adobe Stock

The overall SMR was 2.7 (95% CI, 2.1-3.4), with a sex-stratified SMR of 2 for men (95% CI, 1.4-2.7) and 4.4 for women (95% CI, 3.1-6.2). SMR also increased with age; among the oldest age group (aged 25-29 years), SMR was 6.3 (95% CI, 3.4-10.7).

Adults who died from diabetes had a mean HbA1c of 8.9% during childhood vs. an HbA1c of 7.8% among adults still alive (P < .001).

The researchers noted a “remarkably increased risk” for dying due to diabetes among adults with poor metabolic control during childhood.

“High HbA1c in childhood is a risk factor for premature death,” said Samuelsson, also a pediatrician in the department of pediatrics at Ryhov County Hospital in Jönköping, Sweden. “This fact strengthens the need for diabetes teams to identify these persons and offer them individualized care in order to improve HbA1c. Early achievement and maintenance of good metabolic control is essential to prevent premature death due to diabetes.”

Samuelsson added that, as diabetes care improves, studies are needed on the effect of continuous glucose monitors and improved insulin pump treatments on the risk for mortality. – by Regina Schaffer

For more information:

John Samuelsson, MD, can be reached at the Department of Pediatrics, Ryhov County Hospital, 551 85 Jonkoping, Sweden; email: john.samuelsson@rjl.se.

Disclosures: The Swedish Diabetes Foundation funded this study. The authors report no relevant financial disclosures.