title: Mortality and outcome of patients with brittle diabetes and recurrent ketoacidosis.
abstract: The long-term outlook of patients with brittle insulin-dependent diabetes is uncertain. We assessed the outcome of a group of young female patients with diabetes and recurrent ketoacidosis originally investigated in 1979-85 and reassessed after a mean of 10.5 (SD 1.4) years. 7 of the 33 patients could not be traced. 5 (19%) of the remaining 26 had died. Causes of death were not certain, but were probably ketoacidosis (2), hypoglycaemia (2), and renal failure (1). Of the 21 survivors, only 2 (10%) were still considered to have brittle diabetes. Diabetic complications were common (67%), and were more frequent than in a matched control group of stable patients with diabetes (25%). Brittle diabetic patients also had lower quality-of-life scores, more frequent psychosocial disruptions, and were on higher insulin doses (77 [39] vs 47 [15] U per day, p = 0.007) than controls. Pregnancy complications had occurred in 13 of 28 (46%) pregnancies in severely unstable patients compared with 2 of 27 (7%) in stable controls. Patients with brittle diabetes have a tendency to become more stable with time, but have a higher risk of death, more microvascular and pregnancy complications, and a poorer quality of life.
authors.affiliation: Diabetic Clinic, Royal Liverpool University Hospital, UK.
authors.forename: L A
authors.initials: LA
authors.lastname: Kent
authors.forename: G V
authors.initials: GV
authors.lastname: Gill
authors.forename: G
authors.initials: G
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality* / Q000523:psychology*; D016883:Diabetic Ketoacidosis / Q000209:etiology* / Q000401:mortality / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics; D011379:Prognosis; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D007328:Insulin