title: Causes of death in children with insulin dependent diabetes 1990-96.
abstract: BACKGROUND
  Mortality rates in children with insulin dependent diabetes (IDDM) in the UK are unknown and the causes of death not well documented.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. julie.edge@paediatrics.ox.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Edge
authors.forename: M E
authors.initials: ME
authors.lastname: Ford-Adams
authors.forename: D B
authors.initials: DB
authors.lastname: Dunger
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality*; D003926:Diabetic Coma / Q000401:mortality; D016883:Diabetic Ketoacidosis / Q000401:mortality; D005260:Female; D006699:Home Care Services; D017052:Hospital Mortality; D006801:Humans; D007003:Hypoglycemia / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D006113:United Kingdom / Q000453:epidemiology