Increased mortality in diabetes during the first 10 years of the disease. A population-based study (DISS) in Swedish adults 15-34 years old at diagnosis.
OBJECTIVE
To study, prospectively, in young adult patients, the mortality during the first years after the diagnosis of diabetes.


METHODS
The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases aged 15-34 years. During a 10-year period all deaths were identified by record linkage to the national Cause of Death Registry.


METHODS
During the period, 4097 new cases were registered and classified as type 1 diabetes (73%), type 2 (16%), secondary (2%) and unclassified (9%). The median follow-up was 5 years (21 001 person-years).


METHODS
Calculation of the standardized mortality ratio (SMR) and 95% confidence interval (CI). Evaluation of all deceased by scrutiny of clinical records, death certificates and autopsy protocols.


RESULTS
Fifty-eight patients died, corresponding to an SMR of 3.5 (CI=2.7-4.5), which increased from 1.5 at 15-19 years to 4.1 at 30-34 years. SMR was 2.7 in primary diabetes: 2.3 (1.6-3.3) in type 1 and 4.1 (2.6-6.7) in type 2. In secondary diabetes, alcohol-associated pancreatitis a common cause, SMR was 32 (CI=24-45). Evidence of alcohol or drug misuse, mental dysfunction or suicide was found in 40 of all 58 deceased cases. Less often, hypoglycaemia (n=7) or hyperglycaemia-ketoacidosis (n=11) was present at death. Unexplained 'dead in bed' was found once.


CONCLUSIONS
In the investigated population-based cohort the early mortality was about threefold increased. Hypoglycaemia and ketoacidosis per se played a relatively small role compared with a heavy impact from social and mental dysfunction, and from careless use of alcohol or drugs.
Wibell
L
L
Department of Medicine, Uppsala University Hospital, Uppsala, Sweden. lars.wibell@medecin.uas.lul.se
Nyström
L
L
Ostman
J
J
Arnqvist
H
H
Blohmé
G
G
Lithner
F
F
Littorin
B
B
Sundkvist
G
G
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors