title: In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study.
abstract: OBJECTIVE
  The FinnDiane Study has reported that mortality in type 1 diabetes is not increased over a 7 year follow-up in the absence of renal disease (RD). Using the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study population (n = 658) of childhood-onset type 1 diabetes (age <17 years), the present study sought to replicate and expand these findings to a 20 year follow-up (as of 1 January 2008) and examine cause of death by renal status.
  
  
  METHODS
  At baseline (1986-1988), mean age and duration of diabetes were 28 and 19 years, respectively. RD was defined as an albumin excretion rate ≥20 μg/min from multiple samples and grouped as microalbuminuria (MA; 20-200 μg/min), overt nephropathy (ON; >200 μg/min), or end stage renal disease (ESRD; dialysis or renal transplantation).
  
  
  RESULTS
  At baseline, 311 (47.3%) individuals had RD (MA 21.3%, ON 22.2% and ESRD 3.8%). During a median 20 year follow-up, there were 152 deaths (23.1%). Mortality was 6.2 (95% CI 5.2-7.2) times higher than expected, with standardised mortality ratios of 2.0 (1.2-2.8) for normoalbuminuria (NA); 6.4 (4.4-8.4) for MA; 12.5 (9.5-15.4) for ON; and 29.8 (16.8-42.9) for ESRD. Excluding those (n = 64) with NA who later progressed to RD, no significant excess mortality was observed in the remaining NA group (1.2, 0.5-1.9), whose deaths were largely unrelated to diabetes.
  
  
  CONCLUSIONS
  These data confirm the importance of RD, including persistent microalbuminuria, as a marker of mortality risk and suggest that type 1 diabetes patients without renal disease achieve long-term survival comparable to the general population.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA. tjo@pitt.edu
authors.forename: T J
authors.initials: TJ
authors.lastname: Orchard
authors.forename: A M
authors.initials: AM
authors.lastname: Secrest
authors.forename: R G
authors.initials: RG
authors.lastname: Miller
authors.forename: T
authors.initials: T
authors.lastname: Costacou
mesh_terms: D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D008297:Male; D055815:Young Adult