title: Mortality experience of a low-income population with young-onset diabetes.
abstract: OBJECTIVE
  In young-onset diabetes, insulin therapy status is a rough marker of diabetes type. We describe the mortality experience of a low-income, predominantly minority population with diabetes diagnosed before age 30 years, stratified by insulin therapy.
  
  
  METHODS
  A total of 1,098 adults aged 40-79 years (median 49) diagnosed with diabetes before age 30 years and 49,914 without diabetes were recruited from community health centers. Individuals with diabetes were categorized by insulin therapy at baseline: group A, insulin therapy only; group B, insulin therapy and an oral hypoglycemic agent; and group C, no insulin therapy. Cox models were used to compute hazard ratios (HRs) and 95% CI for cause-specific mortality based on both underlying and contributing causes of death from death certificates.
  
  
  RESULTS
  During follow-up (mean 3.9 years), 15.0, 12.5, and 7.3% of groups A, B, and C, respectively, and 4.6% without diabetes died. Compared with individuals without diabetes, HRs (CI) for all-cause mortality were 4.3 (3.4-5.6), 4.2 (2.8-6.3), and 2.0 (1.4-2.8) in groups A, B, and C, respectively. The leading cause of death was renal failure (end-stage renal disease [ESRD]) in group A, ESRD and coronary artery disease (CAD) in group B, and CAD in group C and individuals without diabetes. HRs for these conditions were at least twice as high as the HRs for all-cause mortality, reaching 17.3 (10.2-29.3), 17.9 (8.3-38.7), and 5.1 (2.3-11.7) in groups A, B, and C, respectively, for ESRD.
  
  
  CONCLUSIONS
  Excess mortality persists among people with young-onset diabetes of long duration, with ESRD and CAD as the leading contributors to mortality.
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA. baqiyyah.conway@vanderbilt.edu
authors.forename: Baqiyyah N
authors.initials: BN
authors.lastname: Conway
authors.forename: Michael E
authors.initials: ME
authors.lastname: May
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Signorello
authors.forename: William J
authors.initials: WJ
authors.lastname: Blot
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data