title: Explaining the increased mortality in type 1 diabetes.
abstract: Despite large improvements in the management of glucose levels and in the treatment of cardiovascular risk factors, the mortality rate in individuals with type 1 diabetes (T1D) is still high. Recently, Lind et al found that T1D individuals with glycated hemoglobin levels of 6.9% or lower had a risk of death from any cause or from cardiovascular causes that is twice as high as the risk for matched controls. T1D is a chronic disease with an early onset (e.g., pediatric age) and thus in order to establish a clear correlation between death rate and the glycometabolic control, the whole history of glycemic control should be considered; particularly in the early years of diabetes. The switch from a normo- to hyperglycemic milieu in an individual with T1D in the pediatric age, represents a stressful event that may impact outcomes and death rate many years later. In this paper we will discuss the aforementioned issues, and offer our view on these findings, paying a particular attention to the several alterations occurring in the earliest phases of T1D and to the many factors that may be associated with the chronic history of T1D. This may help us to better understand the recently published death rate data and to develop future innovative and effective preventive strategies.
authors.affiliation: Chiara Mameli, Sara Mazzantini, Gian Vincenzo Zuccotti, Department of Pediatrics, "Ospedale dei Bambini V. Buzzi", University of Milan, 20154 Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mameli
authors.affiliation: Chiara Mameli, Sara Mazzantini, Gian Vincenzo Zuccotti, Department of Pediatrics, "Ospedale dei Bambini V. Buzzi", University of Milan, 20154 Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Mazzantini
authors.affiliation: Chiara Mameli, Sara Mazzantini, Gian Vincenzo Zuccotti, Department of Pediatrics, "Ospedale dei Bambini V. Buzzi", University of Milan, 20154 Milan, Italy.
authors.forename: Moufida
authors.initials: M
authors.lastname: Ben Nasr
authors.affiliation: Chiara Mameli, Sara Mazzantini, Gian Vincenzo Zuccotti, Department of Pediatrics, "Ospedale dei Bambini V. Buzzi", University of Milan, 20154 Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiorina
authors.affiliation: Chiara Mameli, Sara Mazzantini, Gian Vincenzo Zuccotti, Department of Pediatrics, "Ospedale dei Bambini V. Buzzi", University of Milan, 20154 Milan, Italy.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Scaramuzza
authors.affiliation: Chiara Mameli, Sara Mazzantini, Gian Vincenzo Zuccotti, Department of Pediatrics, "Ospedale dei Bambini V. Buzzi", University of Milan, 20154 Milan, Italy.
authors.forename: Gian Vincenzo
authors.initials: GV
authors.lastname: Zuccotti
keywords: Adolescence; Autonomic neuropathy; Children; Death rates; Endothelial dysfunction; Exercise; Hyperglycemia; Metabolic memory; Type 1 diabetes