Alcohol has become an important cause of death among patients with type 1 diabetes since the 1980s, concludes a study published online in the British Medical Journal.
The study also shows that, while survival of patients with early onset type 1 diabetes (age 0-14 years) has improved with time, survival of patients with late onset type 1 diabetes (age 15-29 years) has deteriorated since the 1980s.
Despite great advances in diabetes care, type 1 diabetes is still associated with premature mortality due to both acute and chronic complications. It is thought that people with late onset diabetes have better long term survival than people with early onset type 1 diabetes, but few studies have compared trends in mortality between early and late onset patients.
So researchers in Finland investigated short and long term time trends in mortality in 17,306 patients diagnosed as having type 1 diabetes below 30 years of age between 1970 and 1999. They also studied the causes of death over time. Participants were followed up for an average of 21 years.
Encouragingly, the researchers found that survival in the early onset group improved from 1970 to 2007. This was explained by a fall in chronic complications of diabetes during the first 20 years of diabetes.
However, this was overshadowed by an increasing trend in both short and long term mortality in the late onset group, due to a rise in alcohol and drug related mortality and acute complications of diabetes.
Alarmingly, mortality due to alcohol and drug related causes accounted for 39% of deaths during the first 20 years of diabetes in this group, say the authors.
They conclude: "This highlights the importance of permanent and long lasting doctor-patient relationships, close supervision, and guidance on the short term and long term effects of alcohol in young people with type 1 diabetes, especially in our alcohol permissive cultures."
- Valma Harjutsalo, Carol Forsblom, Per-Henrik Groop. Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. British Medical Journal, 2011; 343: d5364 DOI: 10.1136/bmj.d5364
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