Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort

Rachel G Miller, Aaron M Secrest, Ravi K Sharma, Thomas J Songer, Trevor J Orchard, Rachel G Miller, Aaron M Secrest, Ravi K Sharma, Thomas J Songer, Trevor J Orchard

Abstract

Survival in type 1 diabetes has improved, but the impact on life expectancy in the U.S. type 1 diabetes population is not well established. Our objective was to estimate the life expectancy of the Pittsburgh Epidemiology of Diabetes Complications (EDC) study cohort and quantify improvements by comparing two subcohorts based on year of diabetes diagnosis (1950-1964 [n = 390] vs. 1965-1980 [n = 543]). The EDC study is a prospective cohort study of 933 participants with childhood-onset (aged <17 years) type 1 diabetes diagnosed at Children's Hospital of Pittsburgh from 1950 to 1980. Mortality ascertainment was censored 31 December 2009. Abridged cohort life tables were constructed to calculate life expectancy. Death occurred in 237 (60.8%) of the 1950-1964 subcohort compared with 88 (16.2%) of the 1965-1980 subcohort. The life expectancy at birth for those diagnosed 1965-1980 was ~15 years greater than participants diagnosed 1950-1964 (68.8 [95% CI 64.7-72.8] vs. 53.4 [50.8-56.0] years, respectively) (P < 0.0001); this difference persisted regardless of sex or pubertal status at diagnosis. This improvement in life expectancy emphasizes the need for insurance companies to update analysis of the life expectancy of those with childhood-onset type 1 diabetes because weighting of insurance premiums is based on outdated estimates.

Figures

FIG. 1.
FIG. 1.
Observed Kaplan-Meier survival function comparing EDC study type 1 diabetes diagnosis year subcohorts (1950–1964 vs. 1965–1980) and the ACR cohort. The small vertical lines represent censoring times of surviving individuals. EDC 1950–1964 vs. 1965–1980 log-rank P < 0.0001; EDC 1965–1980 vs. ACR log-rank P = 0.10. Remaining number at risk at each age: EDC 1950–1964: birth, 390; 20 years, 370; 40 years, 239; 60 years, 26; EDC 1965–1980: birth, 543; 20 years, 537; 40 years, 272; 60 years, 0; ACR: birth, 1,018; 20 years, 1,002; 40 years, 704; 60 years, 0.

References

    1. Borch-Johnsen K, Kreiner S, Deckert T. Mortality of type 1 (insulin-dependent) diabetes mellitus in Denmark: a study of relative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologia 1986;29:767–772
    1. Sartor G, Nyström L, Dahlquist G. The Swedish Childhood Diabetes Study: a seven-fold decrease in short-term mortality? Diabet Med 1991;8:18–21
    1. Borch-Johnsen K. Improving prognosis of type 1 diabetes. Mortality, accidents, and impact on insurance. Diabetes Care 1999;22(Suppl. 2):B1–B3
    1. Podar T, Solntsev A, Reunanen A, et al. Mortality in patients with childhood-onset type 1 diabetes in Finland, Estonia, and Lithuania: follow-up of nationwide cohorts. Diabetes Care 2000;23:290–294
    1. Asao K, Sarti C, Forsen T, et al. Diabetes Epidemiology Research International Mortality Study Group Long-term mortality in nationwide cohorts of childhood-onset type 1 diabetes in Japan and Finland. Diabetes Care 2003;26:2037–2042
    1. Pambianco G, Costacou T, Ellis D, Becker DJ, Klein R, Orchard TJ. The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes 2006;55:1463–1469
    1. Skrivarhaug T, Bangstad HJ, Stene LC, Sandvik L, Hanssen KF, Joner G. Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia 2006;49:298–305
    1. Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ. All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes: the Allegheny County type 1 diabetes registry. Diabetes Care 2010;33:2573–2579
    1. McNally PG, Raymond NT, Burden ML, et al. Trends in mortality of childhood-onset insulin-dependent diabetes mellitus in Leicestershire: 1940-1991. Diabet Med 1995;12:961–966
    1. Brown LJ, Scott RS, Moir CL. All-cause mortality in the Canterbury (New Zealand) insulin-treated Diabetic Registry population. Diabetes Care 2001;24:56–63
    1. Goodkin G. Mortality factors in diabetes. A 20 year mortality study. J Occup Med 1975;17:716–721
    1. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA 2003;290:1884–1890
    1. Manuel DG, Schultz SE. Diabetes health status and risk factors. In Diabetes in Ontario. An Institute for Clinical Evaluative Sciences Practice Atlas. Hux J, Booth G, Slaughter PM, Laupacis A, Eds. Toronto, Ontario, Canada, Canadian Diabetes Association, 2003, p. 77–94
    1. Chiang CL. The life table and its applications. Malabar, FL, Krieger Publishing Co, 1984
    1. Smith DP. Formal demography. New York, Plenum Press, 1992
    1. Kostraba JN, Dorman JS, LaPorte RE, et al. The investigation of age at onset as a risk factor for mortality in persons with insulin-dependent diabetes mellitus using Cox proportional hazards models. Am J Epidemiol 1991;133:67–72
    1. Survival. A program for life tables and related measures [computer program]. Version 10.0. Houston, University of Texas School of Public Health, 2008.
    1. Diabetes Epidemiology Research International Mortality Study Group Major cross-country differences in risk of dying for people with IDDM. Diabetes Care 1991;14:49–54
    1. LaPorte RE, Fishbein HA, Drash AL, et al. The Pittsburgh insulin-dependent diabetes mellitus (IDDM) registry. The incidence of insulin-dependent diabetes mellitus in Allegheny County, Pennsylvania (1965-1976). Diabetes 1981;30:279–284
    1. Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ. Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes 2010;59:3216–3222
    1. Arias E. United States Life Tables, 2006. National Vital Statistics Reports, Vol 58, No 21. Hyattsville, MD, National Center for Health Statistics, 2010
    1. Ioacara S, Lichiardopol R, Ionescu-Tirgoviste C, et al. Improvements in life expectancy in type 1 diabetes patients in the last six decades. Diabetes Res Clin Pract 2009;86:146–151
    1. Wagener DK, Sacks JM, LaPorte RE, Macgregor JM. The Pittsburgh study of insulin-dependent diabetes mellitus. Risk for diabetes among relatives of IDDM. Diabetes 1982;31:136–144
    1. Scibilia J, Finegold D, Dorman J, Becker D, Drash A. Why do children with diabetes die? Acta Endocrinol Suppl (Copenh) 1986;279:326–333
    1. Diabetes Epidemiology Research International Mortality Study Group International evaluation of cause-specific mortality and IDDM. Diabetes Care 1991;14:55–60
    1. Nathan DM, Zinman B, Cleary PA, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005). Arch Intern Med 2009;169:1307–1316
    1. Nishimura R, Dorman JS, Bosnyak Z, Tajima N, Becker DJ, Orchard TJ, Diabetes Epidemiology Research International Mortality Study. Allegheny County Registry Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the Allegheny County Registry. Am J Kidney Dis 2003;42:117–124
    1. Finne P, Reunanen A, Stenman S, Groop PH, Grönhagen-Riska C. Incidence of end-stage renal disease in patients with type 1 diabetes. JAMA 2005;294:1782–1787
    1. Sobolewski BA, Zgibor JC, Orchard TJ. ACE inhibitors and calcium channel blockers: patterns of use and associations with mortality in type 1 diabetes. Diabetes Res Clin Pract 2004;65:37–43
    1. Groop PH, Thomas MC, Moran JL, et al. FinnDiane Study Group The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes 2009;58:1651–1658
    1. Orchard TJ, Secrest AM, Miller RG, Costacou T. 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. Diabetologia 2010;53:2312–2319
    1. Kearney PM, Blackwell L, Collins R, et al. Cholesterol Treatment Trialists’ (CTT) Collaborators Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117–125

Source: PubMed

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