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Fan ZH, Xu J, Ge MW, Huang JW, Ni HT, Shen WQ, Chen HL. Suicide death, suicidal ideation and suicide attempt in patients with diabetes: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38294134 DOI: 10.1111/jan.16074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/12/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
AIMS Diabetes has been indicated to be a risk factor for suicide. We aim to estimate the prevalence of suicide in patients with diabetes. DESIGN A meta-analysis using PRISMA methodology was adopted to examine the incidence of suicide in diabetic patients. DATA SOURCES From inception to October 2022, three online databases (PubMed, China National Knowledge Infrastructure and Web of Science) were used to search studies. REVIEW METHODS We used random-effects model to analysis. And our primary outcome was the incidence of suicide death per 100 person-years, and other outcomes were prevalence of suicidal ideation and suicide attempt. To explore the sources of heterogeneity in our study, we performed subgroup and meta-regression analyses. RESULTS The suicide death rate in diabetic patients was 0.027 per 100 person-years, with a higher rate for Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicidal ideation in diabetes patients was 0.175, with a higher prevalence in Type 1 Diabetes Mellitus compared to Type 2 Diabetes Mellitus. The prevalence of suicide attempts in diabetes patients was 0.033, indicating a higher rate for Type 2 Diabetes Mellitus compared to Type 1 Diabetes Mellitus. CONCLUSIONS The results indicate a high rate of suicide among people with diabetes, and this study identifies populations and regions at high risk for suicide. Our review emphasizes interventions in mental health and the improvement of suicide prevention programmes. IMPACT The study investigated suicide death, suicidal ideation and suicide attempt in diabetic individuals. Suicide rates are elevated among diabetic patients, and various patient groups face distinct suicide risks. It is important to prioritize the mental well-being of diabetic individuals and enhance interventions, including personalized approaches, to inform public health efforts aimed at preventing and addressing suicide among diabetic patients. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Zhan-Hong Fan
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Jie Xu
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Jie-Wei Huang
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Tao Ni
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- Medicine school of Nantong University, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- Public Health school of Nantong University, Nantong, Jiangsu, PR China
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Donzeau A, Piffaretti C, Jossens A, Levaillant L, Bouhours-Nouet N, Amsellem-Jager J, Ghosn W, Rey G, Fosse-Edorh S, Coutant R. Time trend in excess mortality in children with type 1 diabetes from 1987 to 2016 in mainland France. Pediatr Diabetes 2022; 23:38-44. [PMID: 34881493 DOI: 10.1111/pedi.13298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/10/2021] [Accepted: 12/02/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mortality risk for children with type 1 diabetes (T1D) is unknown in France and their causes of death are not well documented. AIM To determine the standardized mortality ratios (SMRs) and causes of death in children aged 1-14 years with T1D from 1987 to 2016. METHODS The French Center for Epidemiology on Medical Causes of Death collected all death certificates in mainland France. SMRs, corrected SMRs (accounting for missing cases of deaths unrelated to diabetes), and 95% confidence intervals were calculated. RESULTS Of 146 deaths with the contribution of diabetes, 97 were due to T1D. Mean age at death of the subjects with T1D was 8.8 ± 4.1 years (54% males). The cause of death was diabetic ketoacidosis (DKA) in 58% of the cases (70% in subjects 1-4 years), hypoglycemia or dead-in-bed syndrome in 4%, related to diabetes but not described in 24%, and unrelated to diabetes in 14%. The SMRs showed a significant decrease across the years, except for the 1-4 age group. In the last decade (2007-2016), the crude and corrected SMRs were significantly different from 1 in the 1-4 age group (5.4 [2.3; 10.7] and 6.1 [2.8; 11.5]), no longer significant in the 5-9 age group (1.7 [0.6; 4.0] and 2.1 [0.8; 4.5]) and borderline significant in the 10-14 age group (1.7 [0.8; 3.2] and 2.3 [1.2; 4.0]). CONCLUSIONS Children with T1D aged 1-4 years still had a high mortality rate. Their needs for early recognition and safe management of diabetes are not being met.
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Affiliation(s)
| | - Clara Piffaretti
- Santé publique France, The French National Public Health Agency, Saint Maurice, France
| | - Anne Jossens
- Department of Pediatrics, St Malo Hospital, Saint Malo, France
| | | | | | | | - Walid Ghosn
- Centre for Epidemiology on Medical Causes of Death, Inserm-CépiDc, Le Kremlin-Bicêtre, France
| | - Grégoire Rey
- Centre for Epidemiology on Medical Causes of Death, Inserm-CépiDc, Le Kremlin-Bicêtre, France
| | - Sandrine Fosse-Edorh
- Santé publique France, The French National Public Health Agency, Saint Maurice, France
| | - Régis Coutant
- Pediatric Diabetology, University Hospital, Angers, France
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Hill RM, Gallagher KAS, Eshtehardi SS, Uysal S, Hilliard ME. Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention. Curr Diab Rep 2021; 21:51. [PMID: 34902071 PMCID: PMC8666467 DOI: 10.1007/s11892-021-01427-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE OF REVIEW The manuscript reviews the extant literature on suicide-related thoughts and behaviors among youth and young adults with pediatric diabetes. This evidence is presented within the context of current theories of the etiology of suicidal behavior to highlight how diabetes may contribute to suicide risk, and to support providers in understanding the interplay between pediatric diabetes and suicide risk. The manuscript also reviews evidence-based approaches to suicide prevention suitable for use in pediatric healthcare settings, with suggestions for their application to this unique population. RECENT FINDINGS Several recent studies identify heightened rates of suicidal ideation, suicide attempts, and suicide among youth and young adults with pediatric diabetes, as compared with their peers without diabetes. Evidence-based suicide prevention approaches frequently emphasize the importance of reducing suicidal youths' access to potentially lethal means for suicidal behavior. This approach may require special considerations for youth with pediatric diabetes, due to their need to carry sufficient quantities of insulin and the dangers of inaccurate insulin dosing and/or overdose. Suggestions for suicide prevention for this population include risk screening as part of routine diabetes care, early prevention, education for youth and families, and provider awareness of risk factors, warning signs, and implications for diabetes care. Youth and young adults with diabetes reported elevated rates of suicide-related behaviors as compared with their peers without diabetes. Existing suicide prevention approaches may require substantial adaptation for use with youth and young adults with diabetes. Further research is needed to examine how to best prevent suicidal behaviors among this population.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine A S Gallagher
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sahar S Eshtehardi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Serife Uysal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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Vergara-Duarte M, Borrell C, Pérez G, Martín-Sánchez JC, Clèries R, Buxó M, Martínez-Solanas È, Yasui Y, Muntaner C, Benach J. Sentinel Amenable Mortality: A New Way to Assess the Quality of Healthcare by Examining Causes of Premature Death for Which Highly Efficacious Medical Interventions Are Available. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5456074. [PMID: 30246022 PMCID: PMC6139231 DOI: 10.1155/2018/5456074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/08/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Amenable mortality, or premature deaths that could be prevented with medical care, is a proven indicator for assessing healthcare quality when adapted to a country or region's specific healthcare context. This concept is currently used to evaluate the performance of national and international healthcare systems. However, the levels of efficacy and effectiveness determined using this indicator can vary greatly depending on the causes of death that are included. We introduce a new approach by identifying a subgroup of causes for which there are available treatments with a high level of efficacy. These causes should be considered sentinel events to help identify limitations in the effectiveness and quality of health provision. METHODS We conducted an extensive literature review using a list of amenable causes of death compiled by Spanish researchers. We complemented this approach by assessing the time trends of amenable mortality in two high-income countries that have a similar quality of healthcare but very different systems of provision, namely, Spain and the United States. This enabled us to identify different levels of efficacy of medical interventions (high, medium, and low). We consulted a group of medical experts and combined this information to help make the final classification of sentinel amenable causes of death. RESULTS Sentinel amenable mortality includes causes such as surgical conditions, thyroid diseases, and asthma. The remaining amenable causes of death either have a higher complexity in terms of the disease or need more effective medical interventions or preventative measures to guarantee early detection and adherence to treatment. These included cardiovascular diseases, diabetes, hypertension, all amenable cancers, and some infectious diseases such as pneumonia, influenza, and tuberculosis. CONCLUSIONS Sentinel amenable mortality could act as a good sentinel indicator to identify major deficiencies in healthcare quality and provision and detect inequalities across populations.
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Affiliation(s)
- Montse Vergara-Duarte
- CAP El Clot and Unitat d'Avaluació, Sistemes d'Informació i Qualitat Assistencial, Gerència Territorial de Barcelona, Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Ramon Clèries
- Pla Director d'Oncología, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Èrica Martínez-Solanas
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Spain
| | - Yutaka Yasui
- Department of Epidemiology & Cancer Control (S6050), St. Jude Children's Research Hospital, Memphis, TN, USA
- School of Public Health, University of Alberta, 4-274, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Carles Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Canada
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University, Public Policy Center, Barcelona, Spain
- Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Wasag DR, Gregory JW, Dayan C, Harvey JN. Excess all-cause mortality before age 30 in childhood onset type 1 diabetes: data from the Brecon Group Cohort in Wales. Arch Dis Child 2018; 103:44-48. [PMID: 28860211 DOI: 10.1136/archdischild-2016-312581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term outcomes in young people with type 1 diabetes continue to be of interest, and may help evaluate the effects of changes to the clinical care of children that have occurred in recent decades. AIMS To identify mortality and its causes before age 30 years in patients developing type 1 diabetes before age 15 years. METHODS Since 1995, paediatricians in Wales have compiled a prospective register of incident cases of type 1 diabetes occurring before age 15 years in Wales (the Brecon Cohort). Their subsequent mortality rates were compared with mortality in the general populations of Wales and England using the patient-years exposure method. Causes of death were ascertained from death certificates and from clinicians. RESULTS The standardised mortality ratio for young people with type 1 diabetes in Wales was 2.91 with no clear evidence of improvement or worsening of mortality risk over time. Most deaths occurred between ages 15 and 30 years although at a slightly younger age than in the general population. There were more deaths with increasing age at diagnosis of diabetes. Ketoacidosis remains the most common cause of death before age 30 years. Hypoglycaemia was difficult to ascertain with certainty but also caused some deaths. In this age group, chronic complications of diabetes were not a cause of mortality. CONCLUSIONS Despite the developments in clinical care in recent years, the mortality risk for people developing type 1 diabetes in childhood remains high in young adult life before the onset of chronic complications.
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Affiliation(s)
- Diana R Wasag
- Diabetes Research Group, Wrexham Academic Unit, Bangor University, Wrexham, UK
| | - John W Gregory
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Colin Dayan
- Department of Experimental and Molecular Medicine, Cardiff University, Cardiff, UK
| | - John N Harvey
- Diabetes Research Group, Wrexham Academic Unit, Bangor University, Wrexham, UK
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Wang B, An X, Shi X, Zhang JA. MANAGEMENT OF ENDOCRINE DISEASE: Suicide risk in patients with diabetes: a systematic review and meta-analysis. Eur J Endocrinol 2017; 177:R169-R181. [PMID: 28512134 DOI: 10.1530/eje-16-0952] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous studies investigating the risk of suicide in diabetes patients reported controversial findings. We did a systematic review and meta-analysis to comprehensively estimate the risk and incidence rate of suicide in diabetic patients. METHODS PubMed, EMBASE and PsycINFO were searched for eligible studies. Random-effects meta-analysis was used to calculate the relative risk (RR) and the incidence rate of suicide in diabetes patients. We also calculated the proportion of deaths attributable to suicide among diabetes patients. RESULTS 54 studies were finally included, including 28 studies on the suicide risk associated with diabetes, 47 studies on the incidence rate of suicide and 45 studies on the proportion of deaths attributable to suicide. Meta-analysis showed that diabetes could significantly increase the risk of suicide (RR = 1.56; 95% CI: 1.29-1.89; P < 0.001). Subgroup analysis showed that the RR of suicide associated with type 1 diabetes was 2.25 (95% CI: 1.50-3.38; P < 0.001). The pooled incidence rate of suicide in patients with diabetes was 2.35 per 10 000 person-years (95% CI: 1.51-3.64). The pooled proportions of long-term deaths attributable to suicide in type 1 diabetes patients and type 2 diabetes patients were 7.7% (95% CI: 6.0-9.8) and 1.3% (95% CI: 0.6-2.6), respectively. CONCLUSION This meta-analysis suggests that diabetes can significantly increase the risk of suicide. Suicide has an obvious contribution to mortality in diabetic patients, especially among type 1 diabetes patients. Effective strategies to decrease suicide risk and improve mental health outcomes in diabetes patients are needed.
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Affiliation(s)
- Bin Wang
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
| | - Xiaofei An
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
| | - Xiaohong Shi
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
| | - Jin-An Zhang
- Department of EndocrinologyJinshan Hospital of Fudan University, Shanghai, China
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Mortality and natural progression of type 1 diabetes patients enrolled in the Rwanda LFAC program from 2004 to 2012. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0536-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Andrade‐Castellanos CA, Colunga‐Lozano LE, Delgado‐Figueroa N, Gonzalez‐Padilla DA. Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis. Cochrane Database Syst Rev 2016; 2016:CD011281. [PMID: 26798030 PMCID: PMC8829395 DOI: 10.1002/14651858.cd011281.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of uncontrolled diabetes that mainly occurs in individuals with autoimmune type 1 diabetes, but it is not uncommon in some people with type 2 diabetes. The treatment of DKA is traditionally accomplished by the administration of intravenous infusion of regular insulin that is initiated in the emergency department and continued in an intensive care unit or a high-dependency unit environment. It is unclear whether people with DKA should be treated with other treatment modalities such as subcutaneous rapid-acting insulin analogues. OBJECTIVES To assess the effects of subcutaneous rapid-acting insulin analogues for the treatment of diabetic ketoacidosis. SEARCH METHODS We identified eligible trials by searching MEDLINE, PubMed, EMBASE, LILACS, CINAHL, and the Cochrane Library. We searched the trials registers WHO ICTRP Search Portal and ClinicalTrials.gov. The date of last search for all databases was 27 October 2015. We also examined reference lists of included randomised controlled trials (RCTs) and systematic reviews, and contacted trial authors. SELECTION CRITERIA We included trials if they were RCTs comparing subcutaneous rapid-acting insulin analogues versus standard intravenous infusion in participants with DKA of any age or sex with type 1 or type 2 diabetes, and in pregnant women. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed studies for risk of bias, and evaluated overall study quality utilising the GRADE instrument. We assessed the statistical heterogeneity of included studies by visually inspecting forest plots and quantifying the diversity using the I² statistic. We synthesised data using random-effects model meta-analysis or descriptive analysis, as appropriate. MAIN RESULTS Five trials randomised 201 participants (110 participants to subcutaneous rapid-acting insulin analogues and 91 to intravenous regular insulin). The criteria for DKA were consistent with the American Diabetes Association criteria for mild or moderate DKA. The underlying cause of DKA was mostly poor compliance with diabetes therapy. Most trials did not report on type of diabetes. Younger diabetic participants and children were underrepresented in our included trials (one trial only). Four trials evaluated the effects of the rapid-acting insulin analogue lispro, and one the effects of the rapid-acting insulin analogue aspart. The mean follow-up period as measured by mean hospital stay ranged between two and seven days. Overall, risk of bias of the evaluated trials was unclear in many domains and high for performance bias for the outcome measure time to resolution of DKA.No deaths were reported in the included trials (186 participants; 3 trials; moderate- (insulin lispro) to low-quality evidence (insulin aspart)). There was very low-quality evidence to evaluate the effects of subcutaneous insulin lispro versus intravenous regular insulin on the time to resolution of DKA: mean difference (MD) 0.2 h (95% CI -1.7 to 2.1); P = 0.81; 90 participants; 2 trials. In one trial involving children with DKA, the time to reach a glucose level of 250 mg/dL was similar between insulin lispro and intravenous regular insulin. There was very low-quality evidence to evaluate the effects of subcutaneous insulin aspart versus intravenous regular insulin on the time to resolution of DKA: MD -1 h (95% CI -3.2 to 1.2); P = 0.36; 30 participants; 1 trial. There was low-quality evidence to evaluate the effects of subcutaneous rapid-acting insulin analogues versus intravenous regular insulin on hypoglycaemic episodes: 6 of 80 insulin lispro-treated participants compared with 9 of 76 regular insulin-treated participants reported hypoglycaemic events; risk ratio (RR) 0.59 (95% CI 0.23 to 1.52); P = 0.28; 156 participants; 4 trials. For insulin aspart compared with regular insulin, RR for hypoglycaemic episodes was 1.00 (95% CI 0.07 to 14.55); P = 1.0; 30 participants; 1 trial; low-quality evidence. Socioeconomic effects as measured by length of mean hospital stay for insulin lispro compared with regular insulin showed a MD of -0.4 days (95% CI -1 to 0.2); P = 0.22; 90 participants; 2 trials; low-quality evidence and for insulin aspart compared with regular insulin 1.1 days (95% CI -3.3 to 1.1); P = 0.32; low-quality evidence. Data on morbidity were limited, but no specific events were reported for the comparison of insulin lispro with regular insulin. No trial reported on adverse events other than hypoglycaemic episodes, and no trial investigated patient satisfaction. AUTHORS' CONCLUSIONS Our review, which provided mainly data on adults, suggests on the basis of mostly low- to very low-quality evidence that there are neither advantages nor disadvantages when comparing the effects of subcutaneous rapid-acting insulin analogues versus intravenous regular insulin for treating mild or moderate DKA.
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Affiliation(s)
- Carlos A Andrade‐Castellanos
- Hospital Civil de Guadalajara "Dr. Juan I. Menchaca"Department of Emergency MedicineSalvador Quevedo y Zubieta No. 750GuadalajaraJaliscoMexico44340
| | - Luis Enrique Colunga‐Lozano
- Hospital Civil de Guadalajara "Fray Antonio Alcalde"Department of Critical Care MedicineCalle Coronel Calderón #777GuadalajaraGuadalajaraMexico44320
| | - Netzahualpilli Delgado‐Figueroa
- Hospital Civil de Guadalajara Dr. Juan I. MenchacaDepartment of PediatricsSalvador Quevedo y Zubieta No. 750GuadalajaraJaliscoMexico44340
| | - Daniel A Gonzalez‐Padilla
- Hospital Universitario 12 de OctubreDepartment of UrologyAvenida de Córdoba, s/nMadridMadridSpain28041
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Suicide risk in type 1 diabetes mellitus: A systematic review. J Psychosom Res 2014; 76:352-60. [PMID: 24745775 DOI: 10.1016/j.jpsychores.2014.02.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 02/20/2014] [Accepted: 02/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research has shown that suicide risk is often present in patients suffering from type 1 diabetes mellitus (DM-1). OBJECTIVES The aim of the present paper was to investigate whether there was a relationship between DM-1 and suicidal behavior and to determine whether or not people affected by DM-1 are at an increased risk of completed suicide, attempted suicide, and suicidal ideation. DATA SOURCES We performed a careful MedLine, ExcerptaMedica, PsycLit, PsycInfo and Index Medicus search to identify all papers on the topic for the period 1970 to 2013 written in English. The following search terms were used: (suicide OR suicide attempt OR ideation) AND (diabetes mellitus). Where a title or abstract seems to describe a study eligible for inclusion, the full article was examined. ELIGIBILITY CRITERIA We included only original articles published in English peer-reviewed journals. We excluded meta-analyses and systematic reviews, studies that were not clear about follow-up times, the method of statistical analysis, diagnostic criteria or the number of patients included, and studies only on patients affected by type 2 diabetes mellitus (DM-2). RESULTS The research reviewed indicated that patients with DM-1 are at an increased risk for suicide, although no clear consensus exists regarding the level of the increased risk. LIMITATIONS The studies used different measurement techniques and different outcomes, and they assessed patients at different time points. CONCLUSIONS AND IMPLICATIONS Our findings support the recommendation that a suicide risk assessment of patients with DM-1 should be part of the routine clinical assessment. The assessment of patients at risk should consist of the evaluation of current and previous suicidal behaviors (both suicidal ideation and attempted suicide).
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O'Grady MJ, Delaney J, Jones TW, Davis EA. Standardised mortality is increased three-fold in a population-based sample of children and adolescents with type 1 diabetes. Pediatr Diabetes 2013; 14:13-7. [PMID: 22765276 DOI: 10.1111/j.1399-5448.2012.00885.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 05/10/2012] [Indexed: 11/27/2022] Open
Abstract
There are no type 1 diabetes (T1DM) mortality data on Australian children and limited contemporary data on their international counterparts. Fatalities in children and adolescents (1-17 yr) with T1DM were identified from the Western Australia Children's Diabetes Database between 1987-2011. Seventeen thousand four hundred and fifty-three patient-years of diabetes data were analysed and 13 deaths were confirmed (six male). The overall standardised mortality ratio was 3.1 [95% confidence interval (CI), 1.7-5.3] and was highest in the 10-14 yr age group, at 4.6 (95% CI, 1.5-10.8). Median age at death was 16.4 yr (range 5 to 17.8 yr), and median haemoglobin A1c at death was 10.5% (range 6.7 to >14). Cause of death was attributed to diabetes in 10 (77%) cases. Two patients were found 'dead-in-bed'. All diabetes-related deaths in subjects with known T1DM occurred outside the hospital setting.
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Affiliation(s)
- Michael Joseph O'Grady
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, 6008, Australia
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Pacaud D, Yale JF. Exploring a black hole: Transition from paediatric to adult care services for youth with diabetes. Paediatr Child Health 2011; 10:31-4. [PMID: 19657443 DOI: 10.1093/pch/10.1.31] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DURING THE PASSAGE FROM ADOLESCENCE TO ADULTHOOD, INDIVIDUALS ARE EXPECTED TO GO THROUGH THREE PSYCHOLOGICAL STAGES: identity formation (finding out who they are), intimacy (establishment of stable intimate relationships) and generativity (productive lifestyle, career or vocational realization). Having diabetes may complicate this process. Further, the period of late adolescence and early adulthood coincides with the transition of care from paediatric to adult care services. This transition is a time when the individual is particularly at risk for loss of medical follow-up and medical complications. The present article reviews the current state of knowledge on psychosocial maturation in youth with diabetes and the process of transition of care from paediatric to adult care services.
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Affiliation(s)
- Danièle Pacaud
- Alberta Children's Hospital, Department of Paediatrics, University of Calgary, Calgary, Alberta
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The epidemiology of childhood stroke. Eur J Paediatr Neurol 2010; 14:197-205. [PMID: 19879783 DOI: 10.1016/j.ejpn.2009.09.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/14/2009] [Accepted: 09/17/2009] [Indexed: 11/21/2022]
Abstract
This paper reviews the epidemiology of childhood stroke. Stroke is an important condition in children. It is one of the top ten causes of childhood death and there is a high risk of serious morbidity for the survivors. Epidemiological data are an integral part of disease understanding and high quality studies are required to ensure that this data is robust. Incidence rates from population-based studies vary from 1.3 per 100,000 to 13.0 per 100,000. Factors found to influence incidence rates include age, gender, and ethnicity but there are also many inherent differences between studies. Temporal analysis of mortality rates from childhood stroke shows falling rates but there has been little long-term study of changes in incidence rates. Improved epidemiological data should be a goal of the national and international collaborative networks that are studying childhood stroke.
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Wright J, Ruck K, Rabbitts R, Charlton M, De P, Barrett T, Baskar V, Kotonya C, Saraf S, Narendran P. Diabetic ketoacidosis (DKA) in Birmingham, UK, 2000—2009: an evaluation of risk factors for recurrence and mortality. ACTA ACUST UNITED AC 2009. [DOI: 10.1177/1474651409353248] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic ketoacidosis (DKA) is an acute metabolic complication of type 1 diabetes mellitus. This study aimed to define the DKA mortality rate in a Birmingham population and to identify risk factors for mortality and repeat admissions. An evaluation of 137 patients’ notes retrieved from five hospitals in and around Birmingham, UK, identified 278 admissions over a 9-year period (2000—2009). The International Classification of Disease 10 coding system for DKA, E101, was employed to identify notes. Overall five (1.8%) patients died. Mortality was significantly associated with age, presence of co-morbidity and diabetic complications. Poor control and compliance, female sex, clinic non-attendance, presence of co-morbidity and psychological problems all increased the risk of recurrent DKA admissions. Our study supports a role for improving education and glycaemic control to reduce DKA and its associated mortality.
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Affiliation(s)
- Jennifer Wright
- The Medical School, University of Birmingham, Edgbaston, Birmingham, UK
| | - Katie Ruck
- The Medical School, University of Birmingham, Edgbaston, Birmingham, UK
| | - Roberta Rabbitts
- The Medical School, University of Birmingham, Edgbaston, Birmingham, UK
| | - Mary Charlton
- Heartlands Hospital, Bordesley Green East, Birmingham, UK
| | - Parijat De
- Endocrinology and General Medicine, City Hospital, Birmingham, UK
| | - Tim Barrett
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, UK
| | - Varadarajan Baskar
- Diabetes, Endocrinology and General Medicine, New Cross Hospital, Wolverhampton, UK
| | - Christine Kotonya
- Diabetes and General Medicine, Hywel Dda NHS Trust, Bronglais Hospital, Aberystwyth, UK
| | - Sanjay Saraf
- Diabetes and Endocrinology, University Hospital Birmingham, Selly Oak Hospital, Birmingham, UK
| | - Parth Narendran
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, UK, Diabetes and Endocrinology, University Hospital Birmingham, Selly Oak Hospital, Birmingham, UK,
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14
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Feltbower RG, Bodansky HJ, Patterson CC, Parslow RC, Stephenson CR, Reynolds C, McKinney PA. Acute complications and drug misuse are important causes of death for children and young adults with type 1 diabetes: results from the Yorkshire Register of diabetes in children and young adults. Diabetes Care 2008; 31:922-6. [PMID: 18285550 DOI: 10.2337/dc07-2029] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine mortality rates and causes of death among subjects diagnosed with type 1 diabetes aged <or=29 years. RESEARCH DESIGN AND METHODS Subjects with type 1 diabetes from a population-based register in Yorkshire, U.K., diagnosed between 1978 and 2004 were linked to the U.K. National Health Service Central Register for death notifications. Deaths were coded using ICD-9 (1979-2000) and ICD-10 (2001-2005). Standardized mortality ratios (SMRs) were calculated using expected numbers of deaths from U.K. mortality rates by cause of death and age at diagnosis. RESULTS A total of 4,246 individuals were followed up, providing 50,471 person-years of follow-up. Mean follow-up length was 12.8 years for individuals aged 0-14 years and 8.3 for those aged 15-29 years. Overall, 108 patients died, of whom 77 (71%) were male. A total of 74 (1.7/1,000 person-years) deaths occurred in inidividuals aged 0-14 years and 34 (4.6/1,000 person-years) in those aged 15-29 years. The SMR was 4.7 (95% CI 3.8-5.6) overall, similar for males and females, but higher for individuals aged 15-29 years (SMR 6.2 [95% CI 4.3-8.6]) compared with those aged 0-14 years (4.2 [3.3-5.3]). The SMR rose with increasing disease duration. A total of 47 of 108 deaths (44%) occurred from diabetes complications, 32 of which were acute and 15 chronic. Twenty-two percent (n = 24) of deaths were attributed to accidents or violence (SMR 2.1 [95% CI 1.4-3.2]), including six suicides. Sixteen percent of all deaths were related to drug misuse (including insulin but excluding tobacco and alcohol) (SMR 6.4 [95% CI 3.7-10.2]). CONCLUSIONS Subjects with type 1 diabetes diagnosed under 30 years of age had a 4.7-fold excess mortality risk. Nearly half of the deaths were due to acute or chronic complications of diabetes. Drug misuse-related deaths may be an emerging trend in this population warranting further investigation.
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Affiliation(s)
- Richard G Feltbower
- Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
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15
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Romon I, Jougla E, Balkau B, Fagot-Campagna A. The burden of diabetes-related mortality in France in 2002: an analysis using both underlying and multiple causes of death. Eur J Epidemiol 2008; 23:327-34. [PMID: 18386133 DOI: 10.1007/s10654-008-9235-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 03/13/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Isabelle Romon
- French Institute for Public Health Surveillance, Institut de Veille Sanitaire (InVS), 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
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16
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Rubenstein JH, Scheiman JM, Anderson MA. A clinical and economic evaluation of endoscopic ultrasound for patients at risk for familial pancreatic adenocarcinoma. Pancreatology 2007; 7:514-25. [PMID: 17912015 DOI: 10.1159/000108969] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 06/06/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Approximately 10% of pancreatic adenocarcinoma is familial. Approximately 50% of 1st-degree relatives (FDRs) have endoscopic ultrasound (EUS) findings of chronic pancreatitis. We modeled the natural history of these patients to compare 4 management strategies. METHODS We performed a systematic review, and created a Markov model for 45-year-old male FDRs, with findings of chronic pancreatitis on screening EUS. We compared 4 strategies: doing nothing, prophylactic total pancreatectomy (PTP), annual surveillance by EUS, and annual surveillance with EUS and fine needle aspiration (EUS/FNA). Outcomes incorporated mortality, quality of life, procedural complications, and costs. RESULTS In the Do Nothing strategy, the lifetime risk of cancer was 20%. Doing nothing provided the greatest remaining years of life, the lowest cost, and the greatest remaining quality-adjusted life years (QALYs). PTP provided the fewest remaining years of life, and the fewest remaining QALYs. Screening with EUS provided nearly identical results to PTP, and screening with EUS/FNA provided intermediate results between PTP and doing nothing. PTP provided the longest life expectancy if the lifetime risk of pancreatic cancer was at least 46%, and provided the most QALYs if the risk was at least 68%. CONCLUSIONS FDRs from familial pancreatic cancer kindreds, who have EUS findings of chronic pancreatitis, have increased risk for cancer, but their precise risk is unknown. Without the ability to further quantify that risk, the most effective strategy is to do nothing.
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Affiliation(s)
- Joel H Rubenstein
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48105, USA.
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17
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Barceló A, Bosnyak Z, Orchard T. A cohort analysis of type 1 diabetes mortality in Havana and Allegheny County, Pittsburgh, PA. Diabetes Res Clin Pract 2007; 75:214-9. [PMID: 16876284 DOI: 10.1016/j.diabres.2006.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 06/12/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the mortality of type 1 diabetes (T1D) in two countries with very different health care systems using two population-based registries of childhood-onset T1D one in Havana (HA), Cuba, and the other in Allegheny County (AC), USA. RESEARCH DESIGN AND METHODS Cases diagnosed with T1D between 1965 and 1980 in HA and between 1965 and 1979 in AC were included. Follow-up started with diagnosis in each individual and ended as of 1 January 1991, or with death. Life-table analyses were used to examine the mortality rates in both populations by duration of diabetes. RESULTS Cumulative mortality by January 1991 in HA (14% in males and females, respectively) was higher than in AC (7% in males and 9% in females) for both genders (males, p=0.0005; females, p=0.0491). Mortality rates were considerably higher in HA for both men and women than in AC however, among females confidence intervals overlapped. Overall mortality rate for Caucasians (AC) was significantly lower than that for African-Americans (AC) or Hispanics (HR). An analysis of causes of death showed a greater proportion of deaths attributed to nephropathy (48.6%) in HA while acute complications (36%) and infections (27%) were more frequent in AC. CONCLUSIONS This study shows a two-fold greater mortality among people with childhood-onset T1D in Havana, Cuba, than in Allegheny, USA. Different strategies may be needed to increase survival among those with type 1 diabetes in the USA and Cuba.
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Affiliation(s)
- A Barceló
- Non-Communicable Diseases, Disease Prevention & Control, Pan American Health Organization, Regional Office of the World Health Organization, 525 23rd Street, N.W., Washington, DC 20037, USA.
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18
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Effect of type 1 diabetes on psychosocial maturation in young adults. J Adolesc Health 2007; 40:29-35. [PMID: 17185203 DOI: 10.1016/j.jadohealth.2006.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 06/30/2006] [Accepted: 07/07/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE Previous research suggests that having diabetes may complicate the passage from adolescence to adulthood. The aim of this study was to establish if young adults with Type 1 diabetes (T1DM) had delays in aspects of their psychosocial maturation compared with healthy controls (HC). METHODS A cross-sectional study compared psychosocial maturation in individuals aged 18-25 years with T1DM to age-matched healthy controls. After obtaining consent, participants completed the following measures: Responsibility and Independence Scale for Adolescents (RISA; psychosocial maturity); Social Maturation Index (SMI, social maturity); Levenson's Locus of Control Scales (LOC, internal versus external locus of control) and the Social Density Grid (SDG, social network). RESULTS In total, 160 subjects completed the study (97 T1DM, 63 HC). Participants included 101 females. No group differences were found on the RISA total score or the Responsibility or Independence Subscales of this measure. On the SMI, the proportion of subjects within each category (good, moderate or poor) was similar for each group. The overall number of social contacts identified on the SDG was similar for all groups; however, individuals with diabetes identified fewer friends within their social network that knew each other (F (2,160) = 3.28, p < .05). No significant group differences were found for LOC. CONCLUSIONS Young adults with Type 1 diabetes did not show delayed psychosocial maturation when compared with healthy young adult controls.
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19
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Waernbaum I, Blohmé G, Ostman J, Sundkvist G, Eriksson JW, Arnqvist HJ, Bolinder J, Nyström L. Excess mortality in incident cases of diabetes mellitus aged 15 to 34 years at diagnosis: a population-based study (DISS) in Sweden. Diabetologia 2006; 49:653-9. [PMID: 16447054 DOI: 10.1007/s00125-005-0135-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Accepted: 11/04/2005] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS The objective of the study was to analyse the mortality, survival and cause of death patterns in incident cases of diabetes in the 15-34-year age group that were reported to the nationwide prospective Diabetes Incidence Study in Sweden (DISS). MATERIALS AND METHODS During the study period 1983-1999, 6,771 incident cases were reported. Identification of deaths was made by linking the records to the nationwide Cause of Death Register. RESULTS With an average follow-up of 8.5 years, resulting in 59,231 person-years, 159 deaths were identified. Diabetes was reported as the underlying cause of death in 51 patients (32%), and as a contributing cause of death in another 42 patients (26%). The standardised mortality ratio (SMR) was significantly elevated (RR=2.4; 95% CI: 2.0-2.8). The SMR was higher for patients classified by the reporting physician as having type 2 diabetes at diagnosis than for those classified as type 1 diabetic (2.9 and 1.8, respectively). Survival analysis showed significant differences in survival curves between males and females (p=0.0003) as well as between cases with different types of diabetes (p=0.005). This pattern was also reflected in the Cox regression model showing significantly increased hazard for males vs females (p=0.0002), and for type 2 vs type 1 (p=0.015) when controlling for age. CONCLUSIONS/INTERPRETATION This study shows a two-fold excess mortality in patients with type 1 diabetes and a three-fold excess mortality in patients with type 2 diabetes. Thus, despite advances in treatment, diabetes still carries an increased mortality in young adults, even in a country with a good economic and educational patient status and easy access to health care.
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Affiliation(s)
- I Waernbaum
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
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20
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Soedamah-Muthu SS, Fuller JH, Mulnier HE, Raleigh VS, Lawrenson RA, Colhoun HM. All-cause mortality rates in patients with type 1 diabetes mellitus compared with a non-diabetic population from the UK general practice research database, 1992-1999. Diabetologia 2006; 49:660-6. [PMID: 16432708 DOI: 10.1007/s00125-005-0120-4] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Accepted: 10/31/2005] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS We compiled up to date estimates of the absolute and relative risk of all-cause mortality in patients with type 1 diabetes in the UK. MATERIALS AND METHODS We selected patients with type 1 diabetes (n=7,713), and for each of these diabetic subjects five age- and sex-matched control subjects without diabetes (n=38,518) from the General Practice Research Database (GPRD). Baseline was 1 January 1992; subjects were followed until 1999. The GPRD is a large primary-care database containing morbidity and mortality data of a large sample representative of the UK population. Deaths occurring in the follow-up period were identified. RESULTS The study comprised 208,178 person-years of follow-up. The prevalence of type 1 diabetes was 2.15/1,000 subjects in 1992 (mean age 33 years, SD 15). Annual mortality rates were 8.0 per 1,000 person-years (95% CI 7.2-8.9) in type 1 diabetic subjects compared with 2.4 per 1,000 person-years (95% CI 2.2-2.6) in those without diabetes (hazard ratio [HR]=3.7, 95% CI 3.2-4.3). The increased mortality rates in patients with type 1 diabetes were apparent across all age-bands. The HR was higher in women (HR=4.5, 95% CI 3.5-5.6 compared with non-diabetic women) than men (HR=3.3, 95% CI 2.7-4.0), such that the sex difference (p<0.0001) in mortality in the non-diabetic population was abolished (p=0.3) in the type 1 diabetic patients. The predominant cause of death in patients with type 1 diabetes was cardiovascular disease. CONCLUSIONS/INTERPRETATION Despite advances in care, UK mortality rates in the past decade continue to be much greater in patients with type 1 diabetes than in those without diabetes.
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Affiliation(s)
- S S Soedamah-Muthu
- Department of Epidemiology and Public Health, Royal Free and University College London Medical School, London, UK.
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21
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Soedamah-Muthu SS, Stehouwer CDA. Cardiovascular disease morbidity and mortality in patients with type 1 diabetes mellitus : management strategies. ACTA ACUST UNITED AC 2005; 4:75-86. [PMID: 15783245 DOI: 10.2165/00024677-200504020-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There is an increased risk of cardiovascular disease (CVD) mortality and morbidity in patients with type 1 diabetes mellitus compared with the general population as shown by epidemiologic studies measuring cardiovascular endpoints, as well as by autopsy, angiographic, and coronary calcification studies. Most of the excess CVD risk associated with type 1 diabetes is concentrated in the subset of approximately 35% of patients who develop diabetic nephropathy (after 20 years of diabetes duration), who also typically have dyslipidemias, elevated blood pressure, and hyperglycemia, factors contributing to CVD. For reasons that remain speculative, the relative risks from CVD are higher in women than in men with type 1 diabetes compared with the general population, which effectively eliminates the gender differences in CVD. As in the general population and in patients with type 2 diabetes, education and lifestyle changes, interventions to reduce hyperglycemia, blood pressure, micro-albuminuria, lipid control, and the use of aspirin are important management areas in order to reduce the increased risk of CVD. Whether management with aspirin and statins should be started in type 1 diabetic patients at a younger age or at a lower risk score than in the general population is still under investigation. There is a need for a better understanding of the pathophysiology of vascular complications in type 1 diabetes, more specific risk engines in type 1 diabetes, and accurate estimations of the absolute and relative risk for CVD in order to improve management of CVD in these high-risk patients.
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Affiliation(s)
- Sabita S Soedamah-Muthu
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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22
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Pritchard C, Peveler R. Changing patterns of diabetic deaths in youth and young adults by gender in the major developed countries 1974-97. Int J Adolesc Med Health 2003; 15:169-77. [PMID: 12955820 DOI: 10.1515/ijamh.2003.15.2.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The objective was to examine any changes in "Diabetic Deaths" in major developed countries 1974-97 and to determine whether youth (aged 15-24 years) and young adult (aged 25-44 years) males are at greater risk of Diabetic Death (DD) than women by comparing DD with "All Cause Deaths" (ACD) by gender. DESIGN Based upon WHO standardized mortality data, three year average death rates for 1974-76 were contrasted against three year average for 1995-97 for ACD and DD rate per million, by gender. Ratios of change for each country were calculated, which were then used for comparison between countries, thus ensuring comparison of like with like, resolving the inherent problem of differential recording between countries. Ratios of ratios were calculated between the ACD and DD ratios by gender indicating any changes between mortalities by gender over the period. Chi square tests examined differences between the gender. RESULTS ALL CAUSE DEATHS: Wide range of male ACD, lowest Japan 939 (per million p.m) to USA 2039 p.m. but there were substantial falls (< 0.2) in five countries. Female ACD ranged from Japan 485 p.m. to USA 889 but fell substantially in every country except the Netherlands. DIABETIC DEATHS: Male DD highest in USA at 24 p.m., lowest Italy 6 p.m. with substantial falls in 8 countries. Female DD were 17 p.m. in USA and 3 p.m. in France and Spain. Fell substantially in every country except the USA. DD:ACD male rates saw substantial improvements in Ratio of Ratios (RoR) in France, Italy and Spain but rose 1.22 in USA. Female RoR showed better improvements in DD in France, Netherlands and Spain but substantial rises in Canada and USA. DD AND GENDER: In every country there were more male than female DD and over time male DD worsened significantly compared to female DD in Japan, Netherlands, Spain and USA. CONCLUSIONS Whilst diabetes continues to be associated with greater mortality, over the period there have been major improvements in DD relative to ACD deaths, especially amongst females. Nonetheless, there are still gains to be made if compliance can be further improved amongst male patients.
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Affiliation(s)
- Colin Pritchard
- Institute of Health & Community Studies, Bournemouth University, Bournemouth House, 17-19 Christchurch Rd, Bournemouth BH 13 LH, UK.
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23
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Abstract
OBJECTIVE In the context of recent improvements in type 1 diabetes therapy, to describe longitudinal trends in mortality attributable to childhood diabetes and to investigate socioeconomic and health services correlates of mortality. RESEARCH DESIGN AND METHODS We extracted mortality data for 1968-1998 from National Center for Health Statistics files and covariates from the Bureau of Health Professions Area Resource File. Analytical techniques included linear and Poisson regression and standard descriptive statistics. RESULTS Childhood (defined as 0-19 years of age) age-adjusted mortality from diabetes declined from 9.5 (1968) to 3.0 (1984) deaths per 10 million but remained relatively constant subsequently. All-cause childhood mortality, however, continued to decline. Older children experienced higher mortality rates, as did those living in counties with higher levels of unemployment. CONCLUSIONS Despite recent improvements in therapy, diabetes-related mortality among children has not declined for 14 years. This finding may be partially attributable to sociodemographic factors influencing access to care, but the remaining mortality may defy available treatment methods. Reducing childhood diabetes mortality rates below the current apparent plateau may require new prevention and/or treatment strategies.
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Affiliation(s)
- J H DiLiberti
- Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois 61637, USA.
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Nishimura R, LaPorte RE, Dorman JS, Tajima N, Becker D, Orchard TJ. Mortality trends in type 1 diabetes. The Allegheny County (Pennsylvania) Registry 1965-1999. Diabetes Care 2001; 24:823-7. [PMID: 11347737 DOI: 10.2337/diacare.24.5.823] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate long-term mortality and its temporal trends as of 1 January 1999 among the 1,075 patients with type 1 diabetes (onset age <18 years, diagnosed between 1965 and 1979) who comprise the Allegheny County population-based registry. RESEARCH DESIGN AND METHODS Overall, sex- and race-specific mortality rates per person-year of follow-up were determined. Standardized mortality ratios were also calculated. Survival analyses and Cox proportional hazard model were also used. Temporal trends were examined by dividing the cohort into three groups by year of diagnosis (1965-1969, 1970-1974, and 1975-1979). RESULTS Living status of 972 cases was ascertained as of January 1, 1999 (ascertainment rate 90.4%). The mean duration of diabetes was 25.2 +/- 5.8 (SD) years. Overall, 170 deaths were observed. The crude mortality rate was 627 per 100,000 person-years (95% CI 532-728) and standardized mortality ratio was 519 (440-602). Life-table analyses by the Kaplan-Meier method indicated cumulative survival rates of 98.0% at 10 years, 92.1% at 20 years, and 79.6% at 30 years duration of diabetes. There was a significant improvement in the survival rate between the cohort diagnosed during 1965-1969 and that diagnosed during 1975-1979 by the log-rank test (P = 0.03). Mortality was higher in African-Americans than in Caucasians, but there were no differences seen by sex. The improvement in recent years was seen in both ethnic groups and sexes. CONCLUSIONS An improvement in long-term survival was observed in the more recently diagnosed cohort. This improvement is consistent with the introduction of HbA1 testing, home blood glucose monitoring, and improved blood pressure therapy in the 1980s.
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Affiliation(s)
- R Nishimura
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
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25
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Abstract
Cerebral oedema remains the leading cause of death and morbidity in children with Type 1 diabetes mellitus. Around seven per thousand episodes of diabetic ketoacidosis (DKA) are complicated by cerebral oedema, and one-quarter of those children will die from it. The cause or causes of cerebral oedema are still very poorly understood, but lawyers are already keen to implicate various aspects of the management of DKA. There have been many theories as to the pathophysiology of cerebral oedema, and possible contributing factors may be excessive rate of rehydration, falling plasma osmolality (particularly that due to a reduction in plasma sodium concentration), hypoxia and insulin dosage. There is some supportive evidence for all of these factors in some cases, but there have been no sizeable case-control studies, in part because of the rarity of the condition. Furthermore, cerebral oedema can still occur even when the management of DKA follows current 'best practice' guidelines. As the mechanisms of cell volume regulation within the brain are increasingly understood, different questions may provide greater insights. For example, what is it about children that makes them so much more susceptible to cerebral oedema than adults? And why does one child treated in a certain way develop cerebral oedema whereas another does not? The anxiety over causing cerebral oedema has driven most of the changes in the management of DKA over recent decades, yet there is no evidence that the incidence has reduced. Until the causes are understood, we cannot be dogmatic about treatment recommendations.
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Affiliation(s)
- J A Edge
- John Radcliffe Hospital, Oxford, UK.
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26
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Abstract
BACKGROUND Mortality rates in children with insulin dependent diabetes (IDDM) in the UK are unknown and the causes of death not well documented. AIM To determine the mortality rate and causes of death in children with IDDM. METHODS The Office of National Statistics (England and Wales) and the General Register Office (Scotland) notified all deaths under 20 years of age from 1990 to 1996 with diabetes on the certificate. Further details were provided by coroners, pathologists, and clinicians. RESULTS 116 deaths were notified and 83 were caused by diabetes. The standardised mortality ratio was 2.3 (95% confidence interval (CI), 1.9 to 2.9), being highest in the age group 1-4 years, at 9.2 (95% CI, 5.4 to 14.7). Of the 83 diabetic deaths, hyperglycaemia/diabetic ketoacidosis (DKA) was implicated in 69 and hypoglycaemia in 7. Cerebral oedema was the most common cause of death in young children (25 of 36 diabetes related deaths in children under 12 years of age). 34 young people (10-19 years; 24 male) were either found dead at home (n = 26) or moribund on arrival at hospital (n = 8). In 24 of these, it appeared that DKA was the cause of death, in four hypoglycaemia was likely. Nine of these were found "dead in bed". CONCLUSIONS Children with IDDM have a higher mortality than the general population. Cerebral oedema accounts for most hospital deaths in young children. There are a large number of young men dying at home from neglected IDDM. Early diagnosis of IDDM in children and closer supervision of young people might prevent some of these deaths.
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Affiliation(s)
- J A Edge
- Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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