Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the post-test.
BARCELONA – Young adults with type 1 diabetes are living substantially longer than they did a couple of generations ago, according to a study of nearly 25,000 people with type 1 diabetes living in Scotland during 2008-2010.
Researchers took observed mortality rates during this period and calculated that the life expectancy for patients aged 20-24 years with type 1 diabetes was about 45 years for men and 47 years for women, respectively 11 and 14 years less than the life expectancy of an average Scottish man or women aged 20-24 years without diabetes.
These rates at which the life expectancy of patients with diabetes lagged behind that of the general population showed a dramatic narrowing of the life-expectancy gap, compared with an average 27-year gap reported in 1975 for men and women with type 1 diabetes versus people without diabetes (J. Occup. Med. 1975;17:716-21), Dr. Helen M. Colhoun said at the annual meeting of the European Association for the Study of Diabetes.
"I’m confident that the much narrowed life-expectancy differences we see now reflect the enormous advances in management of type 1 diabetes in the last 20-30 years," said Dr. Colhoun, a professor of public health at the University of Dundee (Scotland).
Dr. Colhoun also noted that similar findings recently reported for U.S. patients (Diabetes 2012;61:2987-92) suggest that similar trends are occurring among type 1 diabetes patients elsewhere, although she cautioned that current data from other countries are not now available. "I don’t think that Scotland is that different from other populations," she said.
Despite this positive development, which Dr. Colhoun hoped may eventually reduce life insurance costs for type 1 diabetes patients, a substantial life-expectancy gap remains and means that efforts to improve patient care, prevent morbidity, and increase survival must continue, she said.
"We need to get these [life-expectancy] differences down to zero," she said. "There is no doubt that glycemic control is important for long-term outcomes in patients with type 1 diabetes," and data collected by Dr. Colhoun and her associates in this study showed that in recent years, 37% of these patients in Scotland had poor glycemic control. Better glycemic control may be possible through increased education and empowerment of patients and wider availability of insulin pumps, she said. Their data also showed that other risk factors – such as smoking and hypertension – also need improved management.
But Dr. Colhoun cautioned that their research has not yet confirmed specific factors driving survival and mortality in the population studied. "The next stage of our analysis will look to see how life expectancy differs according to risk-factor profiles, which will give us greater insight into where the improvements have occurred. However, we already know that there have been substantial improvements in the last 20 years in cardiovascular risk factors such as lipid profiles and blood pressure. We have not seen improvements in smoking or glycemic control."
The study used data from 24,971 people aged 20 years or older with type 1 diabetes and living in Scotland during 2008-2010, and compared the calculated life-expectancy rates with those of average men and women without type 1 diabetes in the Scottish population of about 12 million people. The gap between life expectancy for type 1 patients and the general population was highest among those aged 20-24 years. The gap progressively narrowed as people aged: Among those 60-65 years old, the life expectancy gap was 5 years for men and 7 years for women.
Dr. Colhoun said that she had no disclosures.
To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here.
On Twitter @mitchelzoler