Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population

type 1 diabetes mortality study

Original article published by Diabetes Care. Click here to read the original article.

Objective

Historically, mortality in type 1 diabetes has exceeded that in the general population.
We compared mortality in the Diabetes Control and Complications Trial/
Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study
cohort to that of the current general U.S. population.

Research Design and Methods

The DCCT (1983–1993) compared intensive versus conventional therapy, with
HbA1c levels of ∼7 vs. 9%, respectively, over an average of 6.5 years of treatment.
EDIC is the observational follow-up study of the DCCT (1994 to the present). Vital
status was ascertained for 97.5% of the original DCCT cohort (n = 1,441) after a
mean of 27 years follow-up. Expected mortality during DCCT/EDIC was estimated
using the current age-, sex-, and race-specific risks in the general U.S. population,
and the observed versus expected mortality compared using standardized mortality
ratios (SMRs) and Poisson regression models.

Results

Mortality in the DCCT intensive therapy group was nonsignificantly lower than
that in the general U.S. population (SMR = 0.88 [95% CI 0.67, 1.16]), whereas
mortality in the DCCT conventional therapy group was significantly greater than
that in the general population (SMR = 1.31 [95% CI 1.05, 1.65]). The SMR increased
with increasing mean HbA1c, and above an HbA1c of 9%, the rate of increase in SMR
among females was greater than that among males.

Conclusions

Overall mortality in the combined DCCT/EDIC cohort was similar to that of the
general population but was higher in the DCCT conventional therapy group. Mortality
increased significantly with increasing mean HbA1c, more so among females
than males, especially for HbA1c >9%.

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