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Clinical and demographic risk factors associated with mortality during early adulthood in a population-based cohort of childhood-onset Type 1 diabetes

Cooper, M. N. ; de Klerk, N. H. ; Jones, T. W. ; Davis, E. A.

Diabetic medicine, 2014-12, Vol.31 (12), p.1550-1558 [Periódico revisado por pares]

Oxford: Blackwell Publishing Ltd

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Título:
Clinical and demographic risk factors associated with mortality during early adulthood in a population-based cohort of childhood-onset Type 1 diabetes
Autor: Cooper, M. N. ; de Klerk, N. H. ; Jones, T. W. ; Davis, E. A.
Assuntos: Adolescent ; Adult ; Age ; Biological and medical sciences ; Cardiovascular Diseases - mortality ; Cohort Studies ; Diabetes ; Diabetes Mellitus, Type 1 - drug therapy ; Diabetes Mellitus, Type 1 - metabolism ; Diabetes Mellitus, Type 1 - mortality ; Diabetes. Impaired glucose tolerance ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Feeding. Feeding behavior ; Female ; Follow-Up Studies ; Fundamental and applied biological sciences. Psychology ; Glycated Hemoglobin A - metabolism ; Health risk assessment ; Humans ; Hypoglycemia - chemically induced ; Hypoglycemic Agents - adverse effects ; Male ; Medical sciences ; Mortality ; Poisoning - mortality ; Population ; Proportional Hazards Models ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Social Class ; Suicide - statistics & numerical data ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology ; Young Adult
É parte de: Diabetic medicine, 2014-12, Vol.31 (12), p.1550-1558
Notas: ark:/67375/WNG-DFZ9JQNL-H
istex:4A92DD1C2E78A95A7074F78CCDF49A6143CC23B9
ArticleID:DME12522
Diabetes Research Foundation of Western Australia
Table S1 Cause of death groupings [International Classification of Diseases (ICD) codes ICD-9, ICD-9 Clinical Modification and ICD-10 Australian Modification]. Table S2 Standardized mortality ratios by age and sex for 1309 cases of childhood-onset Type 1 diabetes followed into early adulthood. Table S3 Adjusted (year of birth and variables present in table) clinical and demographic risk factors for early adulthood all-cause mortality (n = 1272, complete data).
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Descrição: Aims To calculate standardized mortality ratios and to assess the association between paediatric clinical factors and higher risk of mortality during early adulthood in a population‐based cohort of subjects with Type 1 diabetes. Methods Subjects with Type 1 diabetes were identified through the Western Australian Children's Diabetes Database and clinical data for those who reached 18 years of age (n = 1309) were extracted. An age‐ and sex‐matched (without diabetes) comparison cohort (n = 6451) was obtained from the birth registry. Mortality records were obtained from the death registry. Participants were followed up until 31 January 2012. Associations of clinical factors (from clinic visits before 18 years of age) with mortality were assessed using Cox proportional hazard models. Results The standardized mortality ratio for all‐cause mortality was 1.7 (95% CI 0.7–3.3) for male and 10.1 (95% CI 5.2–17.7) for female subjects with Type 1 diabetes (median age at end of study 25.6 years). The adjusted hazard ratio was 1.5 (95% CI 1.1–2.1) for a 1% increase in mean paediatric HbA1c level, 3.8 (95% CI 0.9–15.3) for four episodes of severe hypoglycaemia relative to zero episodes, and 6.21 (95% CI 1.4–28.4) for a low‐level socio‐economic background relative to a high‐level background. Conclusions People with childhood‐onset Type 1 diabetes have higher mortality rates in early adulthood. At particularly high risk are women, those with a history of poor HbA1c levels, those with recurrent severe hypoglycaemia during paediatric management, and those from a low socio‐economic background. These groups may benefit from intensified management during transition from paediatric to adult care facilities. What's new? This was a population‐based cohort with a high case ascertainment of childhood‐onset Type 1 diabetes cases from a population of 2.4 million. We obtained comprehensive clinical data from 3‐monthly clinic visits throughout paediatric management from a well‐established, long‐standing clinical register. The study used population‐linked health data, providing comprehensive subject follow‐up. The study had a robust design and statistical analysis that addressed the limitations of previous studies on this topic. We obtained clear results, providing novel insights into those subgroups of patients who are at higher risk of mortality during early adulthood. The findings can be easily translated into clinical practice with the aim of improving patient outcomes.
Editor: Oxford: Blackwell Publishing Ltd
Idioma: Inglês

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Clinical and demographic risk factors associated with mortality during early adulthood in a population-based cohort of childhood-onset Type 1 diabetes

Cooper, M. N. ; de Klerk, N. H. ; Jones, T. W. ; Davis, E. A.

Oxford: Blackwell Publishing Ltd

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