Transcript 20110922T1DMmortality (2678273 bytes)

Journal Club
Harjutsalo V, Forsblom C, Groop PH.
Time trends in mortality in patients with type 1 diabetes:
nationwide population based cohort study.
BMJ. 2011 Sep 8;343:d5364. doi: 10.1136/bmj.d5364.
2011年9月22日 8:30-8:55
８階 医局
埼玉医科大学 総合医療センター 内分泌・糖尿病内科
Department of Endocrinology and Diabetes,
Saitama Medical Center, Saitama Medical University
松田 昌文
Matsuda, Masafumi
今年になり当院で
１型糖尿病の方が２名死亡しています。
これから高齢の１型糖尿病の方も増えると思われるので
．．．
BMJ 2011;343:d5364 doi: 10.1136/bmj.d5364
Objective
To examine short and long term time
trends in mortality among patients with
early onset (age 0-14 years) and late
onset (15-29 years) type 1 diabetes
and causes of deaths over time.
Design Population based nationwide
cohort study.
Setting Finland.
Participants All Finnish patients
diagnosed as having type 1 diabetes
below age 30 years between 1970 and
1999 (n=17,306).
Main outcome measures Crude
mortality, standardised mortality ratios,
time trends, and cumulative mortality.
All Finnish citizens with certain chronic
diseases such as type 1 diabetes are
entitled to full reimbursement of drug
costs. Because insulin has been free of
charge for patients with diabetes in
Finland since 1964, all patients with
permanent entitlement to free insulin
are entered in the drug reimbursement
register.
NS=not significant. *Adjusted for age at diagnosis and duration of diabetes. †P value for trend <0.001.
Cumulative mortality in patients in Finland with type 1
diabetes diagnosed between 1970 and 1999: early
onset cohort (0-14 years)
Cumulative mortality in patients in Finland with type 1
diabetes diagnosed between 1970 and 1999: late onset
cohort (15-29 years)
Predicted standardised mortality ratios according to 5 year age at onset groups
Results A total of 1338 deaths occurred during 370 733 person
years of follow-up, giving an all cause mortality rate of 361/100
000 person years. The standardised mortality ratio was 3.6 in the
early onset cohort and 2.8 in the late onset cohort. Women had
higher standardised mortality ratios than did men in both cohorts
(5.5 v 3.0 in the early onset cohort; 3.6 v 2.6 in the late onset
cohort). The standardised mortality ratio at 20 years’ duration of
diabetes in the early onset cohort decreased from 3.5 in the
patients diagnosed in 1970-4 to 1.9 in those diagnosed in 1985-9.
In contrast, the standardised mortality ratio in the late onset cohort
increased from 1.4 in those diagnosed in 1970-4 to 2.9 in those
diagnosed in 1985-9. Mortality due to chronic complications of
diabetes decreased with time in the early onset cohort but not in
the late onset cohort. Mortality due to alcohol related and drug
related causes increased in the late onset cohort and accounted
for 39% of the deaths during the first 20 years of diabetes.
Accordingly, mortality due to acute diabetic complications
increased significantly in the late onset cohort.
Conclusion
Survival of people with early onset type 1
diabetes has improved over time,
whereas survival of people with late onset
type 1 diabetes has deteriorated since
the 1980s. Alcohol has become an
important cause of death in patients with
type 1 diabetes, and the proportion of
deaths caused by acute complications of
diabetes has increased in patients with
late onset type 1 diabetes.
Message/Comments
1970-99年に30歳未満で1型糖尿病を発症した
患者（1万7306人）を対象に、死亡率の年次
推移をコホート研究で検討。観察人年は37万
733人年で、早期発病（0-14歳）患者の生存
率は時間とともに上昇したが、晩期発病
（15-29歳）患者の生存率は1980年代以降低
下していた。重要な死因の1つはアルコール
だった。［フィンランドでは］
高齢者１型糖尿病ではまずアルコール禁止！