Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
Oslo Diabetes Research Centre, Oslo, Norway.
Diabetes Care. 2017 Jan;40(1):38-45. doi: 10.2337/dc16-1213. Epub 2016 Oct 21.
To study long-term mortality, causes of death, and end-stage renal disease (ESRD) in people diagnosed with type 1 diabetes at age 15-29 years.
This nationwide, population-based cohort with type 1 diabetes diagnosed during 1978-1982 (n = 719) was followed from diagnosis until death, emigration, or September 2013. Linkages to the Norwegian Cause of Death Registry and the Norwegian Renal Registry provided information on causes of death and whether ESRD was present. A clinical committee reviewed the causes of death. We calculated standardized mortality ratios (SMRs) for comparison with the background population.
During 30 years' follow-up, 4.6% of participants developed ESRD and 20.6% (n = 148; 106 men and 42 women) died. Cumulative mortality by years since diagnosis was 6.0% (95% CI 4.5-8.0) at 10 years, 12.2% (10.0-14.8) at 20 years, and 18.4% (15.8-21.5) at 30 years. The SMR was 4.4 (95% CI 3.7-5.1). Mean time from diagnosis of diabetes to ESRD was 23.6 years (range 14.2-33.5). Death was caused by chronic complications (32.2%), acute complications (20.5%), violent death (19.9%), or any other cause (27.4%). Death was related to alcohol in 15% of cases. SMR for alcohol-related death was 6.8 (95% CI 4.5-10.3), for cardiovascular death was 7.3 (5.4-10.0), and for violent death was 3.6 (2.3-5.3).
The cumulative incidence of ESRD was low in this cohort with type 1 diabetes followed for 30 years. Mortality was 4.4 times that of the general population, and more than 50% of all deaths were caused by acute or chronic complications. A relatively high proportion of deaths were related to alcohol.
研究 15-29 岁确诊为 1 型糖尿病患者的长期死亡率、死因和终末期肾病（ESRD）。
本研究为全国范围内的基于人群的队列研究，纳入 1978-1982 年期间诊断为 1 型糖尿病的患者（n=719），随访至死亡、移民或 2013 年 9 月。与挪威死因登记处和挪威肾脏登记处的链接提供了死因和 ESRD 发生情况的信息。一个临床委员会审查了死因。我们计算了标准化死亡率比（SMR）以与对照人群进行比较。
在 30 年的随访期间，4.6%的参与者发生 ESRD，20.6%（n=148；106 名男性和 42 名女性）死亡。按诊断后年份计算的累积死亡率为 10 年时 6.0%（95%CI 4.5-8.0），20 年时 12.2%（10.0-14.8），30 年时 18.4%（15.8-21.5）。SMR 为 4.4（95%CI 3.7-5.1）。从糖尿病诊断到 ESRD 的平均时间为 23.6 年（范围 14.2-33.5）。死亡原因是慢性并发症（32.2%）、急性并发症（20.5%）、暴力死亡（19.9%）或其他任何原因（27.4%）。15%的病例与酒精有关。与酒精相关的死亡 SMR 为 6.8（95%CI 4.5-10.3），心血管死亡 SMR 为 7.3（5.4-10.0），暴力死亡 SMR 为 3.6（2.3-5.3）。
本研究中，1 型糖尿病患者随访 30 年后，ESRD 的累积发生率较低。死亡率是一般人群的 4.4 倍，超过 50%的死亡是由急性或慢性并发症引起的。与酒精有关的死亡比例相对较高。
