Wasag Diana R, Gregory John W, Dayan Colin, Harvey John N
Diabetes Research Group, Wrexham Academic Unit, Bangor University, Wrexham, UK.
Division of Population Medicine, Cardiff University, Cardiff, UK.
Arch Dis Child. 2018 Jan;103(1):44-48. doi: 10.1136/archdischild-2016-312581. Epub 2017 Aug 31.
Long-term outcomes in young people with type 1 diabetes continue to be of interest, and may help evaluate the effects of changes to the clinical care of children that have occurred in recent decades.
To identify mortality and its causes before age 30 years in patients developing type 1 diabetes before age 15 years.
Since 1995, paediatricians in Wales have compiled a prospective register of incident cases of type 1 diabetes occurring before age 15 years in Wales (the Brecon Cohort). Their subsequent mortality rates were compared with mortality in the general populations of Wales and England using the patient-years exposure method. Causes of death were ascertained from death certificates and from clinicians.
The standardised mortality ratio for young people with type 1 diabetes in Wales was 2.91 with no clear evidence of improvement or worsening of mortality risk over time. Most deaths occurred between ages 15 and 30 years although at a slightly younger age than in the general population. There were more deaths with increasing age at diagnosis of diabetes. Ketoacidosis remains the most common cause of death before age 30 years. Hypoglycaemia was difficult to ascertain with certainty but also caused some deaths. In this age group, chronic complications of diabetes were not a cause of mortality.
Despite the developments in clinical care in recent years, the mortality risk for people developing type 1 diabetes in childhood remains high in young adult life before the onset of chronic complications.
1型糖尿病青少年的长期预后一直备受关注，可能有助于评估近几十年来儿童临床护理变化的影响。
确定15岁前患1型糖尿病的患者在30岁前的死亡率及其原因。
自1995年以来，威尔士的儿科医生编制了一份前瞻性登记册，记录威尔士15岁前发生的1型糖尿病新发病例（布雷肯队列）。使用患者年暴露法将他们随后的死亡率与威尔士和英格兰普通人群的死亡率进行比较。死亡原因从死亡证明和临床医生处确定。
威尔士1型糖尿病青少年的标准化死亡率为2.91，没有明确证据表明死亡率风险随时间有改善或恶化。大多数死亡发生在15至30岁之间，尽管年龄比普通人群稍小。糖尿病诊断时年龄越大，死亡人数越多。酮症酸中毒仍然是30岁前最常见的死亡原因。低血糖难以确切确定，但也导致了一些死亡。在这个年龄组中，糖尿病的慢性并发症不是死亡原因。
尽管近年来临床护理有所发展，但儿童期患1型糖尿病的人在慢性并发症出现之前的年轻成年期死亡率风险仍然很高。
