Glycemic Control and Excess Mortality

in Type 1 Diabetes

Andre Tritansa Faizal

RS Bhayangkara Tingkat 1 R. Said
Sukanto

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Citation : N Engl J Med 2014;371:1972-82.

Background
Type 1 Diabetes is associated wit a

substantially increased risk of premature death

as compared with that in the general
population
The excess risk of death from any cause and of
death from cardiovascular causes is unknown
among patients with type 1 diabetes and
various levels of glycemic control

Methods
patients with type 1 diabetes registered in the

Swedish National Diabetes Register after January 1,

1998
For each patient, five controls were randomly
selected from the general population and matched
according to age and sex,
Patients and controls were followed until December
31, 2011
Information on coexisting conditions and causes of
death was retrieved by linking personal identification
numbers from patients and controls to the Swedish
Inpatient Register and the Cause of Death Register

Results

Results

Results

Discussion
for patients with type 1 diabetes who had

on-target glycemic control, the risk of death

from any cause and the risk of death from
cardiovascular causes were still more than
twice the risks in the general population
For patients with diabetes who had very
poor glycemic control, the risks of death
were 8 and 10 times as high as those in the
general population

Discussion
the risk of death for patients with type 1

diabetes and stage 5 chronic kidney disease

was 30 times
The excess risk of death from any cause or
from cardiovascular disease did not decrease
over time in the present study
In a recent large study from Canada and the
United Kingdom that did not distinguish types
of diabetes, the excess risk of death declined
substantially over time, albeit not among
patients younger than 40 years of age.

Study limitations :
could not conclude that patients who have

consistently good glycemic control from the time

of diagnosis onward still have an excess risk of
death
observational nature of the study does not

allow to definitively exclude the possibility of

residual confounding of death
could have underestimated diabetic coma as a

cause of death, since the majority of unspecified

diabetes-related deaths occurred outside the
hospital

Conclusions
patients with type 1 diabetes who have a

glycated hemoglobin level of 6.9% or lower,

the risks of death from any cause and from
cardiovascular causes are twice as high as
those in the general population and that
the risks are several times as high among
patients with poor glycemic control.

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