In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study

Top Cited Papers
Open Access
Publisher Website
Google Scholar
Abstract
Aims/hypothesis The FinnDiane Study has reported that mortality in type 1 diabetes is not increased over a 7 year follow-up in the absence of renal disease (RD). Using the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study population (n = 658) of childhood-onset type 1 diabetes (age 200 μg/min), or end stage renal disease (ESRD; dialysis or renal transplantation). Results At baseline, 311 (47.3%) individuals had RD (MA 21.3%, ON 22.2% and ESRD 3.8%). During a median 20 year follow-up, there were 152 deaths (23.1%). Mortality was 6.2 (95% CI 5.2–7.2) times higher than expected, with standardised mortality ratios of 2.0 (1.2–2.8) for normoalbuminuria (NA); 6.4 (4.4–8.4) for MA; 12.5 (9.5–15.4) for ON; and 29.8 (16.8–42.9) for ESRD. Excluding those (n = 64) with NA who later progressed to RD, no significant excess mortality was observed in the remaining NA group (1.2, 0.5–1.9), whose deaths were largely unrelated to diabetes. Conclusions/interpretation These data confirm the importance of RD, including persistent microalbuminuria, as a marker of mortality risk and suggest that type 1 diabetes patients without renal disease achieve long-term survival comparable to the general population.