Mortality in young people admitted to hospital for diabetes: database study
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《英国医生杂志》
1 Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF, 2 Department of Public Health, University of Oxford
Correspondence to: S E Roberts stephen.roberts@uhce.ox.ac.uk
Introduction
Young people admitted to hospital for diabetes have an increased risk of death in the following three years, not only from natural causes but also from suicide. Although, in absolute terms, death in young people with diabetes is uncommon, standardised mortality ratios showed that death within three years of hospital admission was nine times more common than in the general population. These ratios were higher than those of 2 to 4 recently reported from population based diabetes cohorts and registers.1-3 This suggests that people with type 1 diabetes who need hospital admission are at much greater risk of mortality, at least in the short term after care, than the population of people with type 1 diabetes as a whole. Increased risk of suicide has previously been reported in men with diabetes,3 4 but we found an even higher risk in young women.
Other studies have reported improvements in prognosis in recent decades for people with type 1 diabetes.1 5 We found no appreciable improvement, however, in young people admitted to hospital for diabetes in the past 30 years. Because methods for glycaemic control and the delivery of insulin therapy have improved over time, the proportion of people admitted with diabetes whose condition is difficult to control is unlikely to have increased. Survival of young people with type 1 diabetes whose disease was serious enough to warrant admission is therefore not likely to have improved much.
See also p 750
Further details about the study's methods and results are at bmj.com
Leicester Gill, Glenys Bettley, and Myfanwy Griffith built the database. We thank Myfanwy Griffith and David Yeates for programming.
Contributors: SER and MJG designed the study and wrote the first draft of the manuscript; SER analysed the data; and HAWN contributed to study design, interpretation, and further drafts. SER and MJG are guarantors for the paper.
Funding: The Oxford record linkage study was a project of the former Oxford Regional Health Authority. The Unit of Health-Care Epidemiology is funded by the Department of Health to analyse the linked data.
Competing interests: None declared.
Ethical approval: The historical data files were built with approval from the Oxford Region Data Protection Steering Group and the Health Authorities' Caldicott Guardians; and are wholly anonymised. Ethical approval was not needed for analysis of anonymised statistical datasets.
References
McNally PG, Raymond NT, Burden ML, Burton PR, Botha JL, Swift PG, et al. Trends in mortality of childhood-onset insulin-dependent diabetes mellitus in Leicestershire: 1940-1991. Diabet Med 1995;12: 961-6.
Laing SP, Swerdlow AJ, Slater SD, Botha JL, Burden AC, Waugh NR, et al. The British Diabetic Association cohort study, I: all-cause mortality in patients with insulin-treated diabetes mellitus. Diabet Med 1999;16: 459-65.
Wibell L, Nystrom L, Ostman J, Arnqvist H, Blohme G, Lithner F, et al. Increased mortality in diabetes during the first 10 years of the disease. A population-based study (DISS) in Swedish adults 15-34 years old at diagnosis. J Intern Med 2001;249: 263-70.
Kyvik KO, Stenager EN, Green A, Svendsen A. Suicides in men with IDDM. Diabetes Care 1994;17: 210-2.
Nishimura R, Matsushima M, Tajima N, Agata T, Shimizu H, LaPorte RE. A major improvement in the prognosis of individuals with IDDM in the past 30 years in Japan. The Diabetes Epidemiology Research International Study Group. Diabetes Care 1996;19: 758-60.(Stephen E Roberts, epidem)
Correspondence to: S E Roberts stephen.roberts@uhce.ox.ac.uk
Introduction
Young people admitted to hospital for diabetes have an increased risk of death in the following three years, not only from natural causes but also from suicide. Although, in absolute terms, death in young people with diabetes is uncommon, standardised mortality ratios showed that death within three years of hospital admission was nine times more common than in the general population. These ratios were higher than those of 2 to 4 recently reported from population based diabetes cohorts and registers.1-3 This suggests that people with type 1 diabetes who need hospital admission are at much greater risk of mortality, at least in the short term after care, than the population of people with type 1 diabetes as a whole. Increased risk of suicide has previously been reported in men with diabetes,3 4 but we found an even higher risk in young women.
Other studies have reported improvements in prognosis in recent decades for people with type 1 diabetes.1 5 We found no appreciable improvement, however, in young people admitted to hospital for diabetes in the past 30 years. Because methods for glycaemic control and the delivery of insulin therapy have improved over time, the proportion of people admitted with diabetes whose condition is difficult to control is unlikely to have increased. Survival of young people with type 1 diabetes whose disease was serious enough to warrant admission is therefore not likely to have improved much.
See also p 750
Further details about the study's methods and results are at bmj.com
Leicester Gill, Glenys Bettley, and Myfanwy Griffith built the database. We thank Myfanwy Griffith and David Yeates for programming.
Contributors: SER and MJG designed the study and wrote the first draft of the manuscript; SER analysed the data; and HAWN contributed to study design, interpretation, and further drafts. SER and MJG are guarantors for the paper.
Funding: The Oxford record linkage study was a project of the former Oxford Regional Health Authority. The Unit of Health-Care Epidemiology is funded by the Department of Health to analyse the linked data.
Competing interests: None declared.
Ethical approval: The historical data files were built with approval from the Oxford Region Data Protection Steering Group and the Health Authorities' Caldicott Guardians; and are wholly anonymised. Ethical approval was not needed for analysis of anonymised statistical datasets.
References
McNally PG, Raymond NT, Burden ML, Burton PR, Botha JL, Swift PG, et al. Trends in mortality of childhood-onset insulin-dependent diabetes mellitus in Leicestershire: 1940-1991. Diabet Med 1995;12: 961-6.
Laing SP, Swerdlow AJ, Slater SD, Botha JL, Burden AC, Waugh NR, et al. The British Diabetic Association cohort study, I: all-cause mortality in patients with insulin-treated diabetes mellitus. Diabet Med 1999;16: 459-65.
Wibell L, Nystrom L, Ostman J, Arnqvist H, Blohme G, Lithner F, et al. Increased mortality in diabetes during the first 10 years of the disease. A population-based study (DISS) in Swedish adults 15-34 years old at diagnosis. J Intern Med 2001;249: 263-70.
Kyvik KO, Stenager EN, Green A, Svendsen A. Suicides in men with IDDM. Diabetes Care 1994;17: 210-2.
Nishimura R, Matsushima M, Tajima N, Agata T, Shimizu H, LaPorte RE. A major improvement in the prognosis of individuals with IDDM in the past 30 years in Japan. The Diabetes Epidemiology Research International Study Group. Diabetes Care 1996;19: 758-60.(Stephen E Roberts, epidem)