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Ketoacidosis Is The Main Cause On Mortality In Childhood-Onset Type 1 Diabetes

Although the main part of excess mortality in type 1 diabetes is due to long-term complications, an excess death rate// has also been reported from several countries in case subjects with short duration without signs of long-term complications. Except for the mortality caused by onset ketoacidosis or diabetic ketoacidosis after onset, part of the excess mortality has been unexplained deaths in bed.

Recently, a study was undertaken with the aim to describe the age- and sex-specific mortality in a cohort of young type 1 diabetic patients and to analyze the causes of death with special focus on suicide, accidents, and unexplained deaths.

For the study which appears in the October issue of the journal Diabetes Care, a population-based incident childhood diabetes register, covering onset cases since 1 July 1977, was linked to the Swedish Cause of Death Register up to 31 December 2000.

The official Swedish population register was used to calculate age- and sex-standardized mortality rates, excluding neonatal deaths. To analyze excess risks for specific diagnoses, case subjects were compared with five nondiabetic control subjects, matched by age, sex, and year of death. Death certificates were collected for all case and control subjects. For case subjects with an unclear diagnosis, hospital records and/or forensic autopsy reports were obtained.

In the present study, the authors from the Department of Clinical Sciences, Paediatrics, Umea University, Sweden, and Tornblad Institute, Lund University, Sweden analyzed the causes of death where clearly diabetic ketoacidosis is the most common diabetes-related cause. The majority of onset deaths were associated with signs of cerebral edema, as was two of the four ketoacidosis deaths treated in hospital several years after the of onset of the disease. It is notable that 10 case subjects were found deceased in their homes but were given an autopsy diagnosis of diabetic ketoacidosis. These were young adults with duration of diabetes of many years and with access to modern home blood glucose and urinary glucose testing. Such tragic deaths should have been avoidable, unless they were not intended. This possibility points to a need of improved psychosocial support in the care of these young type 1 diabetic patients.

The authors conclude that there is still a significant excess mortality in young type 1 diabetic patients with a short duration, where onset deaths due to ketoacidosis, especially in young children, are important to prevent. No clear indications of excess violent deaths or suicide were found. The authors confirm a very large proportion of unexplained deaths in bed, and they stress that this should be further studied.

Medindia on Type-1 Diabetes:

Diabetes is a group of diseases with one thing in common - a problem with insulin. The problem could be that your body doesn't make any insulin, doesn't make enough insulin or doesn't use insulin properly.

The type-1 diabetes is caused by the loss of insulin secreting beta-cell due to selective autoimmune destruction of the pancreatic beta cells. In this type exogenous insulin is required to prevent diabetic ketoacidosis.
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