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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
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