Individuals with type 1 diabetes (T1D) have significantly higher mortality rates than their peers in the general population. Major advances in the management of T1D occurred during the 1980s and 1990s, but recent data on their long-term effects on overall and cause-specific mortality are limited, especially in the United States. A phenomenon, known as dead-in-bed syndrome, is of particular concern as it occurs in young, healthy T1D individuals who are unexpectedly found dead in bed. Using follow-up data from a large population-based cohort, this dissertation provides contemporary mortality rates in persons with long-standing T1D. Cause-specific mortality is also explored, focusing on how mortality rates from major causes compare to the general population and on characterizing T1D deaths that meet the criteria for dead-in-bed syndrome. Overall, the mortality of individuals with T1D is seven times higher than seen in the general population. T1D individuals diagnosed more recently have significantly lower mortality rates than those diagnosed earlier, even after controlling for age. The greatest improvements in mortality have occurred in deaths from diabetes-related causes (diabetic coma, renal disease, cardiovascular disease, or infection), suggesting long-term benefits to improved T1D care. In a pattern quite contrary to what is seen in the general population, females with T1D have a higher mortality than males with T1D, especially from diabetes-related causes. While African-Americans with T1D have much higher mortality rates than T1D Caucasians in this cohort, this racial difference was similar to that seen in the general population. Finally, dead-in-bed syndrome in this population appears associated with male sex, low BMI, and disturbed metabolic control (high HbA1c, high daily insulin dose, and a history of severe hypoglycemia). The public health implications of this dissertation are considerable, as it provides insight into the causes of premature mortality in T1D, permitting the development of more effective and targeted preventative strategies. These findings also have the potential to change routine care practices to address disparities by race and sex in T1D mortality, and resolve disparities in health and life insurance provisions, since antiquated T1D mortality estimates are currently used, which do not account for recent advances in T1D treatments.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-05182010-121323 |
| Date | 29 September 2010 |
| Creators | Secrest, Aaron Michael |
| Contributors | Sheryl F. Kelsey, Dorothy J. Becker, Trevor J. Orchard, Ronald E. LaPorte |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-05182010-121323/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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