Endocrine and metabolic disease also ranked high, accounting for 20.7% of all deaths and almost 30% of all years of life lost, and for 30% to 40% of all deaths between ages 10 and 40,2 according to the data.
In light of these results, the researchers underscored the importance of treating the complications of diabetes.
“Early onset of diabetes tended to be a predictor of premature mortality. Deaths from circulatory disease and endocrine and metabolic disease contributed most to early mortality in type 1 diabetes,” they wrote.
“For improvements in life expectancy, greater attention must therefore be paid to both the acute metabolic and chronic cardiovascular complications of type 1 diabetes. A failure to address either one will continue to leave type 1 diabetic patients at risk of premature mortality.”
Data From Sweden
In the second study, Dennis Petrie, PhD, of the University of Melbourne, and colleagues used health records from the Swedish National Diabetes Register (NDR) linked with death records to compare life expectancy of patients with type 1 diabetes with the general population from 2002 to 2011.
A total of 27 841 people aged at least 20 years were living with type 1 diabetes between 2002 and 2011, contributing to 194 685 person-years of follow-up and 2018 deaths.3
The estimated remaining life expectancy at age 20 for patients with type 1 diabetes increased by 2.1 years for men, from 47.7 years (95% CI, 46.6-48.9) in 2002 to 2006 to 49.8 years (95% CI, 49.0-50.7) in 2007 to 2011.3 For women, there was little change, increasing from 51.7 years (95% CI, 50.3-53.2) in 2002-2006 to 51.9 years (95% CI, 50.9-52.9) in 2007 to 2011.3
Overall, life expectancy at age 20 increased for the Swedish population. However, similar to the findings in Australia, the gap in life expectancy between patients with type 1 diabetes and the general population did not change significantly, remaining at approximately 11 years for men and 12 years for women.3
The researchers reported that cardiovascular (CV) mortality declined significantly, with a hazard ratio (HR) per year decrease of 0.947 (95% CI, 0.917-0.978) for men and 0.952 (95% CI, 0.916-0.989) for women.3
While increased use of lipid-lowering medications and reductions in smoking rates likely account for for the decrease in CV disease (CVD) in both patients with type 1 diabetes and the general population, more can be done.
“There is still some way to go in terms of improvement in care for those with type 1 diabetes in order to close the gap with the general population,” the researchers wrote. “A significant proportion have elevated HbA1c levels and a recent paper based on the Swedish NDR highlighted the stark differences in mortality for those with well-controlled vs poorly controlled HbA1c.”
Additional smoking cessation programs and expansion of the use of lipid-lowering medication could be particularly helpful, they noted.
“Future research needs to quantify these likely benefits against the costs of policies which might achieve them,” the researchers concluded.
They also encouraged further research for specific life expectancy estimates based on age at diagnosis and risk factor and comorbidity profiles.
Disabilities in Diabetes
Unfortunately, patients with diabetes — both type 1 and type 2 diabetes — not only face a shorter life expectancy but also seem to live more years with disabilities than those without the disease, according to a third study that was also published in Diabetologia.4
In this study, also conducted by Drs Magliano and Huo, the researchers used data from the Australian Diabetes, Obesity, and Lifestyle study to determine diabetes rates in Australia. Data on disability were derived from the 2012 Australian Survey of Disability, Ageing, and Careers. They also examined mortality by linking the National Diabetes Service Scheme to National Death Index for diabetes and by reviewing standard mortality datasets for the general population.