New study shows recent improvement in years of life lost.
With minimal studies to evaluate the impact of type 1 diabetes on life expectancy, studies have been developed to retrospectively look at the effects of diabetes on mortality. Diabetes was also compared to other disease states and causes that had an influence on years of life lost (YLL). The YLL of patients with type 1 diabetes and patients with other disease states were compared to those of the general healthy population.
This autoimmune disorder accounts for 10% of all Americans diagnosed with diabetes, and the ability to prevent the development of type 1 diabetes is minimal. Causes have been linked to genetics, and viral infections such as mumps, rubella, cytomegalovirus, measles, influenza, encephalitis, polio, or Epstein-Barr virus.
In a study conducted on Australians with type 1 diabetes between the years of 1997 and 2010, researchers looked at the estimated YLL of the type 1 diabetic patients compared to the general public. Researchers used the Chiang method to estimate life expectancy and Arriaga’s method to estimate the impact of age-specific and cause-specific mortalities.
Results showed no disparity in terms of YLL from type 1 diabetes in women vs. men. When the YLL was organized into two groups, 1997-2003 and 2004-2010, the 2004-2010 groups showed improvement in life expectancies of 1.9 years in men and 1.5 years in women. Overall, over the time period of the study, patients with type 1 diabetes had a life expectancy of 12.2 years less than the general population.
The majority of the YLL was attributed to endocrine and metabolic diseases that occurred between the ages of 10-39, and circulatory diseases that occurred after the age of 40.
Medical advances over the years may account for the YLL improvement seen in the 2004-2010 groups versus the 1997-2003 groups. New guidelines have also changed the treatment of type 1 diabetes in kids.In a 2007 article, pediatric diabetologists expressed the belief that the gold standard of treatment for children with type 1 diabetes is intensified insulin therapy. Intensified therapy regimens include short‐acting insulin before main meals, and intermediate/long‐acting insulin one to three times daily for basal insulin coverage. Previously, the standard of care in children with diabetes included a two-injection therapy, but with the change to an intensified therapy studies have shown positive impacts.
While the YLL has improved over time, the incidence of childhood type 1 diabetes has increased worldwide. Diagnosis of diabetes in the 19th century was uncommon. However, increased access to urine samples resulted in an increase in the frequency of patients being diagnosed with the disease. In addition, there have been speculations that loss of protective factors contributed to the rising incidence of patients who have the disease
Overall, a better understanding of how to live with the disease may have attributed to the improvements through the years. This includes a better understanding of the exercise, nutrition, and medications involved. Even though the contributing factors of type 1 diabetes and type 2 diabetes may be different, there are many parallels between the two.
Investigational approaches such as inhalation insulin and islet cell transplantation have so far been discouraging and are not used in child populations. However, better understanding of the molecular, medical, and psychosocial mechanisms involved with type 1 diabetes will lead to continuous improvement in type 1 diabetes treatment. As methods are investigated to help preserve beta islet cells, better management of the disease state is possible. Research is focused on regenerating human beta cells, targeting the autoimmune response to prevent type 1 diabetes, and identifying type 1 diabetes before beta cell loss.
- Years lost from type 1 diabetes has improved about 1.5-1.9 from 2003 until 2010.
- The life expectancy for type 1 diabetes has increased, as has the incidence of patients being diagnosed.
- Advancements in medication, exercise, nutrition, and overall understanding helps manage the disease state.
Researched and prepared by Jimmy Tran, Doctor of Pharmacy Candidate LECOM College of Pharmacy reviewed by Dave Joffe, BSPharm, CDE
The Rise of Childhood Type 1 Diabetes in the 20th Century. Diabetes. 2002;51(12):3353.
Huo L, Harding JL, Peeters A, Shaw JE, Magliano DJ. Life expectancy of type 1 diabetic patients during 1997-2010: a national Australian registry-based cohort study. Diabetologia. 2016;