Sudden Death More Common in Type 1’s Under 40 Years

Acute complications of diabetes 27%, unnatural deaths 28%, and sudden unexpected deaths 22%, were the predominant causes of death in young individuals with diabetes.

The aim of this study by researchers from Sydney, Australia was to determine the causes of death in Australians with type 1 diabetes mellitus who died aged 40 years or younger. It involved a retrospective review of autopsy reports at the Department of Forensic Medicine, Sydney, New South Wales, 1 January 1994 – 31 December 2006. The main outcome measure was causes of mortality in people with type 1 diabetes aged = 40 years.

They found that of the 26,682 autopsy reports, 1,914 were for individuals with diabetes (type 1, 400; type 2, 1514). Cardiovascular disease significantly accounted for 51% of deaths (169/333) in people with type 1 diabetes aged > 40 years, versus 13% among those aged = 40 years (9/67). Acute complications of diabetes (27%; 18/67), unnatural deaths (28%; 19/67), and sudden unexpected deaths (22%; 15/67) were the predominant causes of death in young individuals with diabetes. Sudden unexpected death was more common in those with type 1 diabetes compared with a sex-matched control population in the same age range (22% v 5%). Of the sudden unexpected deaths, 10 people were found dead in an undisturbed bed with no cause of death found at autopsy ("dead-in-bed" syndrome; mean age SD, 30.2 Years; males : females = 4 :1).

The researchers concluded: "In deceased young people with type 1 diabetes, acute diabetic complications, unnatural causes, and sudden unexpected deaths were the predominant causes of death. The relatively high frequency of sudden unexpected deaths, such as dead-in-bed syndrome, requires further investigation."

This is not only important for doctors to know about for patients with known diabetes, but to consider as the cause of sudden unexpected death in people less than 40.

MJA 16 June 2008; 188 (12): 699-702: The Medical Journal of Australia: Causes of death in young Australians with type 1 diabetes: a review of coronial postmortem examinations