MORTALITY AND OUTCOME OF PATIENTS WITH BRITTLE DIABETES AND RECURRENTKETOACIDOSIS

The long-term outlook of patients with brittle insulin-dependent diabe tes is uncertain. We assessed the outcome of a group of young female p atients with diabetes and recurrent ketoacidosis originally investigat ed in 1979-85 and reassessed after a mean of 10.5 (SD 1.4) years. 7 of the 33 patients could not be traced. 5 (19%) of the remaining 26 had died. Causes of death were not certain, but were probably ketoacidosis (2), hypoglycaemia (2), and renal failure (1). Of the 21 survivors, o nly 2 (10%) were still considered to have brittle diabetes. Diabetic c omplications were common (67%), and were more frequent than in a match ed control group of stable patients with diabetes (25%). Brittle diabe tic patients also had lower quality-of-life scores, more frequent psyc hosocial disruptions, and were on higher insulin doses (77 [39] vs 47 [15] U per day, p = 0.007) than controls. Pregnancy complications had occurred in 13 of 28 (46%) pregnancies in severely unstable patients c ompared with 2 of 27 (7%) in stable controls. Patients with brittle di abetes have a tendency to become more stable with time, but have a hig her risk of death, more microvascular and pregnancy complications, and a poorer quality of life.