Increased mortality in diabetes during the first 10 years of the disease. A population-based study (DISS) in Swedish adults 15-34 years old at diagnosis

Objectives. To study. prospectively, in young adult patients, the mortality during the first years after the diagnosis of diabetes. Design. The Diabetes Incidence Study in Sweden (DISS) aims to register all incident cases aged 15-34 years. During a 10-year period all deaths were id entified by record linkage to the national Cause of Death Registry. Subjects. During the period, 4097 new cases were registered and classified as type 1 diabetes (73%). type 2 (16%), secondary (2%) and unclassified (9% ). The median follow-up was 5 years (21 001 person-years). Main outcome measures. Calculation of the standardized mortality ratio (SMR ) and 95% confidence interval (CI). Evaluation of all deceased by scrutiny of clinical records, death certificates and autopsy protocols. Results. Fifty-eight patients died, corresponding to an SMR of 3.5 (CI = 2. 7-4.5), which increased from 1.5 at 15-19 years to 4.1 at 30-34 years, SMR was 2.7 in primary diabetes: 2.3 (1.6-3.3) in type 1 and 4.1 (2.6-6.7) in t ype 2. In secondary diabetes, alcohol-associated pancreatitis a common caus e, SMR was 32 (CI = 24-45). Evidence of alcohol or drug misuse, mental dysf unction or suicide was found in 40 of all 58 deceased cases. Less often, hy poglycaemia (n = 7) or hyperglycaemia-ketoacidosis (n = 11) was present at death. Unexplained 'dead in bed' was found once. Conclusions. In the investigated population-based cohort the early mortalit y was about threefold increased. Hypoglycaemia and ketoacidosis per se play ed a relatively small role compared with a heavy impact from social and men tal dysfunction, and from careless use of alcohol or drugs.