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Glycemic Control and Excess Mortality

in Type 1 Diabetes

Andre Tritansa Faizal


RS Bhayangkara Tingkat 1 R. Said
Sukanto

Citation : N Engl J Med 2014;371:1972-82.

Background
Type 1 Diabetes is associated with a
substantially increased risk of premature death
as compared with that in the general population
The excess risk of death from any cause and of
death from cardiovascular causes is unknown
among patients with type 1 diabetes and
various levels of glycemic control

Methods
patients with type 1 diabetes registered
in the Swedish National Diabetes Register
after January 1, 1998
For each patient, five controls were
randomly selected from the general
population and matched according to age
and sex,

Methods
Patients and controls were followed until
December 31, 2011
Information on coexisting conditions and
causes of death was retrieved by linking
personal identification numbers from
patients and controls to the Swedish
Inpatient Register and the Cause of
Death Register

Results

Results

Results

Discussion
for patients with type 1 diabetes who had ontarget glycemic control, the risk of death from
any cause and the risk of death from
cardiovascular causes were still more than twice
the risks in the general population
For patients with diabetes who had very poor
glycemic control, the risks of death were 8 and
10 times as high as those in the general
population

Discussion
the risk of death for patients with type 1
diabetes and stage 5 chronic kidney disease
was 30 times
The excess risk of death from any cause or
from cardiovascular disease did not decrease
over time in the present study
In a recent large study from Canada and the
United Kingdom that did not distinguish types
of diabetes, the excess risk of death declined
substantially over time, albeit not among
patients younger than 40 years of age.

Study limitations
could not conclude that patients who have
consistently good glycemic control from the
time of diagnosis onward still have an
excess risk of death
observational nature of the study does not
allow to definitively exclude the possibility of
residual confounding of death
could have underestimated diabetic coma
as a cause of death, since the majority of
unspecified diabetes-related deaths
occurred outside the hospital

Take Home Massage


Control of glycated haemoglobin is
important to reduce mortality
patients with type 1 DM with normal
glycated hemoglobin still had risk of
death twice as high as those in the
general population and several times
higher among patients with poor
glycemic control, and 30 times higher in
patients with CKD stg V
Diabetic ketoacidosis and hypoglycaemia
were common cause of death in younger
person (<30 yo)

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