Overall Type 1 Diabetes Mortality Similar in DCCT/EDIC, General Population. Diab Care

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Significantly higher mortality in the Diabetes Control and Complications Trial conventional therapy group 

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Overall mortality is similar in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study cohort and the general population, according to a study published online July 13 in Diabetes Care.

John M. Lachin, Sc.D., from the George Washington University Biostatistics Center in Rockville, Md., and colleagues compared mortality in the DCCT/EDIC study cohort to that of the general population. They estimated expected mortality during DCCT/EDIC using the current age-, sex-, and race-specific risks in the general U.S. population, and compared observed versus expected mortality.

The researchers found that, compared with the general U.S. population, mortality in the DCCT intensive therapy group was nonsignificantly lower (standardized mortality ratio [SMR], 0.88; 95 percent confidence interval, 0.67 to 1.16), while mortality in the DCCT conventional therapy group was significantly higher (SMR, 1.31; 95 percent confidence interval, 1.05 to 1.65). There was an increase in SMR with increasing mean hemoglobin A1c; the rate of increase in SMR was greater among females than males with hemoglobin A1c above 9.0 percent.

"Overall mortality in the combined DCCT/EDIC cohort was similar to that of the general population but was higher in the DCCT conventional therapy group," the authors write.

 

Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population
The Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
Diabetes Care 2016 Jul; dc152399. http://dx.doi.org/10.2337/dc15-2399

Abstract

OBJECTIVE Historically, mortality in type 1 diabetes has exceeded that in the general population. We compared mortality in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study cohort to that of the current general U.S. population.

RESEARCH DESIGN AND METHODS The DCCT (1983–1993) compared intensive versus conventional therapy, with HbA1c levels of ∼7 vs. 9%, respectively, over an average of 6.5 years of treatment. EDIC is the observational follow-up study of the DCCT (1994 to the present). Vital status was ascertained for 97.5% of the original DCCT cohort (n = 1,441) after a mean of 27 years follow-up. Expected mortality during DCCT/EDIC was estimated using the current age-, sex-, and race-specific risks in the general U.S. population, and the observed versus expected mortality compared using standardized mortality ratios (SMRs) and Poisson regression models.

RESULTS Mortality in the DCCT intensive therapy group was nonsignificantly lower than that in the general U.S. population (SMR = 0.88 [95% CI 0.67, 1.16]), whereas mortality in the DCCT conventional therapy group was significantly greater than that in the general population (SMR = 1.31 [95% CI 1.05, 1.65]). The SMR increased with increasing mean HbA1c, and above an HbA1c of 9%, the rate of increase in SMR among females was greater than that among males.

CONCLUSIONS Overall mortality in the combined DCCT/EDIC cohort was similar to that of the general population but was higher in the DCCT conventional therapy group. Mortality increased significantly with increasing mean HbA1c, more so among females than males, especially for HbA1c >9%.

 
 
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