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Observational Study
. 2016 Aug;39(8):1378-83.
doi: 10.2337/dc15-2399. Epub 2016 Jul 13.

Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population

Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group
Observational Study

Mortality in Type 1 Diabetes in the DCCT/EDIC Versus the General Population

Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group. Diabetes Care. 2016 Aug.

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.

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%.

Trial registration: ClinicalTrials.gov NCT00360815 NCT00360893.

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Figures

Figure 1
Figure 1
The RMR for the mortality in the combined DCCT/EDIC cohort relative to the age-, sex-, and race-specific risk in the general population as a function of the updated time-dependent mean HbA1c during the DCCT and EDIC from a Poisson regression model. The horizontal dashed line at an RMR of 1.0 represents no difference in risk relative to the general population.
Figure 2
Figure 2
The RMR for the mortality in the combined DCCT/EDIC cohort relative to the age-, sex-, and race-specific risk in the general population as a function of the updated time-dependent mean HbA1c during the DCCT and EDIC separately for males and females.
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