Mortality in Dm Tipe 1

7/24/2019 Mortality in Dm Tipe 1

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Glycemic Control and Excess Mortalityin Type 1 Diabetes

Andre Tritansa Faizal

RS Bhayan!ara Tin!at 1 R" SaidS#!anto


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


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Bac!ro#nd

Type 1 Diabetes is associated %ith as#bstantially increased ris! o& premat#re deathas compared %ith that in the eneral pop#lation

The excess ris! o& death &rom any ca#se and o&death &rom cardio'asc#lar ca#ses is #n!no%namon patients %ith type 1 diabetes and

'ario#s le'els o& lycemic control


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Methods

patients %ith type 1 diabetes reisteredin the S%edish (ational Diabetes Reistera&ter )an#ary 1* 1++,

For each patient* -'e controls %ererandomly selected &rom the eneral

pop#lation and matched accordin to aeand sex*


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Methods

.atients and controls %ere &ollo%ed #ntilDecember /1* 011

2n&ormation on coexistin conditions andca#ses o& death %as retrie'ed by lin!inpersonal identi-cation n#mbers &rom

patients and controls to the S%edish2npatient Reister and the Ca#se o&Death Reister


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Res#lts


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Res#lts


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Res#lts


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Disc#ssion

&or patients %ith type 1 diabetes %ho had on3taret lycemic control* the ris! o& death &romany ca#se and the ris! o& death &rom

cardio'asc#lar ca#ses %ere still more than t%icethe ris!s in the eneral pop#lation

For patients %ith diabetes %ho had 'ery poorlycemic control* the ris!s o& death %ere , and1 times as hih as those in the eneralpop#lation


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Disc#ssion

the ris! o& death &or patients %ith type 1diabetes and stae 4 chronic !idney disease%as / times

The excess ris! o& death &rom any ca#se or&rom cardio'asc#lar disease did not decreaseo'er time in the present st#dy

2n a recent lare st#dy &rom Canada and the

5nited 6indom that did not distin#ish typeso& diabetes* the excess ris! o& death declineds#bstantially o'er time* albeit not amonpatients yo#ner than 7 years o& ae"


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St#dy limitations

co#ld not concl#de that patients %ho ha'econsistently ood lycemic control &rom thetime o& dianosis on%ard still ha'e an

excess ris! o& death obser'ational nat#re o& the st#dy does notallo% to de-niti'ely excl#de the possibility o&resid#al con&o#ndin o& death

co#ld ha'e #nderestimated diabetic comaas a ca#se o& death* since the ma8ority onspeci-ed diabetes3related deathsocc#rred o#tside the hospital


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Ta!e 9ome Massae

Control o& lycated haemolobin isimportant to red#ce mortality

patients %ith type 1 DM %ith normallycated hemolobin still had ris! o&death t%ice as hih as those in theeneral pop#lation and se'eral timeshiher amon patients %ith poor

lycemic control* and / times hiher inpatients %ith C6D st :

Diabetic !etoacidosis and hypolycaemia%ere common ca#se o& death in yo#nerperson ;


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T9A(6 >?5

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Mortality in Dm Tipe 1