| الوصف: |
Wibell L, Nystro¨m L, O¨ stman J, Arnqvist H,Blohme´ G, Lithner F, Littorin B, Sundkvist G(Uppsala University Hospital, Uppsala; Umea˚ Uni-versity, Umea˚; Huddinge Hospital, Stockholm;Linko¨ping University Hospital, Linko¨ping; Sahl-grenska Hospital, Gothenburg; University of Lund;and Malmo¨ University Hospital, Malmo¨, Sweden).Increased mortality in diabetes during the first10 years of the disease. A population-based study(DISS) in Swedish adults 15–34 years old at diag-nosis. J Intern Med 2001; 249: 263–270.Objectives. To study, prospectively, in young adultpatients, the mortality during the first years after thediagnosis of diabetes.Design. The Diabetes Incidence Study in Sweden(DISS) aims to register all incident cases aged15–34 years. During a 10-year period all deathswere identified by record linkage to the nationalCause of Death Registry.Subjects. During the period, 4097 new cases wereregistered 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 stan-dardized mortality ratio (SMR) and 95% confidenceinterval (CI). Evaluation of all deceased by scrutinyof clinical records, death certificates and autopsyprotocols.Results. Fifty-eight patients died, corresponding toan SMR of 3.5 (CI ‹2.7–4.5), which increased from1.5 at 15–19 years to 4.1 at 30–34 years. SMR was2.7 in primary diabetes: 2.3 (1.6–3.3) in type 1 and4.1 (2.6–6.7) in type 2. In secondary diabetes,alcohol-associated pancreatitis a common cause,SMR was 32 (CI ‹24–45). Evidence of alcohol ordrug misuse, mental dysfunction or suicide wasfound in 40 of all 58 deceased cases. Less often,hypoglycaemia (n ‹7) or hyperglycaemia-ketoaci-dosis (n ‹11) was present at death. Unexplained‘dead in bed’ was found once.Conclusions. In the investigated population-basedcohort the early mortality was about threefoldincreased. Hypoglycaemia and ketoacidosis per seplayed a relatively small role compared with a heavyimpact from social and mental dysfunction, andfrom careless use of alcohol or drugs.Keywords: alcohol, dead in bed, death certificate,secondary diabetes, standardized mortality rate,suicide. |
