By Dennis Thompson
HealthDay Reporter
TUESDAY, Jan. 6, 2015 (HealthDay News) -- People with type 1 diabetes today lose more than a decade of life to the chronic disease, despite improved treatment of both diabetes and its complications, a new Scottish study reports.
Men with type 1 diabetes lose about 11 years of life expectancy compared to men without the disease. And, women with type 1 diabetes have their lives cut short by about 13 years, according to a report published in the Jan. 6 issue of the Journal of the American Medical Association.
The findings "provide a more up-to-date quantification of how much type 1 diabetes cuts your life span now, in our contemporary era," said senior author Dr. Helen Colhoun, a clinical professor in the diabetes epidemiology unit of the University of Dundee School of Medicine in Scotland.
Diabetes' impact on heart health appeared to be the largest single cause of lost years, according to the study. But, the researchers also found that type 1 diabetics younger than 50 are dying in large numbers from conditions caused by issues in management of the disease -- diabetic coma caused by critically low blood sugar, and ketoacidosis caused by a lack of insulin in the body.
"These conditions really reflect the day-to-day challenge that people with type 1 diabetes continue to face, how to get the right amount of insulin delivered at the right time to deal with your blood sugar levels," Colhoun said.
A second study, also in JAMA, suggested that some of these early deaths might be avoided with intensive blood sugar management.
In that paper, researchers reduced patients' overall risk of premature death by about a third, compared with diabetics receiving standard care, by conducting multiple blood glucose tests throughout the day and constantly adjusting insulin levels to hit very specific blood sugar levels.
"Across the board, individuals who had better glucose control due to intensive therapy had increased survival," said co-author Dr. Samuel Dagogo-Jack, chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center in Memphis.
Strict control of blood sugar appears to be key. Researchers observed a 44 percent reduction in overall risk of death for every 10 percent reduction in a patient's hemoglobin A1c, a test used to determine a person's average blood sugar levels over the prior three months, Dagogo-Jack said.
The Scottish study looked at the life expectancy of nearly 25,000 people with type 1 diabetes in Scotland between 2008 and 2010. All were 20 or older. There were just over 1,000 deaths in this group.
The researchers compared the people with type 1 diabetes to people without the chronic disease. Researchers used a large national registry to find and analyze these patients.
The investigators found that men with type 1 diabetes had an average life expectancy of about 66 years, compared with 77 years among men without it. Women with type 1 diabetes had an average life expectancy of about 68 years, compared with 81 years for those without the disease, the study found.
Heart disease accounted for the most lost life expectancy among type 1 diabetics, affecting 36 percent of men and 31 percent of women. Diabetes damages the heart and blood vessels in many ways, mainly by promoting high blood pressure and hardening of the arteries, Colhoun said.
However, those younger than 50 appeared to die most often from diabetes management complications.
In men, about 29 percent of life expectancy lost for people under 50 was due to diabetes management-related complications like diabetic coma or ketoacidosis, a condition in which the body suffers from high levels of poisonous acids called ketones. These ketones are created when the body burns fat for energy, because low insulin levels are preventing the conversion of blood sugar into fuel. In women under 50, that number was 22 percent, according to the study.
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