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Mortality Trends in a Population-based Type 1 Diabetes Cohort

Secrest, Aaron Michael (2010) Mortality Trends in a Population-based Type 1 Diabetes Cohort. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Individuals with type 1 diabetes (T1D) have significantly higher mortality rates than their peers in the general population. Major advances in the management of T1D occurred during the 1980s and 1990s, but recent data on their long-term effects on overall and cause-specific mortality are limited, especially in the United States. A phenomenon, known as dead-in-bed syndrome, is of particular concern as it occurs in young, healthy T1D individuals who are unexpectedly found dead in bed. Using follow-up data from a large population-based cohort, this dissertation provides contemporary mortality rates in persons with long-standing T1D. Cause-specific mortality is also explored, focusing on how mortality rates from major causes compare to the general population and on characterizing T1D deaths that meet the criteria for dead-in-bed syndrome. Overall, the mortality of individuals with T1D is seven times higher than seen in the general population. T1D individuals diagnosed more recently have significantly lower mortality rates than those diagnosed earlier, even after controlling for age. The greatest improvements in mortality have occurred in deaths from diabetes-related causes (diabetic coma, renal disease, cardiovascular disease, or infection), suggesting long-term benefits to improved T1D care. In a pattern quite contrary to what is seen in the general population, females with T1D have a higher mortality than males with T1D, especially from diabetes-related causes. While African-Americans with T1D have much higher mortality rates than T1D Caucasians in this cohort, this racial difference was similar to that seen in the general population. Finally, dead-in-bed syndrome in this population appears associated with male sex, low BMI, and disturbed metabolic control (high HbA1c, high daily insulin dose, and a history of severe hypoglycemia). The public health implications of this dissertation are considerable, as it provides insight into the causes of premature mortality in T1D, permitting the development of more effective and targeted preventative strategies. These findings also have the potential to change routine care practices to address disparities by race and sex in T1D mortality, and resolve disparities in health and life insurance provisions, since antiquated T1D mortality estimates are currently used, which do not account for recent advances in T1D treatments.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Secrest, Aaron Michaelams134@pitt.eduAMS134
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairOrchard, Trevor Jorchardt@edc.pitt.eduTJO
Committee MemberBecker, Dorothy Jdorothy.becker@chp.eduDJB18
Committee MemberLaPorte, Ronald Eronaldlaporte@gmail.com
Committee MemberKelsey, Sheryl Fkelsey@edc.pitt.eduKELSEYS
Date: 29 September 2010
Date Type: Completion
Defense Date: 25 May 2010
Approval Date: 29 September 2010
Submission Date: 18 May 2010
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: all-cause mortality; Allegheny County; cause-specific mortality; insulin-dependent diabetes mellitus; Pittsburgh; dead-in-bed syndrome; diabetes mellitus; survival; juvenile-onset diabetes
Other ID: http://etd.library.pitt.edu/ETD/available/etd-05182010-121323/, etd-05182010-121323
Date Deposited: 10 Nov 2011 19:45
Last Modified: 19 Dec 2016 14:36
URI: http://d-scholarship.pitt.edu/id/eprint/7909

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