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 While the news may be disheartening for people with type 1 diabetes,
the study’s senior researcher said the new results are more
encouraging than previous estimates that found larger gaps in life
expectancies.
An important message is that the difference in life expectancy is
narrowing, said Dr. Helen Colhoun of the University of Dundee School
of Medicine in Scotland.
“It’s not zero,” she said. “The goal is to get it to zero.”
Among people with type 1 diabetes, formerly known as juvenile
diabetes, the body’s immune system destroys insulin-producing cells
in the pancreas. Insulin removes sugar from the bloodstream so it
can be used for energy.
Instead, those people need to inject insulin and pay special
attention to their blood sugar – or glucose – levels. Untreated,
type 1 diabetes can lead to heart, blood vessel, kidney, eye, and
nerve damage.
About 29.1 million Americans have diabetes, according to the Centers
for Disease Control and Prevention. About 5 percent of those have
type 1 diabetes.
The researchers write in JAMA that according to earlier data from
the U.K., people there with type 1 diabetes died an average of 15 to
20 years earlier than nondiabetics. A 1970s report put the decrease
in life expectancy at 27 years for type 1 diabetics in the U.S., and
a 1980s report from New Zealand put it at 16.5 years.
“They’re mostly very old,” Colhoun said of the estimates. She said
the correct information is important, because it shows how far care
for type 1 diabetes has come.
For the new study, the researchers used national data from Scotland
on 24,691 people diagnosed with type 1 diabetes from 2008 to 2010.
From that data, they estimated that men with type 1 diabetes would
live about 11 fewer years than men without the condition. Women with
type 1 diabetes would live about 13 fewer years than those without
the condition.
At age 20, for example, people with type 1 diabetes could expect to
live, on average, to age 66 (for men) or 68 (for women). Those
without type 1 diabetes, however, would on average live to ages 77
(for men) or 81 (for women).
Even among people with type 1 diabetes and preserved kidney
function, who presumably took care of themselves, there was still
about an eight year gap in life expectancy, the researchers found.
“It’s important to stress that these are averages,” said Colhoun.
“Some people with type 1 diabetes will achieve a very long life
expectancy and some people will have a short life expectancy. These
are estimates.”
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Overall, the largest contributer to loss of life expectancy was
heart disease. People who died younger than age 50 were more likely
to die of more short-lived problems, however. Those include diabetic
comas and ketoacidosis, which is when the body begins to break down
fat and starts producing toxic acids.
Colhoun said the new results emphasize the need for people with type
1 diabetes to have tight control of their blood sugar levels.
Additionally, they should control their risk factors for heart
disease.
“For type 1 diabetes, the key thing is really glycemic control,
because it in turn determines your kidney health – for example –
which in turn has a big impact on cardiovascular health,” she said.
In a second study in the same journal, researchers compared 711
people who maintained tight control over their blood sugar levels
for seven years, with 730 people who did not maintain rigorous
control over their sugar levels.
Overall, people who maintained tight control over their blood sugar
were less likely to die over 27 years, compared to those who did
not.
“It provides optimism that while we don’t have a way to cure
diabetes, at least we have a way to preserve health and the futures
of people with type 1 diabetes,” said Dr. Lori Laffel of the Joslin
Diabetes Center in Boston.
As for the paper from Scotland, Laffel, who co-authored an editorial
accompanying the new studies, said it shows how much better life
expectancy is, compared to previous estimates.
There's ongoing research to implement current tools and future
advances to narrow the gap to zero, she said.
SOURCES: http://bit.ly/1wk4CyH,
http://bit.ly/1wk4C1x and http://bit.ly/1wk4GhY JAMA, online January
6, 2015.
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