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Featured Clinical Reviews

January 6, 2015

Mortality in Type 1 Diabetes in the Current Era: Two Steps Forward, One Step Backward

Author Affiliations
  • 1Young Adult Diabetes and Section of Genetics and Epidemiology, Joslin Diabetes Center, Boston, Massachusetts
  • 2Pediatric Endocrinology Unit, Massachusetts General Hospital for Children, Boston, Massachusetts
  • 3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
JAMA. 2015;313(1):35-36. doi:10.1001/jama.2014.16327

In the preinsulin era, survival following the diagnosis of type 1 diabetes was dismal; 50% of patients died within the first 20 months of diagnosis and fewer than 10% survived 5 years.1 The introduction of insulin therapy in 1922 significantly changed survival as mortality from diabetic ketoacidosis (DKA) decreased substantially. However, in the middle of the 20th century, there was still a 20-year reduction in life expectancy for those diagnosed with type 1 diabetes; 50% of individuals with youth-onset disease failed to reach the age of 55 years.2 A half century later, in the current era, intensive insulin therapy has become the standard of care and advances in insulin delivery and glucose monitoring assist in the management of type 1 diabetes.3 Yet glycemic control remains suboptimal for the majority of patients with type 1 diabetes,4 and acute and chronic diabetes complications persist, reducing life expectancy for many patients.

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