Britons With Type 1 Diabetes Die Nearly 8 Years Earlier

The average British adult with type 1 diabetes loses about eight life-years compared with nondiabetic age peers, according to a modeling study.

Drawing upon national data from the U.K., the "average" person with type 1 diabetes -- age about 43 -- could expect to live 32.6 more years, reported Adrian Heald, MD, of Salford Royal Hospital in England, and colleagues.

That's against an expectancy of 40.2 additional life years for an average 43-year-old without diabetes, the group reported in Cardiovascular Endocrinology & Metabolism and simultaneously at the virtual European Association for the Study of Diabetes 2020 meeting.

The extent of life-years lost also differed among the sexes. Specifically, women with type 1 diabetes lost about 8.5 years of life-expectancy versus a nondiabetic female; in men the figure was about 7 years.

People with type 2 diabetes also had shorter life expectancy, albeit by less than those with type 1 diabetes.

The "average" person with type 2 diabetes -- age 65 -- can expect 18.6 years of additional life, versus 20.3 years for an equivalent population free of diabetes. These life years lost were similarly mediated by sex, as females with type 2 diabetes saw about a 2-year shorter lifespan while males saw a 1.4-year shorter lifespan.

In an interview with MedPage Today, Heald noted that although it's already known that diabetes shortens life expectancy, his group was surprised at the degree found in type 1 diabetes, particularly given the effort that goes into managing type 1 diabetes from both patients and healthcare professionals alike.

The fact that women weren't spared the shortened life expectancy with diabetes also came as a surprise.

"We knew that some of the biological advantages of being a woman is extinguished by diabetes, but we were quite surprised by how much," Heald noted.

Not surprisingly, hyperglycemia was one factor tied to a shorter lifespan in both types of diabetes. Living one year with HbA1c above 7.5% (58 mmol/mol) was equivalent to losing about 100 life-days.

"As we know, having an HbA1c above target is not a good thing in terms of complications, in terms of potential impact on future disability in regard to strokes and myocardial infarctions, amputations," Heald explained. "If patients are able to achieve target with their blood glucose consistently over time, on average they will have a longer life."

Heald recommended that healthcare providers frame the diminished life expectancy in terms of life-days -- not years -- when educating patients on the importance of glucose targets.

"It's actually something people can relate to, it's tangible to them," Heald said.

Such discussions can also be helpful in implementing broader strategies for patients in managing their disease. These may include adding new agents to a regimen, getting regular checkups, monitoring blood glucose, bolstering adherence to medication, maintaining a healthy lifestyle, and increasing awareness of the importance of achieving target glucose levels.

For the modeling study, the researchers pulled actual mortality rates and projected life expectancies from the Office for National Statistics in Britain for the years 2015-2017, along with mortality rates for people with diabetes from the 2015-2016 National Diabetes Audit (NDA).

Out of the 161,871 individuals with type 1 diabetes and 1,620,784 individuals with type 2 diabetes appearing in the NDA, there were 57,814 deaths in 2015. This equated to a 32.1% higher mortality rate during that year versus people free of diabetes.

Heald pointed out these aren't exact numbers since individual patient data weren't available, but rather modelling estimates.

Previous analyses from the same group found a £3 billion (about $3.8 billion) higher cost for hospital services for people with type 1 and type 2 diabetes versus patients without diabetes in England. And more specifically, type 1 diabetes had a roughly tripled hospital cost impact relative to type 2 diabetes.

"The next stage of this work is we are going to have access to a subset of the England outcome data at a general practice level for diabetes using the Royal College of General Practitioners database," Heald explained. The group plans to look at the intersect of diabetes management across various general practices -- determinants ranging from the types of medications prescribed, access to patient programs, population data, number of patients on target, and more -- and how these factors influence HbA1c and mortality rates over a 5- to 7-year period.

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