Mortality and diabetes from a population based register in Yorkshire 1978-93

Objective—To investigate mortality of children diagnosed with insulin dependent diabetes mellitus (IDDM) and to identify common factors before death. Design—Follow up of a population based cohort of children diagnosed with IDDM to ascertain deaths. Setting—Children were diagnosed in Yorkshire but followed up throughout the United Kingdom. Subjects—From the Yorkshire Children’s Diabetes Register details of 1854 children aged 0‐16 years (1978‐93) were submitted to the NHS Central Register. Main outcome measure—Notification and causes of death. Results—98.3% of cases were traced and 26 deaths identified. Follow up ranged from 1‐18 years (median 9.3 years), providing 17 350 person-years of IDDM. Fifteen deaths (58%) were attributed to diabetes or its complications; 11 (42%) were unrelated and included one suicide. For mortality from all causes, the standardised mortality ratio (SMR) of 247 (95% confidence interval (CI) 163 to 362) was significantly increased for those under 34 years. The largest number of deaths (n = 10) occurred in the 15‐19 year age range, with an SMR of 442 (95% CI 209 to 802). Case note examination showed a clear tendency towards poor diabetic control, and worries over control were expressed before death by health care professionals. Conclusions—Despite advances in treatment, IDDM still carries an increased mortality for young people,particularly in the “transition” age range. (Arch Dis Child 1998;78:435‐438)