P-100: Type 1 diabetes and the mortality gap: sex differences and temporal trends from a large-scale matched cohort study
O Pinhas-Hamiel, V Shiraz, N Levek, N Levran, L Lev-Shalem, G Twig, A VinogradAbstract
Introduction
Individuals with type 1 diabetes (T1D) face an elevated risk of premature mortality. Technological advances enhancing glycemic control in T1D have emerged over the past two decades, warranting an updated assessment of mortality rates in a more contemporary cohort.
Objectives
This study aimed to assess the risk of all-cause mortality among individuals with T1D diagnosed after 2000, compared with matched controls, using a large validated cohort.
Methods
We included all T1D Registry cases diagnosed before age 35 between 2000 and 2022 within the second-largest national healthcare provider. Propensity score matching (1:4) by sex and birth year was used to construct a diabetes-free comparison cohort. Follow-up continued until 2023, death, or transfer, whichever occurred first. Kaplan-Meier analysis, adjusted Cox proportional hazards models, and sensitivity analyses were performed.
Results
The study comprised 4,299 individuals with T1D and 17,196 matched controls (45.6% female; mean age at diagnosis 17.4±9.1 years). During follow-up of 204,102 person-years, 112 deaths occurred, with incidence rates of 131.0 and 43.3 per 105 person-years, among individuals with and without T1D, respectively. T1D was associated with higher risk of mortality with an HR of 3.66 (95%CI, 2.53-5.31), that remained consistent after adjustment and when analyses were limited to individuals without pre-existing comorbidities and with a stricter type 1 diabetes definition. Relative to controls, females with type 1 diabetes exhibited higher mortality risk (aHR=8.57; 95%CI, 3.78-19.44) than males (aHR=2.88; 95%CI, 1.77-4.69); P-interaction=0.02. Individuals diagnosed earlier (2000-2010) had higher mortality risk (aHR=4.30; 95%CI, 1.20-15.43) than those diagnosed later (2011 and 2022) (aHR=2.92; 95%CI, 1.30-6.55), relative to period-matched controls.
Conclusions
Type 1 diabetes was associated with higher risk of mortality, particularly among females. This association was attenuated among individuals diagnosed in more recent years.