How Does Type 1 Diabetes Affect Life Expectancy?

From everydayhealth.com

Type 1 diabetes can take years off your life. Reduced life expectancy is one of the condition’s most frightening complications.

But there is reason for optimism. Although studies have suggested that type 1 diabetes has historically shortened lives by a decade or more, recent improvements in diabetes management may be leading to consistently better outcomes in people living with the condition today.

Type 1 Diabetes and Life Expectancy

“It can be very difficult to accurately estimate life expectancy relating to type 1 diabetes, as management of the condition is changing all the time,” says Verity Colder, MBChB, a senior clinical adviser at Diabetes UK.

Several studies in the past decade have found that people with type 1 diabetes die about 10 to 12 years earlier than their peers without diabetes. But that life expectancy is probably going up all the time, says Dr. Colder.

“We know that living with type 1 diabetes can reduce life expectancy," Colder says. "However, recent research shows it has been improving since the 1990s, with the number of deaths due to type 1 diabetes in older people decreasing by 25 percent. This is likely because of improvements in treatment and care over the past 30-plus years.”

Historical data on type 1 diabetes and life expectancy may be of limited relevance to patients today, because the treatment of the condition has improved so much over the decades. For most of the 20th century, insulin dosing was imprecise, and blood sugar measurement was rare, leading most people to regularly encounter severe problems with hypoglycaemia and hyperglycaemia. Doctors typically did not tell their patients to target normal blood sugar levels.

A lot has changed since then. Today, you can measure blood sugar at home with relative ease, reducing the risk of very high and low blood sugar events and allowing for enhanced accuracy in insulin dosing. Modern insulins are more reliable and make it easier to exercise and eat normally. The newest insulin pumps can integrate with continuous glucose monitors to automatically adjust insulin delivery rates throughout the day. Perhaps as a result of these care advancements, type 1 diabetes mortality has declined in a number of countries.

“We anticipate that with continued changes to management … and research into new treatments to delay or prevent type 1 diabetes altogether, this will only continue to improve in the future,” Colder says. 

It’s important to note, however, that life expectancy can vary widely across different communities. Early deaths from type 1 diabetes are far more common in low-income nations, and in the United States, Black and Hispanic Americans have higher A1C levels and more dangerous outcomes than their white peers.

“This also varies significantly around the world depending on the healthcare system and the relative income level of the country, as well as access to technology and innovative treatments,” says Colder.

Causes of Early Death in Type 1 Diabetes

Broadly speaking, type 1 diabetes harms health in two ways: high blood sugar and low blood sugar. Unhealthy blood sugar levels can cause fatal situations to develop slowly over a period of years or decades, or quickly, within minutes.

Hyperglycaemia: Long-Term Risks

Hyperglycemia (high blood sugar) is the root cause of most of the long-term complications of diabetes and is the most significant contributor to reduced life expectancy. Persistently high blood sugars harm the heart and blood vessels, the nerves, vital organs such as the kidneys, and many other parts of the body.

Cardiovascular disease is the leading cause of death in people with type 1 diabetes. While many adults without diabetes eventually die of cardiovascular disease (heart disease is the most common cause of death in the United States), people with type 1 diabetes usually experience heart disease about one decade earlier. The higher your blood sugar levels are above normal, as measured by A1C, the greater your risk of early death from cardiovascular disease.

Kidney disease is a second major cause of early death in people with type 1 diabetes. The development of kidney problems is a direct consequence of hyperglycaemia; elevated blood sugar levels are the strongest predictor of chronic kidney disease in people with type 1 diabetes.

Hyperglycaemia: Short-Term Risks

In the short term, the chief danger of high blood sugars is the development of diabetic ketoacidosis (DKA). In DKA, a critical lack of insulin causes the blood to become acidic and toxic. If not treated at a hospital, it can be deadly. Many people are only diagnosed with type 1 diabetes after developing DKA.

This dangerous condition is less likely to occur in people who have already been prescribed insulin. Nevertheless, DKA remains a significant risk for people with long-standing type 1 diabetes. The condition, which ultimately always stems from an insufficient amount of insulin, can also be precipitated by rationing or skipping insulin doses, dehydrating illnesses (such as the stomach flu), heart attacks, and insulin delivery malfunctions (such as insulin pump tubing problems).

Hypoglycaemia

Hypoglycemia (low blood sugar), an omnipresent risk in people who use insulin, can cause death quickly. Severe low blood sugar levels can cause people to pass out, sometimes leading to coma or death. Hypoglycaemia can also precipitate death indirectly by causing car crashes, drowning, falls, and other accidents. Repeated bouts of hypoglycaemia also lead to a condition called “hypoglycaemia unawareness,” in which people fail to experience the usual symptoms and warning signs of low blood sugar, increasing the risk. Guarding against severe low blood sugars is one of the most important lessons to learn about life with type 1 diabetes.

Historical data has suggested that as many as 4 to 10 percent of patients with type 1 diabetes have died during hypoglycaemic episodes. But it’s possible that the rate of death has improved significantly in recent years. The development of the continuous glucose monitor (CGM), in particular, has given many people the ability to track their blood sugar levels continuously, reducing the likelihood of being surprised by severe hypoglycaemia. CGMs can sound alarms when glucose levels are trending down toward dangerous territory, alerting users of the need to intervene.

Enhancing Life Expectancy

Good diabetes management can add years to your life. Glycaemic control and the avoidance of chronic high blood sugar levels are the keys to reducing your risk factors for early death from type 1 diabetes. Blood sugar stability also makes sudden death from hypoglycaemia or DKA less likely.

Colder encourages people with type 1 diabetes to take advantage of every tool they have access to in order to achieve optimal blood sugar control.

“People [should] access technology that they are eligible for, such as continuous glucose monitors and insulin pumps, as this can reduce the daily burden of living with type 1 diabetes and improve longer-term blood glucose management,” Colder says. 

Of course, glycaemic control is not the only factor determining longevity. Luck and genetics play a big role. An analysis of long-lived adults with type 1 diabetes found that they tended to have the following additional modifiable factors in common.

• High levels of HDL-cholesterol (“good cholesterol”)
• Low insulin resistance, indicated by low daily insulin requirements
• Healthy weight 
• Non-smoking status

Regular communication with your medical team is also important for guarding your long-term health. “We would encourage people to attend their routine review appointments with their healthcare practitioners to pick up any signs of developing complications early,” Colder says.

The Takeaway

• The complications of high and low blood sugar levels, including kidney and cardiovascular diseases, increase the risk of early death for people with type 1 diabetes.
• Breakthroughs in medication and technology are expanding the lifespans of people with type 1 diabetes beyond historical expectations.
• Good glucose control and healthy lifestyle choices may increase the life expectancy of people with type 1 diabetes.

https://www.everydayhealth.com/diabetes/how-type-1-diabetes-affects-life-expectancy/