FUDiabetes

Diabetes, young adults and alcohol: early death statistics

I am still searching :slight_smile: But I did find this link on FUD, which is not exactly what we discussed earlier:

The MRR (Mortality Rate ratio) indicates how much mortality is seen in the population in question compared to the average. So, for instance for diabetic men treated with insulin, there were 692% deaths than for non-diabetic men per unit of population compared to 100% for a normal population unit.

So, in summary, what they saw was approximatively:

  • 600% more deaths due to alcohol among insulin-dependent diabetic males (compared to normal population unit)
  • 900% more deaths due to alcohol among insulin-dependent diabetic females
  • 100% more accidental deaths among insulin-dependent diabetic males
  • 50% more accidental deaths among insulin-dependent diabetic females
  • 100% more suicide deaths among insulin-dependent diabetic males

This info is for the full insulin-dependent population, not only for young adults, though (and it includes insulin-dependent T2s). The numbers on alcohol and suicide deaths are extraordinarily high.

3 Likes

Here are some other studies related to diabetes and alcohol, though maybe not exactly what you’re looking for:
https://www.bmj.com/content/343/bmj.d5364
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2001.00802.x

3 Likes

@Boerenkool, great studies. The second one is particularly focused on younger people due to its population selection. Some excerpts:

Increased mortality in diabetes during the first 10 years of the disease. A population‐based study (DISS) in Swedish adults 15–34 years old at diagnosis.
Fifty‐eight patients died, corresponding to an SMR of 3.5 (CI=2.7–4.5), which increased from 1.5 at 15–19 years to 4.1 at 30–34 years. […] Evidence of alcohol or drug misuse, mental dysfunction or suicide was found in 40 of all 58 deceased cases. Less often, hypoglycaemia ( n =7) or hyperglycaemia‐ketoacidosis ( n =11) was present at death. Unexplained ‘dead in bed’ was found once.
Conclusions. In the investigated population‐based cohort the early mortality was about threefold increased. Hypoglycaemia and ketoacidosis per se played a relatively small role compared with a heavy impact from social and mental dysfunction, and from careless use of alcohol or drugs.

This study, then, looks at PWDs who were 15-34 at diagnosis and follows them for 10 years.

Their findings:

  • Mortality for this cohort is 3.5 times higher than an average cohort
  • Alcohol abuse appears to be a significant cause of death for 19 of the 58 deaths (“According to the clinical records […] acute alcohol intoxication and/or chronic abuse had been of importance in […] 19 cases”) but with a contributive cause in more than that.
  • Depression was the cause for 8 deaths (Table 4) of 58, and may have been involved in 8 others (drug deaths, also Table 4), since drug use is one of the possible complications of depression. In addition, some of the alcohol deaths may also have been linked to depression
  • Deaths from diabetes-related causes were surprisingly low, considering: 7 (or 8 depending upon interpretation) linked to hypoglycemia, and 11 linked to DKA—but you have to be careful of that number, because these do not appear independent from the ones listed above (alcohol for instance).

Another fact I noted—when you look at the specific stats for T1Ds in the tables, the mortality is totally skewed to the 18-34 age groups, and much lower afterwards: 24 deaths between 18-34, and 2 between 35-41. It peaks sharply between 25-29 (11 deaths).

3 Likes

Which is often when mental illness catches up with you.

1 Like

I don’t think it is possible that 600% more diabetics are alcoholics than normal. A good part of them must be dying of hypo after drinking.

1 Like

In fact, diabetics using oral drugs (T2s) only die at 1.71 rate:

So T2 male diabetics not using insulin die at 171% rate of normal, but male diabetics using insulin die at 692% rate of normal. So the difference must be alcoholic hypos (or mostly). That’s bad.

1 Like

It’s not saying anything about whether they are alcoholics or not. It’s saying that alcohol-related deaths are about 7x more common, but could be from a single episode of binge-drinking.

What’s worth pointing out though is that these type of stats (logistic regression results, which come in the form of odds-ratios like those presented) often make findings sound WAY more dramatic than they are—for example, “X increases risk for Y by 700%” seems like a huge deal, but is entirely dependent on what the initial base rate of the risk is as far as to the practical implications. 7x a small number remains a fairly small number (and if initial rate is very small, it takes a lot to move it out of that range). So while it does suggest diabetes increases risk for alcohol-related deaths (which I think should probably surprise no one), it is not necessarily saying this is a particularly high risk for diabetics.

4 Likes

I know. What I am saying is that it would be very unlikely that they would be alcoholics. Therefore, that increase must be mostly due to hypos after drinking, mostly for non-alcoholic drinkers. Since the T2s on oral meds die at 1.71 rate without hypos, it is not super likely that Ds on insulin die at much higher rate just due to alcoholism. So the major part of the difference must be due to the insulin: hypos when drinking.

I get it. That makes sense.

1 Like

I don’t think you can assume that either though—I’ve definitely seen alcoholics with diabetes in the rehab settings I’ve worked in. Typically not well controlled diabetes, but there’s nothing about diabetes that prevents alcoholism.

I do suspect that you are correct that the deaths are due to hypos, but mostly because direct deaths from alcoholism tend to happen at older ages. It takes a while to kill you.

2 Likes

I think this falls squarely into the sort of. First, I think that cardamom is correct that the overall number is quite low, although the increased incidence of death due to alcohol is concerning.

I think that one factor that isn’t being viewed is that people with diabetes are probably more susceptible to depression and that can lead to drinking, which when done as a Type 1 can clearly lead to problems.

5 Likes

Yes. But why would there be 600% more alcoholics with diabetes and insulin, when there are only, at the most, 171% T2 on oral meds who are alcoholics? The point is that it is very unlikely that there that many MORE alcoholics among Ds with insulin. So the difference in the death rate must come from hypos due to alcohol.

I am just looking at the math there. In order for the difference not to be due to alcohol hypos, you would need to have alcoholism rate 692% higher for Ds who use insulin. But T2s on oral meds, at most, are 171% more often alcoholics.

edit: OK, I read your edited post now, cool, makes sense.

2 Likes

Agreed, but the difference is a Type 2 is unlikely to die from a single drinking event, where a Type 1 only needs one event handled poorly to end up dead. I think you guys are in violent agreement.

4 Likes

Great to see you having time to be on the forums @Kaelan, now for the more difficult question.

What do you think could be done to prevent those deaths?

3 Likes

None of the alcohol-related deaths at young ages are likely to be direct effects of alcoholism. Much more likely to be effects of binge-drinking/risky behavior, which is why it’s scarier, because everyone who drinks even sporadically is potentially at risk if not careful. I’m not sure if they include alcohol-influenced driving related deaths in that number, but I’d assume otherwise the death rate is mostly due to acute intoxication/alcohol poisoning and aspiration of vomit for non-diabetics.

4 Likes

@Chris, I did not answer right away because I wanted to think about it. But, honestly, I don’t know at all. My parents let me drink a bit of wine or beer with dinner, or sangria. But I don’t have any experience to use so I can answer. If I came out with something it would probably sound stupid :black_circle:

1 Like

I don’t take any offence at the lag in answering, it is a complicated subject. I am not sure either, in the past our society has tried to use shame to control people, but in the current internet age that is not an effective tool. So it will likely have to be something else. I honestly don’t have an idea either.

1 Like