# T1 mortality rates

**URL:** <https://forum.fudiabetes.org/t/t1-mortality-rates/224>\
**Category:** T1 Research\
**Tags:** complications, statistics, diabetes-deaths\
**Created:** [March 27, 2017, 5:27pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224 "2017-03-27T17:27:37Z")\
**Posts on this page:** 20\
**Page:** 1

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**Author:** ![britt\_j](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/britt_j/32/55_2.png) [@britt\_j](https://forum.fudiabetes.org/u/britt_j)\
**Post date:** [March 27, 2017, 5:27pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/1 "2017-03-27T17:27:37Z")

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I’m currently on my phablet, so it makes editing and providing citations a bit difficult. I’ll provide some counterpoints as time allows throughout the day.

Let’s start w/ “Myth: As far as diseases go, Diabetes isn’t that serious!”

Nobody dies of well-managed diabetes.

One might die from diabetic complications – but not from diabetes per se. (Ex: Autonomic dysfunction compounded by overinsulination might lead to dead-in-bed syndrome or an amputation might lead to sepsis…)

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**Author:** ![docslotnick](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/docslotnick/32/75_2.png) [@docslotnick](https://forum.fudiabetes.org/u/docslotnick)\
**Post date:** [March 27, 2017, 7:40pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/2 "2017-03-27T19:40:32Z")

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> [@Myths surrounding Diabetes](https://forum.fudiabetes.org/t/myths-surrounding-diabetes/151/16):
>
> Nobody dies of well-managed diabetes

It may have been about 90 years ago, but my grandfather was said to have died from diabetes at age 28. Of course it was under insulination, because insulin was not yet available!

I know, I know…it was certainly not well managed😉

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**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [March 27, 2017, 8:08pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/3 "2017-03-27T20:08:33Z")

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> [@Myths surrounding Diabetes](https://forum.fudiabetes.org/t/myths-surrounding-diabetes/151/16):
>
> Nobody dies of well-managed diabetes.

The conclusion of several recent studies, though, is that **5 to 10% of diabetics** (gasp) die of hypoglycemia **before age 40**. To me, that is a shocking number.

EDIT: I was wrong in writing “of hypoglycemia.” It is for all reasons combined. And, as @britt_j mentions below, the data is starting to be dated.

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**Author:** ![britt\_j](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/britt_j/32/55_2.png) [@britt\_j](https://forum.fudiabetes.org/u/britt_j)\
**Post date:** [March 27, 2017, 9:57pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/4 "2017-03-27T21:57:08Z")

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@Michel –

That number seems a bit high… Citation(s), please?\*

_Please note that I’m not doubting you. I specifically noted dead-in-bed syndrome._

Tragically, when I see the blue candle, I invariably see a child/YA w/ a history of roller-coaster numbers – very high variability w/ moderate to severe hypoglycemia.

Since I don’t wish to appear unsympathetic, I will share a bit… I live alone most of the time and I have autonomic neuropathy – including central sleep apnea, hypo unawareness and cardiac neuropathy. (Why? Living on the roller-coaster w/ bad genes.)

At this point in time, I can’t do anything about my genes. But, I _can_ control my variability. As Dr. Bernstein says, “Big inputs make big mistakes; small inputs make small mistakes.”

Please note that I’m also not saying that all diabetics should eat 6-12-12. I don’t. You’ve seen how I’ve tweaked Dr. Bernstein’s rules. I’m not even suggesting that kids/YAs should eat low carb. What I suggest is that we focus on keeping glycemic variability as low as possible.

I’d also suggest that if a PWD wishes to enjoy (non-low carb versions) pizza, cake, cookies, etc. experiments, they plan for it. Time it earlier in the day and bolus accordingly. Test frequently, apply corrections liberally and don’t overtreat hypos. I’d also suggest following such an experiment w/ lower carb meals, snacks and dessert for the remainder of the day. (Tacos made w/ a parm frico shell, buffalo wings, almond shortbread cookies, etc.)

ETA:  
[  
“Sudden nocturnal deaths also known as “dead in bed” syndrome has been attributed to nocturnal hypoglycemia, which account for 5%-6% of all deaths among young people with type 1 diabetes.”](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784865/#ref33)

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**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [March 27, 2017, 10:37pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/5 "2017-03-27T22:37:07Z")

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> [@Myths surrounding Diabetes](https://forum.fudiabetes.org/t/myths-surrounding-diabetes/151/16):
>
> Nobody dies of well-managed diabetes.

I am on the road but will post your ref when home. I just read my 2-liner above btw- I sounded like a certain person who advised you on friendships:( I’ll have to be more careful when I write quickly 🙂

I have a hard time quoting on my phone too. I wanted to reference your list of personal challenges. Britt, you are quite amazing! I hope my son shows as much spunk as you do!

This forum gives me daily lessons in humility.

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**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\
**Post date:** [March 27, 2017, 11:07pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/6 "2017-03-27T23:07:23Z")

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> [@Myths surrounding Diabetes](https://forum.fudiabetes.org/t/myths-surrounding-diabetes/151/22):
>
> This forum gives me daily lessons in humility

Humility? Yep, you’ve come to the right place! Ha!  
JK  
😄

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**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [March 28, 2017, 12:03am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/7 "2017-03-28T00:03:30Z")

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> [@Myths surrounding Diabetes](https://forum.fudiabetes.org/t/myths-surrounding-diabetes/151/22):
>
> I am on the road but will post your ref when home.

OK, as usual I can’t quite find just the studies I wanted in the limited amount of time I have btw meetings, but this is close:

- from NIH, Diabetes in America, 1995, Chapter 10 (you can download the PDF here): [https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/Pages/diabetes-america-2nd-edition.aspx](https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/Pages/diabetes-america-2nd-edition.aspx)  
“Mortality rates among IDDM patients remain high. For childhood-onset cases, data suggest that \>15% will die by age 40 years, at which time the annual mortality will be 20 times that seen in the general population.”

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<div class="post-metadata">

**Author:** ![britt\_j](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/britt_j/32/55_2.png) [@britt\_j](https://forum.fudiabetes.org/u/britt_j)\
**Post date:** [March 28, 2017, 12:17am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/8 "2017-03-28T00:17:40Z")

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@Michel, @ClaudnDaye and other parents of children w/ diabetes –

First, hats off to all parents of children with diabetes. Seriously. IMO, living with it is much easier than loving someone who has it.

Taken w/o context, the PDF posted by Michel is positively frightening. So, I’d like to put things in perspective. The stats we see about early mortality are driven by data that is decades old. Even newer data is driven by PWDs w/ high glycemic variability.

_We now have better meters, faster insulin and the ability to analyze our own data. Via forums like this, we’re becoming informed. Knowledge truly is power._

@Michel –

“This forum gives me daily lessons in humility.” – I think living with any chronic condition will do that.

Thanks for the fix.

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**Author:** ![docslotnick](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/docslotnick/32/75_2.png) [@docslotnick](https://forum.fudiabetes.org/u/docslotnick)\
**Post date:** [March 28, 2017, 1:01am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/9 "2017-03-28T01:01:37Z")

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> [@Myths surrounding Diabetes](https://forum.fudiabetes.org/t/myths-surrounding-diabetes/151/25):
>
> We now have better meters, faster insulin and the ability to analyze our own data. Via forums like this, we’re becoming informed. Knowledge truly is power.

Amen to that. I often cite my grandfather, from whom I inherited diabetes within two generations, and the state of treatment at the time he was diagnosed. He died in a few years because _there was no insulin yet available_.

When I was diagnosed there were inferior insulins and no means to monitor glucose at home. I was told I would probably be dead in less than thirty years.

Fast forward a generation and we have fast insulins, continuous meters, data management and analysis at our fingertips, and unlimited support. In such a short period of time I’ve been given the opportunity to live a long and healthy life, despite only having had the tools for good control for the last twenty five years.

When I look at my situation through the lens of a hundred years of history, I can’t believe how truly lucky I am.

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**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [March 28, 2017, 2:24am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/10 "2017-03-28T02:24:13Z")

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> [@Myths surrounding Diabetes](https://forum.fudiabetes.org/t/myths-surrounding-diabetes/151/25):
>
> The stats we see about early mortality are driven by data that is decades old. Even newer data is driven by PWDs w/ high glycemic variability.

Totally true.

Here is an interesting set of stats from Finland, where treatment is universal and high quality: [http://www.bmj.com/content/343/bmj.d5364](http://www.bmj.com/content/343/bmj.d5364)

More than likely, death rate in Finland is lower than here - but these are the results for cumulative death rate of early onset T1Ds (in this study, up to the age of 15):  
“In the early onset cohort, the 20 year cumulative mortality in the groups diagnosed in 1970-4, 1975-9, 1980-4, and 1985-9 was 4.7% (3.7% to 5.8%), 4.3% (3.3% to 5.2%), 3.6% (2.8% to 4.5%), and 2.7% (1.9% to 3.4%) … However, the follow-up time of the last group had not yet reached 20 years,” which means that the 2.7% is not valid - but the 3.6% is (for people diagnosed on 1985-1989).

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**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [March 28, 2017, 3:05am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/11 "2017-03-28T03:05:13Z")

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Here is the latest NIH report on diabetes: [https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=120](https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=120)

“For people born between 1975 and 1980, about 3.5 percent die within 20 years of diagnosis, and 7 percent die within 25 years of diagnosis. These death rates are much lower than those of patients born in the 1950s, but are still significantly increased compared to the general population.”

This US number compares to 4.3% for Finland in the same timeframe (see my last post above), but specifically for early onset diagnosis.

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**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\
**Post date:** [March 28, 2017, 4:15am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/12 "2017-03-28T04:15:13Z")

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This doesn’t seem like a happy thread…😟

Be careful with statistics everybody.

For example this one:  
_“For people born between 1975 and 1980, about 3.5 percent die within 20 years of diagnosis, and 7 percent die within 25 years of diagnosis.”_

But there is no causation referenced in that statistic. How many of those that died actually died as a result of the disease, either directly or indirectly? Children die from car accidents, drowning, accidental poisoning, etc. Are those deaths counted in the percentages? A much more useful figure would be a comparison between diabetic and non-diabetic during those time-frames, or at least a number that says how many actually died from the disease.

I am not disputing the numbers, but I just hope they are being read in the correct way.

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**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [March 28, 2017, 6:02am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/13 "2017-03-28T06:02:08Z")

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> [@Eric](#):
>
> But there is no causation referenced in that statistic. How many of those that died actually died as a result of the disease, either directly or indirectly?

There are many papers that discuss SMRs, i.e. standardized mortality rates, which are essentially a way to compare the actual mortality of a cohort vs the expected mortality based on the overall population and the composition of the cohort.

In general, it seems that SMR varies along the life of a T1 (if we talk about T1s), peaking after a certain number of years, then dropping late. In many early parts of the curve, T1D SMR is typically 3-4, which means 3 to 4 times more than what would be expected in the general population.

For instance, in this sample from Sweden diagnosed before 1973, [this study](https://www.ncbi.nlm.nih.gov/pubmed/20500731) found a combined SMR of 3.4 across the whole sample, meaning that this sample of diabetics, all diagnosed before 1973, died 3.4 more often than expected based on general population stats.

This [survey paper](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925303/) identifies multiple sources of SMR data, ranging from 2.0 (average across 12 European countries) to 3.7 in Finland, 4.0 in Norway and 12.9 (?!) in Japan for specific cohorts.

I think, like @britt_j, that participating in this forum, and being aggressive in controlling your A1c, would significantly decrease your chances to die early.

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<div class="post-metadata">

**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [March 28, 2017, 2:58pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/14 "2017-03-28T14:58:46Z")

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> [@docslotnick](#):
>
> When I look at my situation through the lens of a hundred years of history, I can’t believe how truly lucky I am.

I feel the same about my son.

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**Author:** ![John58](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/john58/32/147_2.png) [@John58](https://forum.fudiabetes.org/u/John58)\
**Post date:** [March 30, 2017, 8:47am UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/15 "2017-03-30T08:47:16Z")

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Every person is different physically and mentally. Some are not capable of taking control of diabetes, or their body will not let them control it despite their best efforts. Some are too poor and can’t find help (this disease is expensive!). Those variables can not be accounted for in the clinical studies and cause my eyes to glaze over when I see those statistics.

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**Author:** ![britt\_j](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/britt_j/32/55_2.png) [@britt\_j](https://forum.fudiabetes.org/u/britt_j)\
**Post date:** [May 1, 2017, 11:23pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/16 "2017-05-01T23:23:34Z")

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On a happier note…

[Glycemic Control, Renal Complications, and Current Smoking in Relation to Excess Risk of Mortality in Persons With Type 1 Diabetes; by Elsa Ahlén, MSc et al; Journal of Diabetes Science and Technology; 14 June 2016](http://journals.sagepub.com/doi/abs/10.1177/1932296816652901)

Conclusions: _If currently recommended HbA1c targets can be reached, renal complications and smoking avoided in persons with type 1 diabetes, the excess risk of mortality **will likely converge substantially to that of the general population.** _ 🙂

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<div class="post-metadata">

**Author:** ![Michel](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/michel/32/387_2.png) [@Michel](https://forum.fudiabetes.org/u/Michel)\
**Post date:** [May 1, 2017, 11:34pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/17 "2017-05-01T23:34:03Z")

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> [@britt\_j](#):
>
> If currently recommended HbA1c targets can be reached, renal complications and smoking avoided in persons with type 1 diabetes, the excess risk of mortality will likely converge substantially to that of the general population.

Amazing and wonderfully cheering result!

What they are doing:

- Taking A1c \<=6.9%

- removing everyone with renal complications, e.g. assuming normoalbuminuria and eGFR ≥ 60 ml/min

That’s when they get converging mortality numbers. We know what it takes to get A1c down – that’s what we work on every day. So the next question is – what do we do to avoid renal complications?

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**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\
**Post date:** [May 1, 2017, 11:44pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/18 "2017-05-01T23:44:01Z")

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> [@Michel](#):
>
> So the next question is – what do we do to avoid renal complications?

The most important thing is good BG management.

Then of course, doing the things they recommend for everyone - have a healthy diet, get plenty of water, lower your salt intake, plenty of exercise, good blood pressure, don’t smoke. All that applies to everyone!

And the other thing to do is start using an ACE inhibitor like Lisinopril as a preventative measure. Not sure how old you want to be when you start, but it’s a good thing to do. A low dose is all you would need.

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**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\
**Post date:** [May 1, 2017, 11:50pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/19 "2017-05-01T23:50:13Z")

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Reducing A1C certainly reduces renal complications but I think a large fraction of complication risk is attributable to unknown or unconfirmed factors, and renal complications are tightly related to cardiovascular risk. Basically, it is still a huge puzzle.  
Here are a few interesting articles on that:

> <https://www.ncbi.nlm.nih.gov/pubmed/27995339>
>
> Despite recent findings of increased life expectancy among individuals with type 1 diabetes, mortality remains greatly increased compared to the general population. As this is largely the result of cardiovascular and renal complications, we aimed to review recent findings surrounding these diseases in type 1 diabetes.We reviewed published findings concerning the cardiovascular complications of type 1 diabetes, with a particular focus on links with renal disease.The cardiovascular and renal complications of type 1 diabetes share many features including insulin resistance, oxidative damage, and genetic associations with the Haptoglobin genotype, and both are strongly affected by glycemic control.Although current knowledge on predictors of type 1 diabetes cardiovascular and renal complications has increased, further investigation is required to understand the mechanisms leading to cardio-renal complications in this population.

> <https://www.ncbi.nlm.nih.gov/pubmed/27973749>
>
> Adolescence is a challenging period of life for any young person, and for those with Type 1 diabetes, physiological and psychological factors can result in a deterioration in glycaemic control. In young people with Type 1 diabetes, puberty may be an additional risk factor impacting on the lifetime risk for renal and cardiovascular complications. Our longitudinal studies have identified that increases in urinary albumin excretion through childhood are associated with the development of microalbuminuria and a generalized endotheliopathy linked to cardiovascular risk. Screening of participants recruited to the Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT) confirms that these early changes in albumin excretion are related to both diabetic nephropathy and cardiovascular risk; in part, independent of glycaemic control. Thus, as well as current attempts to improve glycaemic control through enhanced targeted insulin delivery, pumps, sensors and closed loop, we have explored the role of angiotensin-converting enzyme inhibitors and statins in providing cardio-renal protection during adolescence.

> <https://www.ncbi.nlm.nih.gov/pubmed/27872156>
>
> To compare different blood pressure (BP) levels in their association with the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association.We included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT). The exposures of interest were time-updated systolic BP (SBP) and diastolic BP (DBP) categories. Outcomes included macroalbuminuria (\>300 mg/24 h) or stage III chronic kidney disease (CKD) (sustained estimated glomerular filtration rate \<60 mL/min/1.73 m2).During a median follow-up time of 24 years, there were 84 cases of stage III CKD and 169 cases of macroalbuminuria. In adjusted models, SBP in the \<120 mmHg range was associated with a 0.59 times higher risk of macroalbuminuria (95% CI 0.37-0.95) and a 0.32 times higher risk of stage III CKD (95% CI 0.14-0.75) compared with SBPs between 130 and 140 mmHg. DBP in the \<70 mmHg range were associated with a 0.73 times higher risk of macroalbuminuria (95% CI 0.44-1.18) and a 0.47 times higher risk of stage III CKD (95% CI 0.21-1.05) compared with DBPs between 80 and 90 mmHg. No interaction was noted between BP and prior DCCT-assigned glycemic control strategy (all P \> 0.05).A lower BP (\<120/70 mmHg) was associated with a substantially lower risk of adverse renal outcomes, regardless of the prior assigned glycemic control strategy. Interventional trials may be useful to help determine whether the currently recommended BP target of 140/90 mmHg may be too high for optimal renal protection in type 1 diabetes.

> <https://www.ncbi.nlm.nih.gov/pubmed/27797889>
>
> In trials of people with type 2 diabetes, albuminuria reduction with renin-angiotensin system inhibitors is associated with lower risks of cardiovascular events and CKD progression. We tested whether progression or remission of microalbuminuria is associated with cardiovascular and renal risk in a well characterized cohort of type 1 diabetes.We studied 1441 participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study. Albumin excretion rate (AER) was quantified annually or biennially for up to 30 years. For each participant, albuminuria status was defined over time as normoalbuminuria (AER continuously \<30 mg/d), sustained microalbuminuria (AER, 30-299 mg/d on two consecutive visits), macroalbuminuria (AER≥300 mg/d), or remitted microalbuminuria (transition from sustained microalbuminuria to AER\<30 mg/d on two consecutive visits). We tested associations of time-updated albuminuria status with adjudicated clinical cardiovascular events, the development of reduced GFR (\<60 ml/min per 1.73 m2 on two consecutive visits), and subclinical cardiovascular disease.At least one cardiovascular event occurred in 184 participants, and 98 participants developed reduced eGFR. Compared with normoalbuminuria, sustained microalbuminuria, remitted microalbuminuria, and macroalbuminuria were each associated with higher risk of cardiovascular events (adjusted hazard ratios \[HRs\] and 95% confidence intervals \[95% CIs\]: 1.79 \[1.13 to 2.85\], 2.62 \[1.68 to 4.07\], and 2.65 \[1.68 to 4.19\], respectively) and reduced eGFR (adjusted HRs \[95% CIs\], 5.26 \[2.43 to 11.41\], 4.36 \[1.80 to 10.57\], and 54.35 \[30.79 to 95.94\], respectively). Compared with sustained microalbuminuria, remission to normoalbuminuria was not associated with reduced risk of cardiovascular events (adjusted HR, 1.33; 95% CI, 0.68 to 2.59) or reduced eGFR (adjusted HR, 1.75; 95% CI, 0.56 to 5.49). Compared with normoalbuminuria, sustained microalbuminuria, remitted microalbuminuria, and macroalbuminuria were associated with greater carotid intima-media thickness, and macroalbuminuria was associated with a greater degree of coronary artery calcification.In type 1 diabetes, microalbuminuria and macroalbuminuria are associated with higher risks of cardiovascular disease and reduced eGFR, but achieving a remission of established microalbuminuria to normoalbuminuria does not appear to improve outcomes.

> <https://www.ncbi.nlm.nih.gov/pubmed/27647854>
>
> Diabetes is the leading cause of ESRD. Despite evidence for a substantial heritability of diabetic kidney disease, efforts to identify genetic susceptibility variants have had limited success. We extended previous efforts in three dimensions, examining a more comprehensive set of genetic variants in larger numbers of subjects with type 1 diabetes characterized for a wider range of cross-sectional diabetic kidney disease phenotypes. In 2843 subjects, we estimated that the heritability of diabetic kidney disease was 35% (P=6.4×10-3). Genome-wide association analysis and replication in 12,540 individuals identified no single variants reaching stringent levels of significance and, despite excellent power, provided little independent confirmation of previously published associated variants. Whole-exome sequencing in 997 subjects failed to identify any large-effect coding alleles of lower frequency influencing the risk of diabetic kidney disease. However, sets of alleles increasing body mass index (P=2.2×10-5) and the risk of type 2 diabetes (P=6.1×10-4) associated with the risk of diabetic kidney disease. We also found genome-wide genetic correlation between diabetic kidney disease and failure at smoking cessation (P=1.1×10-4). Pathway analysis implicated ascorbate and aldarate metabolism (P=9.0×10-6), and pentose and glucuronate interconversions (P=3.0×10-6) in pathogenesis of diabetic kidney disease. These data provide further evidence for the role of genetic factors influencing diabetic kidney disease in those with type 1 diabetes and highlight some key pathways that may be responsible. Altogether these results reveal important biology behind the major cause of kidney disease.

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<div class="post-metadata">

**Author:** ![britt\_j](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/britt_j/32/55_2.png) [@britt\_j](https://forum.fudiabetes.org/u/britt_j)\
**Post date:** [May 1, 2017, 11:52pm UTC](https://forum.fudiabetes.org/t/t1-mortality-rates/224/20 "2017-05-01T23:52:03Z")

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My guess:

- Minimizing variability

- Lowering A1C to near-nondiabetic numbers _without_ serious hypos

- Genetics – I’ll be posting some links to videos from The Broad Institute (Harvard/MIT) and TUM soon.

[Next page](https://forum.fudiabetes.org/t/t1-mortality-rates/224.md?page=2)