Abstract 20507: Young Persons With Diabetes Have a 7-Fold Increased Risk of Sudden Cardiac Death Compared to Persons Without Diabetes: A Nationwide Cohort Study in Denmark

Abstract

Introduction: Persons with diabetes mellitus (DM) have increased all-cause mortality compared to the general population. Mortality rates (MR) and causes of death among children and young persons with type 1 DM (DM1) and type 2 DM (DM2) have not previously been examined in a nationwide setting. Therefore, the aim of this nationwide and unselected study was to examine all-cause and cardiac MR in children and young adults with DM1 and DM2. Furthermore, we aimed to calculate MR ratio between persons with and without DM.

Method and results: The study population consisted of all persons in Denmark aged 1-35 in 2000-09 and 36-49 in 2007-09, which equals 27.1 million person-years. All 14,294 deaths in the 10-year period were included and cause of death was established based on information from death certificates and autopsy reports. The Danish Register of Medicinal Product Statistics, which holds information on all prescriptions dispensed from Danish pharmacies, was used to identify persons with DM1 (treatment with insulin or insulin-analogs only) and DM2 (other antidiabetic agents +/- insulin). MR among persons with DM was calculated using the age-specific diabetic background population as denominator. Among the 14,294 decedents there were 669 (5%) persons with DM, of which 471 (70%) had DM1 and 198 (30%) DM2. Persons with DM had an all-cause MR of 235 per 100,000 person-years compared to 51 among persons without DM (MR ratio 5, 95% CI, 4-5, p<0.001). The leading cause of death among persons with DM was cardiac diseases (n=230, 34%) with a MR ratio between persons with and without DM of 8 (95% CI, 7-10, p<0.001). Among persons with DM, 118 (17%) suffered sudden cardiac death and the MR ratio between persons with and without DM was 7 (95% CI, 6-9, p<0.001). The most common causes of SCD in autopsied decedents were coronary artery disease (n=18, 47%) and sudden arrhythmic death syndrome (n=10, 26%).

Conclusion: Children and young adults with DM have a 5-fold increased all-cause MR and a 7-fold increased risk of SCD compared to age-matched persons without DM. This study highlights the need for continuous cardiovascular risk monitoring and management in young persons with DM.