A meta-analysis of the relative risk of mortality for type 1 diabetes patients compared to the general population: exploring temporal changes in relative mortality

Tom W. C. Lung, Alison J. Hayes, William H. Herman, Lei Si, Andrew J. Palmer, Philip M. Clarke

Research output: Contribution to journalArticleResearchpeer-review

Abstract

AIMS: Type 1 diabetes has been associated with an elevated relative risk (RR) of mortality compared to the general population. To review published studies on the RR of mortality of Type 1 diabetes patients compared to the general population, we conducted a meta-analysis and examined the temporal changes in the RR of mortality over time. METHODS: Systematic review of studies reporting RR of mortality for Type 1 diabetes compared to the general population. We conducted meta-analyses using a DerSimonian and Laird random effects model to obtain the average effect and the distribution of RR estimates. Sub-group meta-analyses and multivariate meta-regression analysis was performed to examine heterogeneity. Summary RR with 95% CIs was calculated using a random-effects model. RESULTS: 26 studies with a total of 88 subpopulations were included in the meta-analysis and overall RR of mortality was 3.82 (95% CI 3.41, 3.4.29) compared to the general population. Observations using data prior to 1971 had a much larger estimated RR (5.80 (95% CI 4.20, 8.01)) when compared to: data between; 1971 and 1980 (5.06 (95% CI 3.44, 7.45)); 1981-90 (3.59 (95% CI 3.15, 4.09)); and those after 1990 (3.11 (95% CI 2.47, 3.91)); suggesting mortality of Type 1 diabetes patients when compared to the general population have been improving over time. Similarly, females (4.54 (95% CI 3.79-5.45)) had a larger RR estimate when compared to males (3.25 (95% CI 2.82-3.73) and the meta-regression found evidence for temporal trends and sex (p CONCLUSIONS: Type 1 diabetes patients' mortality has declined at a faster rate than the general population. However, the largest relative improvements have occurred prior to 1990. Emphasis on intensive blood glucose control alongside blood pressure control and statin therapy may translate into further reductions in mortality in coming years.
LanguageEnglish
Article numbere113635
Pages1-15
Number of pages15
JournalPLoS ONE
Volume9
Issue number11
DOIs
Publication statusPublished - 2014
Externally publishedYes

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insulin-dependent diabetes mellitus
relative risk
Medical problems
Type 1 Diabetes Mellitus
meta-analysis
Meta-Analysis
Mortality
Population
risk estimate
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Pressure control
Blood pressure
systematic review
Regression analysis
blood glucose
blood pressure
Blood Glucose
regression analysis
Regression Analysis
Blood Pressure

Bibliographical note

Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Cite this

Lung, Tom W. C. ; Hayes, Alison J. ; Herman, William H. ; Si, Lei ; Palmer, Andrew J. ; Clarke, Philip M. / A meta-analysis of the relative risk of mortality for type 1 diabetes patients compared to the general population : exploring temporal changes in relative mortality. In: PLoS ONE. 2014 ; Vol. 9, No. 11. pp. 1-15.
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abstract = "AIMS: Type 1 diabetes has been associated with an elevated relative risk (RR) of mortality compared to the general population. To review published studies on the RR of mortality of Type 1 diabetes patients compared to the general population, we conducted a meta-analysis and examined the temporal changes in the RR of mortality over time. METHODS: Systematic review of studies reporting RR of mortality for Type 1 diabetes compared to the general population. We conducted meta-analyses using a DerSimonian and Laird random effects model to obtain the average effect and the distribution of RR estimates. Sub-group meta-analyses and multivariate meta-regression analysis was performed to examine heterogeneity. Summary RR with 95{\%} CIs was calculated using a random-effects model. RESULTS: 26 studies with a total of 88 subpopulations were included in the meta-analysis and overall RR of mortality was 3.82 (95{\%} CI 3.41, 3.4.29) compared to the general population. Observations using data prior to 1971 had a much larger estimated RR (5.80 (95{\%} CI 4.20, 8.01)) when compared to: data between; 1971 and 1980 (5.06 (95{\%} CI 3.44, 7.45)); 1981-90 (3.59 (95{\%} CI 3.15, 4.09)); and those after 1990 (3.11 (95{\%} CI 2.47, 3.91)); suggesting mortality of Type 1 diabetes patients when compared to the general population have been improving over time. Similarly, females (4.54 (95{\%} CI 3.79-5.45)) had a larger RR estimate when compared to males (3.25 (95{\%} CI 2.82-3.73) and the meta-regression found evidence for temporal trends and sex (p CONCLUSIONS: Type 1 diabetes patients' mortality has declined at a faster rate than the general population. However, the largest relative improvements have occurred prior to 1990. Emphasis on intensive blood glucose control alongside blood pressure control and statin therapy may translate into further reductions in mortality in coming years.",
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A meta-analysis of the relative risk of mortality for type 1 diabetes patients compared to the general population : exploring temporal changes in relative mortality. / Lung, Tom W. C.; Hayes, Alison J.; Herman, William H.; Si, Lei; Palmer, Andrew J.; Clarke, Philip M.

In: PLoS ONE, Vol. 9, No. 11, e113635, 2014, p. 1-15.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A meta-analysis of the relative risk of mortality for type 1 diabetes patients compared to the general population

T2 - PLoS ONE

AU - Lung, Tom W. C.

AU - Hayes, Alison J.

AU - Herman, William H.

AU - Si, Lei

AU - Palmer, Andrew J.

AU - Clarke, Philip M.

N1 - Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2014

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N2 - AIMS: Type 1 diabetes has been associated with an elevated relative risk (RR) of mortality compared to the general population. To review published studies on the RR of mortality of Type 1 diabetes patients compared to the general population, we conducted a meta-analysis and examined the temporal changes in the RR of mortality over time. METHODS: Systematic review of studies reporting RR of mortality for Type 1 diabetes compared to the general population. We conducted meta-analyses using a DerSimonian and Laird random effects model to obtain the average effect and the distribution of RR estimates. Sub-group meta-analyses and multivariate meta-regression analysis was performed to examine heterogeneity. Summary RR with 95% CIs was calculated using a random-effects model. RESULTS: 26 studies with a total of 88 subpopulations were included in the meta-analysis and overall RR of mortality was 3.82 (95% CI 3.41, 3.4.29) compared to the general population. Observations using data prior to 1971 had a much larger estimated RR (5.80 (95% CI 4.20, 8.01)) when compared to: data between; 1971 and 1980 (5.06 (95% CI 3.44, 7.45)); 1981-90 (3.59 (95% CI 3.15, 4.09)); and those after 1990 (3.11 (95% CI 2.47, 3.91)); suggesting mortality of Type 1 diabetes patients when compared to the general population have been improving over time. Similarly, females (4.54 (95% CI 3.79-5.45)) had a larger RR estimate when compared to males (3.25 (95% CI 2.82-3.73) and the meta-regression found evidence for temporal trends and sex (p CONCLUSIONS: Type 1 diabetes patients' mortality has declined at a faster rate than the general population. However, the largest relative improvements have occurred prior to 1990. Emphasis on intensive blood glucose control alongside blood pressure control and statin therapy may translate into further reductions in mortality in coming years.

AB - AIMS: Type 1 diabetes has been associated with an elevated relative risk (RR) of mortality compared to the general population. To review published studies on the RR of mortality of Type 1 diabetes patients compared to the general population, we conducted a meta-analysis and examined the temporal changes in the RR of mortality over time. METHODS: Systematic review of studies reporting RR of mortality for Type 1 diabetes compared to the general population. We conducted meta-analyses using a DerSimonian and Laird random effects model to obtain the average effect and the distribution of RR estimates. Sub-group meta-analyses and multivariate meta-regression analysis was performed to examine heterogeneity. Summary RR with 95% CIs was calculated using a random-effects model. RESULTS: 26 studies with a total of 88 subpopulations were included in the meta-analysis and overall RR of mortality was 3.82 (95% CI 3.41, 3.4.29) compared to the general population. Observations using data prior to 1971 had a much larger estimated RR (5.80 (95% CI 4.20, 8.01)) when compared to: data between; 1971 and 1980 (5.06 (95% CI 3.44, 7.45)); 1981-90 (3.59 (95% CI 3.15, 4.09)); and those after 1990 (3.11 (95% CI 2.47, 3.91)); suggesting mortality of Type 1 diabetes patients when compared to the general population have been improving over time. Similarly, females (4.54 (95% CI 3.79-5.45)) had a larger RR estimate when compared to males (3.25 (95% CI 2.82-3.73) and the meta-regression found evidence for temporal trends and sex (p CONCLUSIONS: Type 1 diabetes patients' mortality has declined at a faster rate than the general population. However, the largest relative improvements have occurred prior to 1990. Emphasis on intensive blood glucose control alongside blood pressure control and statin therapy may translate into further reductions in mortality in coming years.

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DO - 10.1371/journal.pone.0113635

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