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Editorial |

Mortality in Type 1 Diabetes in the Current Era Two Steps Forward, One Step Backward

Michelle Katz, MD, MPH1,2,3; Lori Laffel, MD, MPH1,3
[+] Author Affiliations
1Young Adult Diabetes and Section of Genetics and Epidemiology, Joslin Diabetes Center, Boston, Massachusetts
2Pediatric Endocrinology Unit, Massachusetts General Hospital for Children, Boston, Massachusetts
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
JAMA. 2015;313(1):35-36. doi:10.1001/jama.2014.16327.
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In the preinsulin era, survival following the diagnosis of type 1 diabetes was dismal; 50% of patients died within the first 20 months of diagnosis and fewer than 10% survived 5 years.1 The introduction of insulin therapy in 1922 significantly changed survival as mortality from diabetic ketoacidosis (DKA) decreased substantially. However, in the middle of the 20th century, there was still a 20-year reduction in life expectancy for those diagnosed with type 1 diabetes; 50% of individuals with youth-onset disease failed to reach the age of 55 years.2 A half century later, in the current era, intensive insulin therapy has become the standard of care and advances in insulin delivery and glucose monitoring assist in the management of type 1 diabetes.3 Yet glycemic control remains suboptimal for the majority of patients with type 1 diabetes,4 and acute and chronic diabetes complications persist, reducing life expectancy for many patients.

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