Download - Mortality in Dm Tipe 1
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Glycemic Control and Excess Mortalityin Type 1 Diabetes
Andre Tritansa Faizal
RS Bhayan!ara Tin!at 1 R" SaidS#!anto
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Citation $ N Engl J Med 2014;371:1972-82.
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Bac!ro#nd
Type 1 Diabetes is associated %ith as#bstantially increased ris! o& premat#re deathas compared %ith that in the eneral pop#lation
The excess ris! o& death &rom any ca#se and o&death &rom cardio'asc#lar ca#ses is #n!no%namon patients %ith type 1 diabetes and
'ario#s le'els o& lycemic control
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Methods
patients %ith type 1 diabetes reisteredin the S%edish (ational Diabetes Reistera&ter )an#ary 1* 1++,
For each patient* -'e controls %ererandomly selected &rom the eneral
pop#lation and matched accordin to aeand sex*
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Methods
.atients and controls %ere &ollo%ed #ntilDecember /1* 011
2n&ormation on coexistin conditions andca#ses o& death %as retrie'ed by lin!inpersonal identi-cation n#mbers &rom
patients and controls to the S%edish2npatient Reister and the Ca#se o&Death Reister
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Res#lts
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Res#lts
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Res#lts
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Disc#ssion
&or patients %ith type 1 diabetes %ho had on3taret lycemic control* the ris! o& death &romany ca#se and the ris! o& death &rom
cardio'asc#lar ca#ses %ere still more than t%icethe ris!s in the eneral pop#lation
For patients %ith diabetes %ho had 'ery poorlycemic control* the ris!s o& death %ere , and1 times as hih as those in the eneralpop#lation
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Disc#ssion
the ris! o& death &or patients %ith type 1diabetes and stae 4 chronic !idney disease%as / times
The excess ris! o& death &rom any ca#se or&rom cardio'asc#lar disease did not decreaseo'er time in the present st#dy
2n a recent lare st#dy &rom Canada and the
5nited 6indom that did not distin#ish typeso& diabetes* the excess ris! o& death declineds#bstantially o'er time* albeit not amonpatients yo#ner than 7 years o& ae"
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St#dy limitations
co#ld not concl#de that patients %ho ha'econsistently ood lycemic control &rom thetime o& dianosis on%ard still ha'e an
excess ris! o& death obser'ational nat#re o& the st#dy does notallo% to de-niti'ely excl#de the possibility o&resid#al con&o#ndin o& death
co#ld ha'e #nderestimated diabetic comaas a ca#se o& death* since the ma8ority onspeci-ed diabetes3related deathsocc#rred o#tside the hospital
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Ta!e 9ome Massae
Control o& lycated haemolobin isimportant to red#ce mortality
patients %ith type 1 DM %ith normallycated hemolobin still had ris! o&death t%ice as hih as those in theeneral pop#lation and se'eral timeshiher amon patients %ith poor
lycemic control* and / times hiher inpatients %ith C6D st :
Diabetic !etoacidosis and hypolycaemia%ere common ca#se o& death in yo#nerperson ;
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T9A(6 >?5