Excess mortality in middle-aged men with diabetes aged 15–34 years at diagnosis

The aim of this study is to assess mortality risk and the excess of risk in patients with diabetes. Patients were 15–34 years old at diagnosis of diabetes mellitus (n = 879) in 1992 and 1993 in this national cohort from Sweden. Healthy controls were matched for gender and birth on the same day as the index cases (n = 837). The civic registration number was used to link patients and controls to the Swedish Cause of Death Registry. During follow-up, 3.3% (29/879) of patients and 1.1% (9/837; P = 0.002) of controls died. The risk for a patient with diabetes to die was almost threefold increased compared with healthy controls; hazard ratio, 2.9 (95% CI 1.4–6.2). This increased risk was significant in men; hazard ratio, 2.8 (95% CI 1.2–6.5). Diabetes as the underlying cause of death accounted for 38% (11/29) of deaths among patients. Most patients, 55% (16/29), died at home, remaining patients in hospital, 28% (8/29), or elsewhere 17% (5/29) compared to controls of whom 33% (3/9; P = 0.45) died at home, 33% (3/9; P = 1.0) in hospital, and 33% (3/9; P = 0.36) elsewhere. Only 55% (16/29) of patients had a specified day of death on death certificates compared to 100% (9/9; P = 0.016) of controls. Adult men with diabetes had an almost threefold increased risk to die within 15 years of diagnosis compared to healthy men. Most middle-aged patients with diabetes died at home and often without a specified date of death recorded.