scholarly journals Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders

2021 ◽  
Author(s):  
Nicole K. Gibbings ◽  
Paul A. Kurdyak ◽  
Patricia A. Colton ◽  
Baiju R. Shah
Keyword(s):  
Eating Disorders ◽  
Type 1 Diabetes ◽  
Young Adults ◽  
Confidence Interval ◽  
Diabetic Ketoacidosis ◽  
Hazard Ratio ◽  
Adolescents And Young Adults ◽  
All Cause Mortality ◽  
History Of

Objective: To determine the risk of diabetic ketoacidosis (DKA) and all-cause mortality among adolescents and young adults with type 1 diabetes with and without an eating disorder. <p>Research Design and Methods: Using population-level healthcare administrative data covering the entire population of Ontario, Canada, all people with type 1 diabetes aged 10 to 39 as of January 2014 were identified. Individuals with a history of eating disorders were age/sex matched 10:1 with individuals without eating disorders. All individuals were followed for 6 years for hospitalization/emergency department visits for diabetic ketoacidosis, and for all-cause mortality.</p> <p>Results: We studied 168 people with eating disorders and 1680 age/sex-matched people without eating disorders. Among adolescents and young adults with type 1 diabetes, 168 (0.8%) had a history of eating disorders. The crude incidence of diabetic ketoacidosis was 112.5 per 1,000 patient-years in people with eating disorders, versus 30.8 in people without eating disorders. After adjustment for baseline differences, the subdistribution hazard ratio comparing people with and without eating disorders was 3.30 (95% confidence interval 2.58-4.23, p<0.0001). All-cause mortality was 16.0 per 1,000 person-years in people with eating disorders, versus 2.5 in people without eating disorders. The adjusted hazard ratio was 5.80 (95% confidence interval 3.04-11.08, p<0.0001). </p> <p>Conclusions: Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of diabetic ketoacidosis and nearly 6-fold increased risk of death compared to their peers without eating disorders.</p>

scholarly journals Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders

2021 ◽  
Author(s):  
Nicole K. Gibbings ◽  
Paul A. Kurdyak ◽  
Patricia A. Colton ◽  
Baiju R. Shah
Keyword(s):  
Eating Disorders ◽  
Type 1 Diabetes ◽  
Young Adults ◽  
Confidence Interval ◽  
Diabetic Ketoacidosis ◽  
Hazard Ratio ◽  
Adolescents And Young Adults ◽  
All Cause Mortality ◽  
History Of

Objective: To determine the risk of diabetic ketoacidosis (DKA) and all-cause mortality among adolescents and young adults with type 1 diabetes with and without an eating disorder. <p>Research Design and Methods: Using population-level healthcare administrative data covering the entire population of Ontario, Canada, all people with type 1 diabetes aged 10 to 39 as of January 2014 were identified. Individuals with a history of eating disorders were age/sex matched 10:1 with individuals without eating disorders. All individuals were followed for 6 years for hospitalization/emergency department visits for diabetic ketoacidosis, and for all-cause mortality.</p> <p>Results: We studied 168 people with eating disorders and 1680 age/sex-matched people without eating disorders. Among adolescents and young adults with type 1 diabetes, 168 (0.8%) had a history of eating disorders. The crude incidence of diabetic ketoacidosis was 112.5 per 1,000 patient-years in people with eating disorders, versus 30.8 in people without eating disorders. After adjustment for baseline differences, the subdistribution hazard ratio comparing people with and without eating disorders was 3.30 (95% confidence interval 2.58-4.23, p<0.0001). All-cause mortality was 16.0 per 1,000 person-years in people with eating disorders, versus 2.5 in people without eating disorders. The adjusted hazard ratio was 5.80 (95% confidence interval 3.04-11.08, p<0.0001). </p> <p>Conclusions: Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of diabetic ketoacidosis and nearly 6-fold increased risk of death compared to their peers without eating disorders.</p>

scholarly journals Maternal and child gluten intake and risk of type 1 diabetes: The Norwegian Mother and Child Cohort Study

2019 ◽  
Author(s):  
Nicolai A Lund-Blix ◽  
German Tapia ◽  
Karl Mårild ◽  
Anne Lise Brantsaeter ◽  
Pål R Njølstad ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Confidence Interval ◽  
Population Based ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Pregnancy Cohort ◽  
Increased Risk ◽  
Mother And Child

ABSTRACTOBJECTIVETo examine the association between maternal and child gluten intake and risk of type 1 diabetes in children.DESIGNPregnancy cohortSETTINGPopulation-based, nation-wide study in NorwayPARTICIPANTS86,306 children in The Norwegian Mother and Child Cohort Study born from 1999 through 2009, followed to April 15, 2018.MAIN OUTCOME MEASURESClinical type 1 diabetes, ascertained in a nation-wide childhood diabetes registry. Hazard ratios were estimated using Cox regression for the exposures maternal gluten intake up to week 22 of pregnancy and child’s gluten intake when the child was 18 months old.RESULTSDuring a mean follow-up of 12.3 years (range 0.7-16.0), 346 children (0.4%) developed type 1 diabetes (incidence rate 32.6 per 100,000 person-years). The average gluten intake was 13.6 grams/day for mothers during pregnancy, and 8.8 grams/day for the child at 18 months of age. Maternal gluten intake in mid-pregnancy was not associated with the development of type 1 diabetes in the child (adjusted hazard ratio 1.02 (95% confidence interval 0.73 to 1.43) per 10 grams/day increase in gluten intake). However, the child’s gluten intake at 18 months of age was associated with an increased risk of later developing type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake).CONCLUSIONSThis study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child.WHAT IS ALREADY KNOWN ON THIS TOPICA national prospective cohort study from Denmark found that a high maternal gluten intake during pregnancy could increase the risk of type 1 diabetes in the offspring (adjusted hazard ratio 1.31 (95% confidence interval 1.001 to 1.72) per 10 grams/day increase in gluten intake). No studies have investigated the relation between the amount of gluten intake by both the mother during pregnancy and the child in early life and risk of developing type 1 diabetes in childhood.WHAT THIS STUDY ADDSIn this prospective population-based pregnancy cohort with 86,306 children of whom 346 developed type 1 diabetes we found that the child’s gluten intake at 18 months of age was associated with the risk of type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake). This study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the child’s risk of type 1 diabetes.

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