“What's the life expectancy of a child with type 1 diabetes?”
My daughter's doctor suggested that type 1 diabetes reduces a child's lifetime. She was diagnosed when she was 10 years old, and now that she's 14, she knows how to manage her insulin therapy and monitor it. But what's the life expectancy of a child with type 1 diabetes?
4 Answers
The same as any other girl at her age as long she keeps a good control of her blood sugars.
Type 1 diabetes is the commonest metabolic disorder and the second commonest chronic disease of childhood. About 90% of type 1 diabetes (type A) is an autoimmune disease were as the 10% is idiopathic type 1 diabetes (type B). There are about 200,000 children with type 1 diabetes in America. It is increasing by about 3% annually. It will triple in the next 30 years to 600,000 children in America, with an incidence rate of about 20,000 newly diagnosed type 1 diabetes children in America.
Type 1 diabetes is based on genetic susceptibly and strong environmental triggers. Genetic susceptibility is conferred by about 40 genes. About 50% of genetic susceptibility is conferred by a gene that control the a Major histocompatibity ll molecule (MHC ll) also known as human leukocyte antigen (HLA).
Changes in MHC ll gene with strong influence from environmental triggers activate a cytotoxic lymphocytes (killer cells) cascading into an autoimmune reaction. Certain gene variants called HLA Class II DR4-DQ8 and DR3-DQ2 are strongly associated with type 1 diabetes. About 90% of children with type 1 diabetes have this susceptibility. People with DR15-DQ6 alleles are protected from type 1 diabetes.
The autoimmune reaction destroys insulin producing cells called Islet of Langerhans in honor of the German scientist Paul Langerhans.
Generally it takes 2-5 years for clinical diabetes to emerge once the autoimmune process starts. It takes the destruction of more than 80% of the islet cells for clinical diabetes to evolve.
There are also antibodies in type 1 diabetes whose purpose in unknown but they are good markers for predicting type 1 diabetes and to determine if the new onset diabetes have type 1 diabetes. These islet cell antibodies are called GAD, ICA, AAI, AI2 and ZnT8.
Type 1 diabetes is more common in the Caucasian population than other ethnic groups, because there is more clustering of the susceptibity genes in this ethnic group. However only 4% of the people who have theses susceptibility genes develop type 1 diabetes. Most people (96%) with these genes do not develop type 1 diabetes. This is because there are multiple variables (alleles) of the same gene leading to variable expression of the same gene resulting in greater polymorphism and environmental triggers strongly influence epigenetic changes with out changing the basic DNA sequence, but only changing the expression. Therefore polymorphism of the gene (about 2000 of them) and environmental modifiers (epigenetics) determine who will develop type 1 diabetes among the population with susceptibility genes. Even in identical twins the concordance rate is about 40% risk of developing type 1 diabetes. In siblings with type 1 diabetes or parents with type 1 diabetes only pass a risk of developing type 1 diabetes <10%. This shows environmental exposure is a strong modifier.
Once over 80% of the islet cells are destroyed the body can no make enough insulin to control blood sugars and clinical diabetes evolve.
Type 1 diabetes is insulin deficiency state and requires insulin not only for metabolic (glucose) control but also survival. If blood glucose is not treated with insulin excessive urination leads to dehydration and acidosis leading to diabetes coma and death.
When insulin was discovered in 1921 it was made commercially available globally in a short period of time.
Before the discovery of insulin type 1 diabetes was managed by carbohydrate restriction (literally starvation) therapy. The life expectancy was only few weeks to few months and some survived up to 3 years with starvation therapy. But thy literally died slowly as emaciated ghosts.
After the introduction of insulin a disease that was a death sentence (terminal illness) became a disease with grave acute and chronic complications. The life expectance however was improved dramatically.
In the early years of insulin therapy acute complications from severe hypoglycemia were very common cause of death. Dehydration from hyperglycemia, and diabetes acidosis and diabetes coma were also common cause of death. Chronic complications such as eye disease, kidney disease, nerve disease and cardiovascular disease (heat disease, heart attack, stroke and arterial diseases) start to develop in 10-15 years after diagnosis. These diabetes related comorbidities became the commonest killers of type 1 diabetes in the 1950's. Due to these acute and chronic complications the life expectancy of type 1 diabetics was much shorter. In the 1950's and 1960's (i.e 20-30 years after the introduction of insulin about 35% of patients with type 1 diabetes died of diabetes related complications. There were about 90% eye disease, 25% kidney disease, over 40% cardiovascular disease. Over 12% of blindness in America was from diabetes.
In the first 20-30 years after insulin production the insulin was crude as it have so much impurities. It caused more side effects such as skin atrophies and very erratic blood sugars. different short acting, intermediate acting and long acting insulin were advanced, though they have impurities. However as our understanding diabetes, insulin and much more technological advances were made mortality from acute and chronic complications start to slow down.
In 1972 blood sugar testing glucometer was commercially available in the hospital setting and in 1982 self blood sugar monitors were commercially available for patients.
The 1980's saw one of the greatest technological advancement. Pure Human insulin was synthesized and was made commercially available. Both short acting and long acting insulin became pure and less immunogenic with the human insulin. Diabetics start to monitor their blood sugars at home as often as they need and glycemic control improved much better leading to less complications and longer life expectancy.
Insulin pumps, blood sugar sensors and various advanced blood glucose monitors made management of diabetes much better and brought better quality of life and the life expectancy got longer.
A large multicenter trail called the DCCT trail conducted between 1983-1993 demonstrated that tight glycemic control lowered all forms of chronic complications by almost 40% (eye disease, kidney disease, and Cardiovascular disease) These was done in over 1400 type 1 diabetic patients over a span of 10 years. This was a great paradigm shift in the management of diabetes that intensification of insulin in type 1 diabetes showed great improvement in all forms of chronic complications of diabetes.
Today intensive insulin therapy using fast acting and long acting insulin or insulin pumps with frequent blood sugar monitoring or using sensors has become a standard of care. And as such, chronic and acute complications of diabetes are much lower than the 1970-1990. The quality of life and life expectancy have dramatically improved though there is about 3-4 fold more risk of dying from diabetes related complications compared to the general population.
The commonest cause of death for type diabetes are complications of diabetes such as high cholesterol(cardiovascular disease), inflammation, metabolic syndrome, hypertension, endothelial dysfunction oxidative stress, metabolic syndrome and Advanced glycation end products from chronic hyperglycemia leading to cardiovascular disease, kidney disease eye disease and nerve disease. Without this complications life expectance with well controlled diabetes would be close to the normal population. Out of all the comorbidities the commonest cause of death in diabetes is heart disease.
Currently the mortality rate of type 1 diabetes is about 7% in 25 years of having diabetes. So the over all life expectancy of a diabetic patient is about 13 years shorter for women and 11 years shorter for men.
Patients diagnosed with type 1 diabetes have shorter life expectancy than type 2 diabetes, because type 2 diabetes is mostly diagnosed in later years and their comorbidities (HTN, dyslipidemia, metabolic syndrome, inflammation) are treated earlier, though, it is not fare to compare both of them because both suffer all the complications of diabetes.
Some studies show that type 2 diabetes have a bout 10 years shorter life expectance and type 1 about 20 years shorter.
The Canadian study puts the average life expectancy about 55 years. In the USA the average life expectancy for a woman with diabetes is 68 years (13 years shorter) Vs. 81 years and for men 66 years (11 years shorter) vs. 77 years.
In children the younger the age of diagnoses the shorter the life span is. If a person is diagnosed before the age of 10 years the life expectancy is shorter by 14 for boys and 18 years for girls. If it is greater than the age of 14 years the life expectancy is higher lower than diagnosed in their 20's or 30's because they have more exposure to hyperglycemia that causes glycemic load leading to inflammation, HTN, heart disease , kidney disease, eye disease, nerve disease and metabolic syndrome.
Diabetic patients would have life expectancy if they would maintain good glycemic control and prevent the comorbidities or aggressively treat them early. However 50% are non-complaint and only 30% of diabetic patients have good glycemic control. Most type 1 diabetic patients do not get treated for the most of the comorbidities and that is why they develop more chronic complications.
Before the age of 40years acute complications are the commonest cause of death in type 1 diabetes. After the age of 40 years chronic complications are more common cause of death.
Poorly controlled diabetics have persistent hyperglycemia. Hyperglycemia overtime causes elevation in advanced glycation end products (AGE). Glucose reacts with proteins, fats and nucleic acids to form glycated products. When excess glycated products are produced they can advance to become oxidizing agent that free radicals and reactive oxygen species. These AGE can cause alteration in cell receptors, cause inflammation (through releasing inflammatory cytokines) and denature proteins and disrupt cell function. They cause faster aging and dyslipidemia, atherosclerosis heart disease, HTN, kidney and eye disease, degenerative diseases, through their oxidative stress. These can lead to shortened life expectancy.
Children with early onset diabetes especially before the age of 10 years will spend may years with more glycemic load. This glycemic load leads to metabolic or oxidative stress through the formation of AGE. This leads to chronic complications of diabetes intern increasing morbidity and mortality. life expectancy will be expected to shorten by about 10-16 years in those with history of poor glycemic control and genetic susceptibility to develop chronic complications.
Therefore good glycemic control can avoid complications of diabetes. This can lead into a healthy long life with normal life expectancy.
Longevity could be achieved by:
Eating healthy balance diet
Obtaining good glycemic control
Regular doctor visit
Exercise regularly
Avoid stress
Sleep well
Check HbA1C regularly
Remember that diabetics die not because they have diabetes but they die from diabetes related complication such as heart disease (cardiovascular disease), kidney disease, HTN, chronic inflammation to leads to atherosclerosis. Preventing or treating these early enough will prolong life expectancy.
Going back to your Daughter:
Your daughter seems to be doing well with managing her diabetes. She should continue to do so until we have a cure. She should check her blood glucose as often as necessary without additional stress. She needs to get her insulin appropriate to the food eaten and correct blood sugars that are out of range without causing hypoglycemia. Maintain blood sugars between 70-140 about 75% of the time. Maintain HA1c <7.5%. Let her exercise regularly. She need to eat healthy and balanced diet. Maintain ideal weight if possible.
She needs to have regular check up for HBA1c, urine microalbumine, Let her get regular eye exam and lipid profile should be monitored on regular basis. Any comorbidities such as high lipids, HTN, nerve disease and urine microalbumine should be treated early and aggressively. If she maintains good glycemic control until there is a cure she should be able to enjoy a happy normal life with normal longevity. But if the glycemic control is poor and the comorbidities are not prevented or not treated early and aggressively the life expectancy with diabetes from the age of 10 years is about 14-18 years shorter than average.
However this is a statistical probability (relative risk not an absolute risk) since she does not have any complications at this time and may not develop them in the future. The most important issue right now is to take good care of her diabetes and maintain good glycemic control and not worry about (statistical probability) future complications since we would not know for sure if she will develop complications of diabetes that will cut her life expectancy shorter. She should enjoy normal life with normal life expectancy as long as she is in good glycemic control.
Work with your daughter's doctor closely, and utilize any of the available diabetes gadgets we have including insulin pumps and blood glucose sensors, if you are comfortable using them. You should also remain hopeful that a cure may be on horizon.
Good Luck
Type 1 diabetes is based on genetic susceptibly and strong environmental triggers. Genetic susceptibility is conferred by about 40 genes. About 50% of genetic susceptibility is conferred by a gene that control the a Major histocompatibity ll molecule (MHC ll) also known as human leukocyte antigen (HLA).
Changes in MHC ll gene with strong influence from environmental triggers activate a cytotoxic lymphocytes (killer cells) cascading into an autoimmune reaction. Certain gene variants called HLA Class II DR4-DQ8 and DR3-DQ2 are strongly associated with type 1 diabetes. About 90% of children with type 1 diabetes have this susceptibility. People with DR15-DQ6 alleles are protected from type 1 diabetes.
The autoimmune reaction destroys insulin producing cells called Islet of Langerhans in honor of the German scientist Paul Langerhans.
Generally it takes 2-5 years for clinical diabetes to emerge once the autoimmune process starts. It takes the destruction of more than 80% of the islet cells for clinical diabetes to evolve.
There are also antibodies in type 1 diabetes whose purpose in unknown but they are good markers for predicting type 1 diabetes and to determine if the new onset diabetes have type 1 diabetes. These islet cell antibodies are called GAD, ICA, AAI, AI2 and ZnT8.
Type 1 diabetes is more common in the Caucasian population than other ethnic groups, because there is more clustering of the susceptibity genes in this ethnic group. However only 4% of the people who have theses susceptibility genes develop type 1 diabetes. Most people (96%) with these genes do not develop type 1 diabetes. This is because there are multiple variables (alleles) of the same gene leading to variable expression of the same gene resulting in greater polymorphism and environmental triggers strongly influence epigenetic changes with out changing the basic DNA sequence, but only changing the expression. Therefore polymorphism of the gene (about 2000 of them) and environmental modifiers (epigenetics) determine who will develop type 1 diabetes among the population with susceptibility genes. Even in identical twins the concordance rate is about 40% risk of developing type 1 diabetes. In siblings with type 1 diabetes or parents with type 1 diabetes only pass a risk of developing type 1 diabetes <10%. This shows environmental exposure is a strong modifier.
Once over 80% of the islet cells are destroyed the body can no make enough insulin to control blood sugars and clinical diabetes evolve.
Type 1 diabetes is insulin deficiency state and requires insulin not only for metabolic (glucose) control but also survival. If blood glucose is not treated with insulin excessive urination leads to dehydration and acidosis leading to diabetes coma and death.
When insulin was discovered in 1921 it was made commercially available globally in a short period of time.
Before the discovery of insulin type 1 diabetes was managed by carbohydrate restriction (literally starvation) therapy. The life expectancy was only few weeks to few months and some survived up to 3 years with starvation therapy. But thy literally died slowly as emaciated ghosts.
After the introduction of insulin a disease that was a death sentence (terminal illness) became a disease with grave acute and chronic complications. The life expectance however was improved dramatically.
In the early years of insulin therapy acute complications from severe hypoglycemia were very common cause of death. Dehydration from hyperglycemia, and diabetes acidosis and diabetes coma were also common cause of death. Chronic complications such as eye disease, kidney disease, nerve disease and cardiovascular disease (heat disease, heart attack, stroke and arterial diseases) start to develop in 10-15 years after diagnosis. These diabetes related comorbidities became the commonest killers of type 1 diabetes in the 1950's. Due to these acute and chronic complications the life expectancy of type 1 diabetics was much shorter. In the 1950's and 1960's (i.e 20-30 years after the introduction of insulin about 35% of patients with type 1 diabetes died of diabetes related complications. There were about 90% eye disease, 25% kidney disease, over 40% cardiovascular disease. Over 12% of blindness in America was from diabetes.
In the first 20-30 years after insulin production the insulin was crude as it have so much impurities. It caused more side effects such as skin atrophies and very erratic blood sugars. different short acting, intermediate acting and long acting insulin were advanced, though they have impurities. However as our understanding diabetes, insulin and much more technological advances were made mortality from acute and chronic complications start to slow down.
In 1972 blood sugar testing glucometer was commercially available in the hospital setting and in 1982 self blood sugar monitors were commercially available for patients.
The 1980's saw one of the greatest technological advancement. Pure Human insulin was synthesized and was made commercially available. Both short acting and long acting insulin became pure and less immunogenic with the human insulin. Diabetics start to monitor their blood sugars at home as often as they need and glycemic control improved much better leading to less complications and longer life expectancy.
Insulin pumps, blood sugar sensors and various advanced blood glucose monitors made management of diabetes much better and brought better quality of life and the life expectancy got longer.
A large multicenter trail called the DCCT trail conducted between 1983-1993 demonstrated that tight glycemic control lowered all forms of chronic complications by almost 40% (eye disease, kidney disease, and Cardiovascular disease) These was done in over 1400 type 1 diabetic patients over a span of 10 years. This was a great paradigm shift in the management of diabetes that intensification of insulin in type 1 diabetes showed great improvement in all forms of chronic complications of diabetes.
Today intensive insulin therapy using fast acting and long acting insulin or insulin pumps with frequent blood sugar monitoring or using sensors has become a standard of care. And as such, chronic and acute complications of diabetes are much lower than the 1970-1990. The quality of life and life expectancy have dramatically improved though there is about 3-4 fold more risk of dying from diabetes related complications compared to the general population.
The commonest cause of death for type diabetes are complications of diabetes such as high cholesterol(cardiovascular disease), inflammation, metabolic syndrome, hypertension, endothelial dysfunction oxidative stress, metabolic syndrome and Advanced glycation end products from chronic hyperglycemia leading to cardiovascular disease, kidney disease eye disease and nerve disease. Without this complications life expectance with well controlled diabetes would be close to the normal population. Out of all the comorbidities the commonest cause of death in diabetes is heart disease.
Currently the mortality rate of type 1 diabetes is about 7% in 25 years of having diabetes. So the over all life expectancy of a diabetic patient is about 13 years shorter for women and 11 years shorter for men.
Patients diagnosed with type 1 diabetes have shorter life expectancy than type 2 diabetes, because type 2 diabetes is mostly diagnosed in later years and their comorbidities (HTN, dyslipidemia, metabolic syndrome, inflammation) are treated earlier, though, it is not fare to compare both of them because both suffer all the complications of diabetes.
Some studies show that type 2 diabetes have a bout 10 years shorter life expectance and type 1 about 20 years shorter.
The Canadian study puts the average life expectancy about 55 years. In the USA the average life expectancy for a woman with diabetes is 68 years (13 years shorter) Vs. 81 years and for men 66 years (11 years shorter) vs. 77 years.
In children the younger the age of diagnoses the shorter the life span is. If a person is diagnosed before the age of 10 years the life expectancy is shorter by 14 for boys and 18 years for girls. If it is greater than the age of 14 years the life expectancy is higher lower than diagnosed in their 20's or 30's because they have more exposure to hyperglycemia that causes glycemic load leading to inflammation, HTN, heart disease , kidney disease, eye disease, nerve disease and metabolic syndrome.
Diabetic patients would have life expectancy if they would maintain good glycemic control and prevent the comorbidities or aggressively treat them early. However 50% are non-complaint and only 30% of diabetic patients have good glycemic control. Most type 1 diabetic patients do not get treated for the most of the comorbidities and that is why they develop more chronic complications.
Before the age of 40years acute complications are the commonest cause of death in type 1 diabetes. After the age of 40 years chronic complications are more common cause of death.
Poorly controlled diabetics have persistent hyperglycemia. Hyperglycemia overtime causes elevation in advanced glycation end products (AGE). Glucose reacts with proteins, fats and nucleic acids to form glycated products. When excess glycated products are produced they can advance to become oxidizing agent that free radicals and reactive oxygen species. These AGE can cause alteration in cell receptors, cause inflammation (through releasing inflammatory cytokines) and denature proteins and disrupt cell function. They cause faster aging and dyslipidemia, atherosclerosis heart disease, HTN, kidney and eye disease, degenerative diseases, through their oxidative stress. These can lead to shortened life expectancy.
Children with early onset diabetes especially before the age of 10 years will spend may years with more glycemic load. This glycemic load leads to metabolic or oxidative stress through the formation of AGE. This leads to chronic complications of diabetes intern increasing morbidity and mortality. life expectancy will be expected to shorten by about 10-16 years in those with history of poor glycemic control and genetic susceptibility to develop chronic complications.
Therefore good glycemic control can avoid complications of diabetes. This can lead into a healthy long life with normal life expectancy.
Longevity could be achieved by:
Eating healthy balance diet
Obtaining good glycemic control
Regular doctor visit
Exercise regularly
Avoid stress
Sleep well
Check HbA1C regularly
Remember that diabetics die not because they have diabetes but they die from diabetes related complication such as heart disease (cardiovascular disease), kidney disease, HTN, chronic inflammation to leads to atherosclerosis. Preventing or treating these early enough will prolong life expectancy.
Going back to your Daughter:
Your daughter seems to be doing well with managing her diabetes. She should continue to do so until we have a cure. She should check her blood glucose as often as necessary without additional stress. She needs to get her insulin appropriate to the food eaten and correct blood sugars that are out of range without causing hypoglycemia. Maintain blood sugars between 70-140 about 75% of the time. Maintain HA1c <7.5%. Let her exercise regularly. She need to eat healthy and balanced diet. Maintain ideal weight if possible.
She needs to have regular check up for HBA1c, urine microalbumine, Let her get regular eye exam and lipid profile should be monitored on regular basis. Any comorbidities such as high lipids, HTN, nerve disease and urine microalbumine should be treated early and aggressively. If she maintains good glycemic control until there is a cure she should be able to enjoy a happy normal life with normal longevity. But if the glycemic control is poor and the comorbidities are not prevented or not treated early and aggressively the life expectancy with diabetes from the age of 10 years is about 14-18 years shorter than average.
However this is a statistical probability (relative risk not an absolute risk) since she does not have any complications at this time and may not develop them in the future. The most important issue right now is to take good care of her diabetes and maintain good glycemic control and not worry about (statistical probability) future complications since we would not know for sure if she will develop complications of diabetes that will cut her life expectancy shorter. She should enjoy normal life with normal life expectancy as long as she is in good glycemic control.
Work with your daughter's doctor closely, and utilize any of the available diabetes gadgets we have including insulin pumps and blood glucose sensors, if you are comfortable using them. You should also remain hopeful that a cure may be on horizon.
Good Luck
People with type 1 diabetes will, in the majority of cases, develop diabetes at a younger age than those with type 2 diabetes, therefore they will usually spend a longer period of their life living with the condition.
However, there is good news - people with type 1 diabetes have been known to live for as long as over 85 years with the condition. Recent studies into life expectancy are showing significant improvement in life expectancy rates for people with type 1 diabetes born later in the 20th century.
What can I do as a diabetic to help increase my life expectancy?
Maintaining good blood glucose control is a key way to prolong the length of your life.
Keeping blood sugar levels within the recommended blood glucose level ranges will help to offset the likelihood of the complications and therefore increase life expectancy.
It is highly recommended to enjoy a healthy lifestyle, of a well balanced diet and regular activity, in order to help keep blood pressure and cholesterol at healthy levels and promote good blood circulation.
However, there is good news - people with type 1 diabetes have been known to live for as long as over 85 years with the condition. Recent studies into life expectancy are showing significant improvement in life expectancy rates for people with type 1 diabetes born later in the 20th century.
What can I do as a diabetic to help increase my life expectancy?
Maintaining good blood glucose control is a key way to prolong the length of your life.
Keeping blood sugar levels within the recommended blood glucose level ranges will help to offset the likelihood of the complications and therefore increase life expectancy.
It is highly recommended to enjoy a healthy lifestyle, of a well balanced diet and regular activity, in order to help keep blood pressure and cholesterol at healthy levels and promote good blood circulation.
Yes, we used to say it cut many years off a life span. But with better insulins, pumps, monitoring devices, better diet, etc., we can expect a normal life span. This is good news & reflects the many strides we have made in the last 50 yrs. and expect more strides in the next few years. Great research is going on now. Expect a "closed loop pump" in the next couple of years & life will be much better. I know she is still young, but when the time comes she will be able to have children as well as any non-diabetic woman. So, reassure her she can have a good long life if she keeps her diabetes in good control.
