Diabetes Bites Newsletter

Increased risk of mortality and cardiovascular disease for those with type 1 diabetes are known factors. However, there are no guidelines for management based on age of onset as an important piece in this risk.

A nationwide, register-based cohort study of people with type 1 diabetes was done comparing those with diabetes, to matched controls in the general population (individuals were found from the Swedish National Diabetes Register (1998 – 2012). The goal was to look at how age at diagnosis of type 1 diabetes related to cardiovascular disease and mortality. Age categories were noted as age of diagnosis in the following ranges: 0–10 years, 11–15 years, 16–20 years, 21–25 years, and 26–30 years and risk was estimated for all cardiovascular related mortality as well as for heart attack, stroke, heart failure, atrial fib as well as coronary heart disease.

27,195 individuals with type 1 diabetes and 135,178 matched controls were selected for this study. In a nutshell (without all the statistics) what they found was “The highest overall incidence rate, noted for all-cause mortality, was 1·9 (95% CI 1·71–2·11) per 100?000 person-years for people with type 1 diabetes. Development of type 1 diabetes before 10 years of age resulted in a loss of 17·7 life-years (95% CI 14·5–20·4) for women and 14·2 life-years (12·1–18·2) for men.

Age at onset of type 1 diabetes CAN be an important determinant of life expectancy, and cardiovascular effect, with what seems to be the highest excess risk in women.

While this focused on the potential negative effect of diabetes on hearth health and life expectancy, as an RD, CDE and person with diabetes for 30+ years myself, the article made me take a step back and consider the fact that there was not mention of other evidence noting why cardiovascular disease and death happens more other than earlier age at dx and more significant loss of beta cells earlier.

They should have also looked at lifestyle and glucose control for kids across the board to say “with more optimal TIR (time in range), cardio events/death were less common”. Or with healthy lifestyle changes like food type, activity and therapy (pump/CGM vs MDI, etc.) there was less negative health effect even with early diagnosis. Even kids without type 1 who are following the typical diet and “activity” plan that is common now seem to have more health issues like obesity and lifelong health issues – so just targeting kids with type 1 and saying it is the D that is the total cause isn’t complete information.

How we can help our kids with Type 1 diabetes and make them healthier

Earlier is better for lifestyle changes: As I educate and work with people of all ages with diabetes (and who were diagnosed at all different ages), I always make lifestyle change a hallmark of management.  An article like this should call attention to the need to emphasize cardio protective lifestyle choices for all with diabetes, and more so for those who are diagnosed at a young age.  If we start from the beginning teaching that activity and food choices are as much part of management as insulin is, then we can prevent a lot of issues despite age of diagnosis.  With more optimal glucose control and time spent in target range, we can avoid a lot of the complications that are well known including heart disease.

Greater focus on cardio protection might be a necessary focus in people with early-onset type 1 diabetes but it can start early with changes to what we allow our kids to choose. Just because you can cover food with insulin, does not mean it is healthy to have treats or high carb processed food all the time (what I call non-food).

Kids will learn what we teach them – if we give ice cream every night, or a treat with every kid’s meal eaten out, or a cookie because it was a bad day is that a good choice? Consider if you are giving it to them because THEY want and it can technically be covered with insulin (but is it easily controlled?). Look at how real food can be incorporated in more often – it might mean a little more work on your part as a parent of course, but you want the best for your children right? I could go on and on about food vs non-food and its overall impact on long-term health, but it isn’t’ rocket science. What we put in our body makes a difference, whether we have diabetes or not. What this study points out is that it might very well have heavier impact on long term health for those who are diagnosed with diabetes at a younger age.

Food is a basic necessity of life, and I believe that activity is also a basic need.

We are meant to move and to fuel our body with nutrients that meet growth needs across the age spectrum.  Kids are growing and changing so much, especially in their early years that it makes sense to give them what they need to fully meet their potential. While diabetes puts a bit of a wrench in this, if we focus on healthy lifestyle all along we can ensure that we are creating a healthy environment for growth, brain development and healthy heart long term.

If you feel your child needs a revamp of food intake, I’d be happy to help with ideas, grocery lists and recipes! Email me to set up a visit: email

Original article found here: thelancet.com

Articles| Volume 392, ISSUE 10146, P477-486, August 11, 2018