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Department of
Paediatrics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
Correspondence to: Dr Edge. email: julie.edge{at}paediatrics.ox.ac.uk
Accepted 25 June 1999
BACKGROUND
Mortality
rates in children with insulin dependent diabetes (IDDM) in the UK are
unknown and the causes of death not well documented.
AIMTo determine the
mortality rate and causes of death in children with IDDM.
METHODSThe Office of
National Statistics (England and Wales) and the General Register Office
(Scotland) notified all deaths under 20 years of age from 1990 to 1996 with diabetes on the certificate. Further details were provided by
coroners, pathologists, and clinicians.
RESULTS116
deaths were notified and 83 were caused by diabetes. The standardised
mortality ratio was 2.3 (95% confidence interval (CI), 1.9 to 2.9),
being highest in the age group 1-4 years, at 9.2 (95% CI, 5.4 to
14.7). Of the 83 diabetic deaths, hyperglycaemia/diabetic ketoacidosis
(DKA) was implicated in 69 and hypoglycaemia in 7. Cerebral oedema was
the most common cause of death in young children (25 of 36 diabetes
related deaths in children under 12 years of age). 34 young people
(10-19 years; 24 male) were either found dead at home (n = 26) or
moribund on arrival at hospital (n = 8). In 24 of these, it appeared
that DKA was the cause of death, in four hypoglycaemia was likely. Nine
of these were found "dead in bed".
CONCLUSIONSChildren
with IDDM have a higher mortality than the general population. Cerebral
oedema accounts for most hospital deaths in young children. There are a
large number of young men dying at home from neglected IDDM. Early
diagnosis of IDDM in children and closer supervision of young people
might prevent some of these deaths.
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