Fatal complications on the rise among Type 1 diabetes patients

CASES of a life-threatening diabetes complication are steadily increasing in Scotland, with those from the poorest areas most likely to fall ill or die.

A nationwide study led by Edinburgh University found that rates of fatal diabetic ketoacidosis (DKA) doubled in Scotland between 2004 and 2018, with a total of 472 deaths and 30,427 hospital admissions recorded over the 14 year period.

Angela Mitchell, director of charity Diabetes Scotland which funded the study, said the figures were “incredibly concerning”.

DKA is a serious complication affecting people with Type 1 diabetes, whose pancreases cannot produce insulin – the hormone required to enable glucose to be used by the body for energy. About 11 per cent of people in Scotland with diabetes have Type 1, equivalent to about 34,000 people.

Patients inject insulin instead to make up for the lack of naturallyoccurring levels of the hormone, but if they forget or run out of supplies, this can lead to a severe lack of insulin in the body and cause blood sugar levels to soar.

As these sugars cannot be broken down and converted into energy, the person’s body will try to use up fat stores instead.

However, this results in a build-up of chemicals called ketones, which cause the blood to become dangerously acidic – leading to DKA.

If not treated quickly, this can become life-threatening.

People living with Type 1 diabetes must carefully monitor their blood sugar, keeping them in a target range as much as possible, to reduce their risk of DKA.

Rates of hospital admissions and deaths due to the condition are seen as a gauge of how well-supported people with Type 1 diabetes are in managing their condition.

Researchers led by epidemiologist and biostatistician Dr Joe O’reilly used National Records of Scotland data to track cases of DKA against people with Type 1 diabetes from 2004 until 2018.

Among the 37,939 patients identified, over one-quarter (27%) had experienced a DKA event.

Rates of fatal DKA were found to be more than twice as high in 2018 compared to 2004, rising from 95 to 204 deaths “per 100,000 person years”.

This is a measure of the number of people in the study and the amount of time each person spent in the study. For example, if 100,000 individuals participated in a study for one year, this would equal 100,000 person years.

It enables researchers to fairly compare rates for different years when a different number of patients may have been counted in the population.

Rates of DKA events increased among all age groups over the study period, except those who were aged between 10 to 19 years when the study began.

This group initially had the highest number of DKA events, but rates decreased over time.

People living in more socially deprived areas had higher rates of DKA hospitalisations and deaths throughout the study period than those from more affluent areas. Women were found to have higher rates of hospitalisations than men.

Rates of DKA admissions and deaths were lower in those who used an insulin pump or had completed a structured diabetes education course.

Dr O’reilly said: “Our study shows an overall increase in rates of DKA in Scotland since 2004 and that people from socially deprived backgrounds experience higher rates of DKA events. These findings highlight the importance of reducing the impact of deprivation on diabetes care and preventing incidents of DKA, which are priorities in the Scottish Government’s Diabetes Improvement Plan.”

Ms Mitchell of Diabetes Scotland said: “Dr O’reilly’s research reinforces the urgent need to address the deep-rooted inequalities that persist within diabetes care in Scotland.

“It is time for a renewed and focused effort to end the disparities in diabetes care.”