Type 1 Diabetes and Improved Life Expectancy
Based on my personal experience during the last 30 years in practice, the anecdotal evidence is in--it appears that children/adolescents adults diagnosed with diabetes more recently have longer and healthier lives!
There has been a virtually logarithmic increase in the availability of new insulins and regimens, new technology, and improved behavioral support that has led to improved life span and quality of life.
- The development of human insulin and analogs (humalog, novolog, apidra, glargine, levemir along with appropriate utilization of our old-standbys, NPH and Regular insulin)
- The technology revolution that led to smaller and more accurate glucometers, blood ketone meters, smart insulin pumps, continuous glucose monitors and eventually the “artificial pancreas”
- The behavioral research that has improved both adherence and quality of life
A recent publication now supports what has been empirically assumed. There is an improvement in the life expectancy in people with type 1 diabetes. Miller, Secrest, Sharma, Songer and Orchard recently published “Improvements in the life expectancy of type 1 diabetes” (The Pittsburgh Epidemiology of Diabetes Complications Study cohort) in Diabetes (online ahead of print July 30, 2012, doi: 10:2337/db11-1625). According to the authors, “although survival in type 1 diabetes has improved, the impact on life expectancy in the U.S. type 1 diabetes population has not been well established.” The authors compared two subcohorts based on year of diabetes diagnosis (1950-1964 [n=390] vs. 1965-1980 [n=543]) to determine if one could quantify improvements in life expectancy.
The results were statistically significant (P<0.0001). The life expectancy at birth for the 1965-1980 cohort was 15 years greater than the 1950-1964 cohort (68.6 vs. 53.4 years)! According to the authors, the difference persisted regardless of sex or pubertal status at birth.
These improved statistics are based on a cohort 1 year before I graduated medical school. Imagine what they are now in view of the present and future exploding technology and research!
One additional and significant reason for the improvement in life expectancy is the chronic healthcare model that relies on the multidisciplinary team approach. Different healthcare professionals are required at different stages in the delivery of healthcare (see previous 2 blogs). A recent paper published by Shechter, Cohen, Shmukler and Walker in Diabetes Care called “Intervention Costs and Cost-Effectiveness of a Successful Telephonic Intervention to Promote Diabetes Control” (published online ahead of print July 30, 2012, doi:10.2337/dc12-0048) characterized the costs and cost-effectiveness of a telephonic behavioral intervention to promote glycemic control in the Improving Diabetes Outcomes study. Although the study was performed on adults with Type 2 diabetes, “it was concluded that a modest improvement in A1c can be achieved at a moderate cost using telephonic intervention conducted by health educators trained and supervised by a nurse certified diabetes educator.”
The management of type 1 diabetes requires constant communication with the multidisciplinary team, including an enormous amount of “telephonic intervention.” It seems quite clear that a significant contribution leading to the improvement of care and life expectancy in type 1 diabetes is directly correlated to the frequency of communication between the family and child/adolescent/adult with type 1 diabetes and the multidisciplinary team. The management of chronic illnesses, such as type 1 diabetes, is often determined by “committee” in which the family, person with diabetes, and multidisciplinary health team work together to set behavioral goals and management expectations.
Indeed, as we move forward towards the construction of the Washington Nationals Diabetes Care Complex at Children’s National Medical Center, the infrastructure for telecommunication is included, as clearly this is a major direction in present and future diabetes care.
In summary, the future for our children/adolescents/adults with diabetes is not without optimism!
Knickers update: We have completed and passed “beginners obedience training” and are now in week 5 of the intermediate obedience class. We plan on “auditioning” for a therapy dog group in the fall to be eligible for therapy work at Children’s National Medical Center. There will be a “dog show” at Children’s National on Wednesday, September 5 from 10 am to 3pm in which Knickers and I are planning to make an appearance!