Life Expectancy With Type 1 Diabetes

Type 1 diabetes is a chronic autoimmune condition in which the body attacks the insulin-producing cells of the pancreas. It was previously called juvenile diabetes as it’s most commonly diagnosed in adolescents.

Insulin is a hormone required for glucose (sugar) from food to enter cells and be used for energy. Without it, our cells starve, and blood glucose remains high. Currently, lifelong insulin injection therapy is the main treatment for type 1 diabetes.

How does the life expectancy of people with type 1 diabetes compare with that of people in general?

Currently, the average lifespan sits around 72.6 years,¹ according to a United Nations report. There have been significant improvements in health over recent years, allowing people to live for much longer in both wealthy and poor countries.

Before the discovery of insulin in 1922, people with type 1 diabetes had an average life expectancy of only three years after developing the disease. While insulin and other therapies have extended this lifespan significantly, there is still a gap between the life expectancy of healthy people and people with type 1 diabetes.

Generally, early mortality is around two to five times higher² in diabetics than in the general population.

People with type 1 diabetes have an estimated 12.2 years of life lost compared with the life expectancy of the general population. In 1975, years of life lost were closer to 27 years for diabetics, showing the dramatic improvements in patient care.

In men

Type 1 diabetes is more commonly diagnosed in men³ than women across all age groups. Men with type 1 diabetes have a life expectancy of 11.1⁴ years shorter than men without the condition, according to a Scottish study.

In women

Women with type 1 diabetes have a 7.9-year shorter life expectancy than women without the condition.

This is mainly due to cardiovascular events, with studies identifying that women with type 1 diabetes have twice⁵ the risk of fatal and nonfatal cardiovascular events and 40% additional risk for all-cause mortality compared to men with type 1 diabetes.

It’s thought that this is caused by poor insulin management, undertreatment, and hormonal differences. This highlights the need for women to be provided with more personalized treatment to reduce the risk of complications on overall life expectancy.

Why is life expectancy lower for people with type 1 diabetes?

The predominant reason type 1 diabetes contributes to a shorter life expectancy is damage to heart health.

Poorly controlled type 1 diabetes means the body must cope with extended periods of high blood glucose levels, which can cause significant damage and long-term complications.

Psychological barriers

For many people with type 1 diabetes, a lack of support and access to sufficient care leads to poor glycemic control.

Many patients don’t achieve their blood glucose targets due to fears of hypoglycemia (low blood glucose) or complicated insulin treatment plans, causing them to miss insulin doses.

Hypoglycemia is usually mild, but it can have unwanted side effects and become life-threatening if not treated appropriately. A desire to avoid hypoglycemia causes people to stop adhering to their diabetes management plan.

As a result, people experience wide variability in their blood glucose levels, which leads to health complications.

Circulatory disease

Circulatory disease includes numerous heart conditions, such as blood clots and diseased vessels. There is at least a ten-fold increase⁶ in circulatory disease in type 1 diabetic patients compared to age-matched non-diabetics.

It is thought that hyperglycemia (high blood glucose) leads to an increase in oxidative stress. This causes damage to the endothelium, the thin membrane lining the inside of the heart and blood vessels.

This isn’t evident in young people with type 1 diabetes but appears later in life. Vascular inflammation is also a contributor. This can lead to serious, life-threatening complications, including strokes and heart attacks.

Metabolic disease

Metabolic disease⁷ encompasses a cluster of conditions that impact metabolism and is commonly found in people who are obese. It includes:

• High blood pressure

• Increased weight

• High cholesterol

It is usually associated with type 2 diabetes but has been identified in people with type 1 diabetes. Metabolic disease can damage the vascular system, leading to cardiovascular disease.

Kidney disease

Kidney disease is characterized by impaired functioning of the kidneys. Usually, kidneys filter waste and excess fluid from the blood, so as their function becomes impaired, wastes build up.

Type 1 diabetes can lead to this if blood glucose levels are poorly controlled. This is because persistent high blood glucose levels can damage the blood vessels and the filters in the kidneys. High blood pressure can exacerbate this as it increases the pressure on the already delicate filtering system of the kidneys.

It is estimated that the risk of having lifetime kidney disease in people with type 1 diabetes is around 50%-70%.⁸

Dyslipidemia

Dyslipidemia refers to abnormal levels of one kind of lipid (fat) in the blood. Blood contains three kinds of lipids:

• Triacylglycerols

• Phospholipids

• Sterols

Dyslipidemia is quite common in poorly controlled type 1 diabetes⁹ and contributes to the increased risk of cardiovascular events seen in the condition. Insulin plays a critical role in lipid metabolism by inhibiting the breakdown of adipose tissue into fatty acids.

Nerve damage

Neuropathy encompasses the damage of both small and large nerve fibers and is a relatively common complication of type 1 diabetes. Damage to peripheral nerves has a prevalence of 6%¹⁰ at the onset of the disease, which increases to 30% around 13-14 years into the disease progression.

Type 1 diabetes can impact both the peripheral and the autonomous nervous systems, leading to increased morbidity and mortality.

People with small fiber neuropathy experience impaired sensations of pain and temperature. This can lead to undetected injuries.

Large fiber damage can impact balance and touch, and in severe cases lead to difficulties in walking, hand coordination, and speech. Early detection of neuropathy is possible, but only via a highly invasive procedure.

Poor glycemic control is the key cause of diabetic neuropathy.

Suicide

Research directly investigating mental health issues associated with type 1 diabetes is rare, but evidence shows that younger people are particularly at risk of suicide.

Adolescents with type 1 diabetes have been found to have a 61%¹¹ higher chance of reporting suicidal thoughts, with suicide rates among diabetics over twice¹² those of their nondiabetic peers.

Type 1 diabetes can be exhausting given the constant monitoring, calculating, troubleshooting, and experiencing the side effects of both hyperglycemic and hypoglycemic events.

This highlights the need to offer additional support, particularly in the early stages of a diagnosis, to help minimize this pressure and responsibility.

How can a person with type 1 diabetes increase their life expectancy?

Luckily, in recent years, life expectancy has been increasing due to better access to treatment. Many steps can be taken to maximize life expectancy.

Some of these are straightforward and may be easily adopted in your day-to-day life, regardless of whether you have type 1 diabetes. These include:

• Staying active

• Eating healthily

• Maintaining a healthy weight

• Getting sufficient sleep

• Not smoking

• Socializing

Maintaining tight control of blood glucose levels is the most important step to increasing life expectancy with type 1 diabetes. This can be achieved through:

• Engaging in intensive insulin therapy (more than three insulin injections per day)

• Counting carbohydrates

• Testing blood glucose levels regularly

• Recognizing how stress and other external factors impact blood glucose levels

• Limiting alcohol consumption

• Taking care of mental health

This intensive approach to monitoring blood glucose levels helps people keep their blood glucose close to target levels. This will limit the possibility of damage and further complications, thus extending their life expectancy.

This is particularly important in children with type 1 diabetes as they will experience the disease for the longest duration.

The significant mental burden that comes with a diagnosis is important to acknowledge as mental illnesses can drastically shorten life expectancy.

Diabetics need to identify appropriate support services, possibly with the help of their doctor, to alleviate the weight of this condition and resume the activities they love.

Living with type 1 diabetes

Management

Managing type 1 diabetes and keeping it under tight control greatly increases life expectancy. The condition can be best managed through:

• Consistent blood glucose monitoring

• Taking insulin

• Counting carbohydrates

• Exercising regularly

• Eating healthily

Treatment

Type 1 diabetes requires lifelong insulin therapy as treatment. Insulin can be taken via regular insulin injections under the skin or via an insulin pump to provide a continuous level of insulin.

When carried out correctly, insulin treatment is highly effective and allows people to keep their blood glucose levels within the target range.

Continuous pump administration has been found to result in improved glycemic control compared to multiple daily injections, making this a better option for improving life expectancy overall.

It’s also great for anyone who wants more flexibility with their lifestyle choices, including exercise and food. New pumps remain relatively expensive, at around US$6,000, but it’s hoped that, with further funding and recognition of the impacts of type 1 diabetes, pumps will become more affordable and accessible to all.

This will contribute to significantly reduced diabetic complications, leading to drastic improvements in life expectancy.

Prevention

Type 1 diabetes currently has no cure or prevention strategy; following a doctor’s advice and undertaking a strict treatment regimen is the best option to manage this complex condition.

Research is currently investigating various signals that the body sends when fighting disease to understand the causes and potential prevention methods for type 1 diabetes.

When to visit a doctor?

If you have concerns about potential complications associated with type 1 diabetes, talk to your doctor about steps to maximize your life expectancy. The earlier you do this, the better chance you have of minimizing the potential damage that poor glycemic control can have on your body.

If you are experiencing a low mood, feelings of hopelessness, or a loss of interest in activities, you may want to consider checking in with your doctor to get help. Depression and suicide are common in type 1 diabetes, so it's important to realize you aren't alone and that support is available.

The lowdown

A person with type 1 diabetes can take many steps to manage blood glucose levels and keep them within a tightly controlled range. In doing so and adopting other healthy behaviors, they will be able to drastically increase their overall quality of life and life expectancy.

If you know someone with type 1 diabetes, reach out to them and offer support where you can, or guide them to appropriate support services.

Look for online or local support groups in the area. These are great for hearing from others going through similar experiences to see how they manage type 1 diabetes and continue to participate fully in life.