How old does a diabetic person get? My 14 year old daughter was diagnosed as type 1 almost a year ago. In South Africa, we don’t have all the applicable sites on diabetes as overseas people. Almost all links for assistance and care are for UK, etc. In the past year, she was hospitalized four times. There was a phone-in radio program where people could phone in and talk about diabetes. All people that phoned in basically had the same story line: “My child did…. when..” coming to the concluding that the child died. My husband is upset over this and he can’t stop thinking on how long she will still be with us.

One of the modern miracles of the 20th century was insulin therapy for type 1 diabetic patients. With insulin availability, the case fatality rate of up to 80 percent each year dropped precipitously below five percent. There is, nowadays, strong evidence that the major improvement in the life expectancy of type 1 diabetic patients in the past 50 years has been the result of a reduction in the mortality associated with the onset of the disease and shortly afterwards. This avoidance of early deaths probably explains the observed similarity between the survival of young type 1 subjects compared with the general population for the first 15 years of disease duration. Moreover, children, females more than males, with onset at adolescent “transition” age, carry an increased mortality probably reflecting personal, family, and medical difficulties in dealing with the particular psychosocial characteristics of teenagers. These difficulties can lead to poor metabolic control, acute metabolic complications of diabetes such as DKA or hypoglycemia, infections, etc.. This is an area where much attention is needed in the provision of childhood diabetic care and it requires a thorough and sensitive multidisciplinary approach, i.e. a diabetes team approach. The rate of diabetic complications seems to have sharply declined over the last decade, quite probably because of better and integrated medical approaches towards diabetes and its complications (e.g., intensified insulin therapy (DCCT), antihypertensive agents (UKPDS), laser therapy (EDTRS)).

In long term mortality, studies so far appear to indicate that type 1 diabetes, when chronic complications are present (mainly if renal disease), despite advances in care and refinements of insulin treatment and metabolic control, still carries an unacceptable high mortality rate. But if the compliance and metabolic control are both fine, i.e. the A1c is less than seven, for the most part since the beginning of the disease, the long term prognosis is undoubtedly fine and life expectancy of a young with type 1 diabetes is almost the same as the one of a people the same age and sex without the disease.

MS