Contemporary Sex-Specific Mortality Risk in Type 1 Diabetes During the Era of Advanced Therapeutic Care

OBJECTIVE: Amid major advances in diabetes care technologies, this study aimed to assess all-cause mortality risk among individuals diagnosed with type 1 diabetes in recent decades compared with matched control individuals. RESEARCH DESIGN AND METHODS: This retrospective cohort study included all patients with type 1 diabetes diagnosed before age 35 between 2000 and 2022, identified through a validated registry from Maccabi Healthcare Services (MHS), a large state-mandated health care provider network. A diabetes-free comparison cohort was constructed using 1:4 propensity score matching by sex and age. Follow-up continued until 2023, death, or transfer from MHS, whichever occurred first. Cox regression and sensitivity analyses were performed. RESULTS: Mortality rates among 4,299 individuals with type 1 diabetes (mean ± SD age at diagnosis, 17.4 ± 9.1 years) and 17,196 matched control individuals (45.6% female overall) were 131.0 and 35.2 per 100,000 person-years, respectively, with 112 deaths over 204,102 person-years. Type 1 diabetes was associated with higher mortality (hazard ratio [HR] 3.66; 95% CI 2.53-5.31), with consistent estimates after adjustment and sensitivity analyses. Excess mortality was greater in females than males (adjusted HR 8.40 [3.71-19.04] vs. 2.90 [1.78-4.72]; P-interaction = 0.02), although absolute mortality rates were higher in males. Mortality risk was higher in those diagnosed in 2000-2010 than in 2011-2022 (adjusted HR 4.36 [1.22-15.57] vs. 2.94 [1.31-6.60]), with follow-up truncated for comparability. CONCLUSIONS: Type 1 diabetes was associated with higher risk of mortality, particularly among females. This association was attenuated among individuals diagnosed in more recent years.