An Observational Study on the Mortality Pattern of Type 1 Diabetic Patients in West Bengal, India: A 22 Years' Follow Up Report of 212 Patients.

Background: Limited information is available on the total profile of type 1 diabetes mellitus (T1DM) patients in India as type 1 diabetes is not common in India. The present study has been undertaken therefore, in search of mortality pattern of the type 1 diabetics attending the diabetic clinic run by the Calcutta Diabetes and Endocrine Foundation at Kolkata which has a special diabetes care program for the type 1 diabetics.

Objectives: • To obtain the mortality rate of type 1 diabetes in India and to compare it with overall Indian mortality. • To identify the role of different complications of diabetes responsible for the death and thereby, getting a mortality pattern in type 1 diabetes. • To take necessary action for prevention of the complication(s), mainly responsible for the death Study Design and settings: Longitudinal Observational Study: A number of 264 type 1 diabetics attending our clinic were considered for the study. The patients registered in the clinic since April 1996 and had at least one or more follow up visits per year have been included in the study. Follow-up up to 31st March, 2019 have been determined as selection criteria. Out of 264, 212 patients satisfied the criteria and therefore have been included in the study.

Methods Of Study: Age, sex, height, weight, educational qualifications, profession, annual family income and number of family members of each patient was recorded in the first visit. Age and year of detection of diabetes was also recorded. Fasting and Post Prandial plasma glucose level, insulin type and dose, daily dietary habit, presence of diabetic complications, i.e. Retinopathy Neuropathy, Nephropathy, Coronary Artery Disease. Life Style and diabetic education status were assessed during first visit and also in successive visits. An average value for each of the above parameters was calculated for every patient and recorded to explain their individual status. Mortality data was collected from the patients expired during this period.

Results: 22 (10.38%) out of 212 patients were expired during the study period. 8 (36.36%) of them were males and 14 (63.64%) were females. The age of the expired patients at death varied from 5 to 73 years. 3 ( 13,64% ) patients died within 20 years of age,14 (63.64%) between 21-40 years, 2 ( 9.09% ) between 41 - 60 years and 3 ( 13.63% ) were above 60 years. Chronic Kidney Disease (CKD) was the cause of death for maximum number of patients (45.45%) followed by Diabetic Ketoacidosis (DKA, 18.18%),!3.63% died of Coronary Artery Disease, 9.09% of infections (pneumonia, encephalitis). Accidental and psycho-social reasons were present in 13.63%.

Conclusion: In this observational study, the total number of death observed was 22 out of 212 type 1 diabetic patients in this 22 years' period.CKD is the leading cause of death in this cohort, followed by DKA, Infection, and Coronary Artery Disease. Infection and DKA was found in the poor socio economic group. Some patients died of accident and other psycho social problem in the family. A regular communication with the patients made a lot of positive influence in our patients.