Potential years of life lost and factors associated with different causes of death in type 1 diabetes in Finland

AIMS: To assess the potential years of life loss (PYLL) due to different causes of death among individuals with type 1 diabetes in Finland, and to identify factors associated with the leading causes of death contributing most to PYLL. METHODS: All 45,801 individuals with type 1 diabetes in the Finnish Diabetes Registry during the period 2018-2022 were included. Cause-of-death data were obtained from Statistics Finland. PYLL were calculated as the sum of deaths multiplied by the difference between age 80 and age at death. The incidence rate ratios for cause-specific mortality were estimated with multivariable Poisson regression. RESULTS: Diabetes-related deaths had the greatest impact on PYLL, with an average of 20.2 years of life lost per death, accounting for a total of 12,691 years of life lost, consisting of severe hypoglycaemia (657 PYLL), ketoacidosis (4380 PYLL) and complications of diabetes (7654 PYLL). Cardiovascular diseases (8630 PYLL), cancer (4549 PYLL) and alcohol- and substance-related causes (3146 PYLL) were the next largest contributors to PYLL. In the multivariable Poisson analysis, age at onset of diabetes, age at beginning of follow-up, HbA1c ≥ 64 mmol/mol (≥ 8%), LDL-cholesterol ≥ 2.6 mmol/l, renal risk group, recorded end-stage renal disease, cardiovascular diseases and alcohol or substance abuse were associated with diabetes-related mortality. CONCLUSIONS: These findings emphasise the need for intensified prevention strategies focusing on modifiable risk factors, timely detection and management of complications, and comprehensive support for individuals at increased risk to reduce premature mortality in type 1 diabetes.