Type 1 diabetes mortality gap narrows but persists, and widest in women

The edition in brief

An Israeli registry cohort of 4,299 people diagnosed with type 1 diabetes before 35 found all-cause mortality 3.7 times that of matched controls (HR 3.66, 95% CI 2.53 to 5.31). Excess mortality was larger in females (adjusted HR 8.40) than males (2.90), though absolute rates were higher in men, and it was lower for those diagnosed from 2011 onwards. A Swedish register study of 34,155 adults found each extra year of age at diagnosis was associated with 1.7% lower mortality, with the highest excess risk when diagnosis came before age 10 (HR 3.23). A Medicare claims analysis (EMPRISE) found empagliflozin associated with fewer cardiovascular events than DPP-4 inhibitors, and fewer heart failure admissions than GLP-1 receptor agonists, with no heterogeneity across sociodemographic groups. A Gulf-region expert consensus sets out a stepwise approach to diabetic foot ulcers, but it is consensus rather than trial evidence. Finally, in 422 US youth, the insulin dose-adjusted HbA1c cut-off of 9 or below detected C-peptide-defined partial remission with only 61% sensitivity, falling to 45% in those with overweight or obesity.