Design: Retrospective registry cohort with 1:4 propensity-matched controls
Population: 4,299 people diagnosed with type 1 diabetes before age 35 (2000 to 2022) in an Israeli health network, and 17,196 controls
Primary outcome: All-cause mortality
Effect: HR 3.66 (95% CI 2.53 to 5.31); women HR 8.40 (3.71 to 19.04), men HR 2.90 (1.78 to 4.72)

This cohort drew on a validated registry in a large Israeli health network and matched each person diagnosed with type 1 diabetes before 35 to four people without diabetes of the same age and sex. Follow-up covered about 204,000 person-years and 112 deaths.

Type 1 diabetes was associated with mortality about 3.7 times higher than controls. The relative excess was much larger in women, though the absolute death rate remained higher in men because baseline male mortality is higher. People diagnosed after 2010 had a smaller excess than those diagnosed in the decade before.

The causes of death are not given in the abstract, so the study cannot say what drives the gap. It is a reminder that the survival disadvantage persists among young people in a well-resourced system, and that women are not protected.

Mortality was 131 per 100,000 person-years in type 1 diabetes against 35 in matched controls.
Relative excess was larger in women (HR 8.40) than in men (HR 2.90), though men died more often in absolute terms.
People diagnosed after 2010 had a smaller excess than those diagnosed in 2000 to 2010.
Use each review to check hypoglycaemia awareness, blood pressure, lipids and mental health, not only HbA1c.

Why it matters

Modern technology has narrowed but not closed the survival gap, and the relative burden falls more heavily on women than many clinicians assume.

The statistics, in plain English

A hazard ratio of 3.66 means deaths occurred at about 3.7 times the rate. The female estimate has a very wide interval (3.7 to 19) because there were few deaths, so the exact size is uncertain even though the direction is clear. Relative and absolute risk differ here: women had the larger relative excess, men the higher death rate.