Why is diabetes killing so many teenagers?

Young British men have a problem with diabetes. Recent studies have highlighted that death rates from type 1 diabetes in boys and men aged 15 to 24 years have almost doubled since 2000 in the UK. This is higher than reported death rates among young men with diabetes in other European countries. Why has type 1 diabetes become such a problem for our young people?

Overall, about 10% of people with diabetes have type 1 diabetes. The condition is caused when the immune system makes a mistake. The cells in the pancreas that make insulin are crucial for controlling blood glucose levels, but in a patient with type 1 diabetes the immune system treats these cells as a threat and targets them for destruction.

When about 70% of these “beta cells” have been destroyed there is no longer enough insulin to control blood sugars, which means the patient will need daily insulin injections. The condition is more common in children and young people with an average age at onset of 12 years.

Young people dying as a result of type 1 diabetes is rare but is possible if the condition is not diagnosed quickly. The disease is associated with increased risk of health complications, with particularly detrimental effects on the kidneys and eyes if the condition is not well managed. And poor management of insulin treatment can lead to blood glucose levels getting too high or too low, which can also cause death.

Type 1 diabetes is a growing problem in most developed countries, with particular increases among young people. From our research, as well as other studies, we know that the incidence of type 1 diabetes is increasing at a rate of 3% per year in most European populations. The rate is even higher in children diagnosed under the age of 5 years.

The cause for this increase in the number of people diagnosed with type 1 diabetes is unclear. Certain genes occur more often in people with the disease but these genes are not becoming more frequent. Instead, it appears that some factors in our environment are increasing the risk of type 1 diabetes.

Several factors mean young men can poorly manage their diabetes, potentially resulting in death.Momboluem/flickr, CC BY-NC-ND

A lot of research is ongoing trying to determine what these factors are and how they contribute to the increasing numbers of people with the condition. In particular, a study called The Environmental Determinants of Diabetes in the Young (TEDDY) is examining early-life events including diet changes and viral infections.

But the increasing rates of type 1 diabetes cannot explain the rising death rate among young British men, because we know incidence of the disease is growing at similar rates in other European populations – but the diabetes-related deaths aren’t rising at the same rate.

Poor management of diabetes can result from a combination of factors including changes during puberty, the lack of engagement by teenage boys with the healthcare system, and other social factors during a time in their lives when they may start living away from home. During this same period, young men in the UK also transition from childhood to adult NHS services and this could result in loss of follow-up for some patients.

National data showing increased rates of diabetes-related complications in teenagers supports the view that there is an urgent need to focus on this age group. We need to ensure that all young people with diabetes attend all clinic appointments and that there is a support mechanism in place for those who have difficulties coping with their condition.

Perhaps research studies could be designed to establish whether social networks could be used to help young people who manage their diabetes well to help those who have problems.

Ultimately, if successful, this could save lives and save the NHS money by helping to prevent conditions such as diabetic kidney disease.

Kathleen Gillespie receives funding from Diabetes UK and the Juvenile Diabetes Research Foundation.