International comparisons of IDDM mortality. Clues to prevention and the role of diabetes care.

A striking difference in all-cause mortality has been noted between individuals with insulin-dependent diabetes mellitus (IDDM) from Finland and Allegheny County, PA. Mortality rates among people 25-37 yr of age from the Allegheny County IDDM Registry were over two times greater than the rates observed from the Finland IDDM Registry. Applying the Finnish rate to the structure of the IDDM population from Allegheny County suggests that about one-half of the deaths in the Allegheny County cohort may be theoretically preventable. Most deaths that might be avoided appear to be caused by the acute complications of diabetes. Deaths from acute-related causes were higher (as a proportion of all deaths) in the Allegheny County cohort than in Finland (46.2 vs. 33.3%). There is some indication that barriers to health care may be present among individuals with IDDM in the United States. Individuals without health insurance from the Children's Hospital IDDM Registry in Pittsburgh had fewer physician visits than those with insurance. Even for those with insurance, out-of-pocket health-care expenses were significant. People with lower household incomes (less than $20,000) spent more, as a percentage of their income, on medical supplies than those with higher incomes and may have been less likely to monitor blood glucose levels and visit an eye doctor because of it. These findings suggest that health system barriers, such as the access to care and the financial burden of diabetes care, in the United States may be affecting the health of adults with IDDM. Further investigation is needed to clarify the extent of barriers to care in IDDM and their contribution to adverse health outcomes.