Type 1 diabetes (T1D), with its array of complications, increases the risk of mortality compared to the general population. Although advances in treatment since the 1980s have significantly reduced long-term morbidity, recent estimates of T1D mortality remain twice as high as the general population. The Allegheny County Insulin-dependent diabetes mellitus Registry (ACIR) consists of 1,075 persons diagnosed between 1965 and 1979 with T1D before 18 years of age in Allegheny County, Pennsylvania. The current research proposal aims to survey this cohort to determine: 1) population-based mortality rates for long-term T1D (25-40 yr duration) and factors associated with increased mortality;2) time trends of total and cause-specific mortality by diagnosis cohort;and 3) the prevalence of long-term diabetes complications in a population based cohort and factors associated with increased risk of morbidity. Initially, we will re-contact this population by mail with a health survey to ascertain vital status as of 1 January 2007. We will search both the Social Security Death Index and the National Death Index for persons we are unable to contact. We will calculate overall, sex-, and race-specific mortality rates and survival curves to examine risk differences by race and gender, and cumulative survival rates up to 40 years duration of diabetes. We will also calculate standardized mortality ratios based on local and national mortality statistics for the general population. Next, we will explore time trends of total and cause-specific mortality by diagnosis cohort, assessing variations by race and gender. Using regression analysis, we will examine an interaction between cohort and time to death to explore differential time trends in mortality. We will explore whether rates have continued to decline by diagnosis cohort between 2000 and 2007 as we previously reported up to 1999. We will also examine whether patterns in causes of death have changed over time. Finally, we will determine the prevalence of, and factors associated with, long-term diabetes complications in this large population-based cohort through a cross-sectional analysis of survey data. Based on surveys from the Pittsburgh EDC Study, we have developed a detailed survey that includes information on physician-diagnosed complications, diabetes treatment, and demographic and socioeconomic factors. Our ultimate goal is to determine factors associated with long-term morbidity and mortality in T1D that can be the focus of prevention efforts. Ideally, we expect mortality rates in T1D patients to continue to approach those of the general population.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Individual Predoctoral NRSA for M.D./Ph.D. Fellowships (ADAMHA) (F30)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-F16-Y (20))
Program Officer
Castle, Arthur
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Secrest, Aaron M; Prince, Catherine T; Costacou, Tina et al. (2013) Predictors of and survival after incident stroke in type 1 diabetes. Diab Vasc Dis Res 10:3-10
Shay, C M; Secrest, A M; Miller, R G et al. (2012) Femoral-gluteal adiposity is not associated with insulin sensitivity in type 1 diabetes. Diabet Med 29:1407-11
Secrest, Aaron M; Seethala, Raja R; Ferris, Laura K et al. (2011) Cutaneous apocrine carcinoma masquerading as head and neck cellulitis: an ominous sign. Arch Dermatol 147:1335-7
Secrest, Aaron M; Marshall, Sara L; Miller, Rachel G et al. (2011) Pulse wave analysis and cardiac autonomic neuropathy in type 1 diabetes: a report from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Technol Ther 13:1264-8
Secrest, A M; Becker, D J; Kelsey, S F et al. (2011) Characterizing sudden death and dead-in-bed syndrome in Type 1 diabetes: analysis from two childhood-onset Type 1 diabetes registries. Diabet Med 28:293-300
Secrest, Aaron M; Costacou, Tina; Gutelius, Bruce et al. (2011) Association of socioeconomic status with mortality in type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study. Ann Epidemiol 21:367-73
Secrest, Aaron M; Costacou, Tina; Gutelius, Bruce et al. (2011) Associations between socioeconomic status and major complications in type 1 diabetes: the Pittsburgh epidemiology of diabetes complication (EDC) Study. Ann Epidemiol 21:374-81
Prince, Catherine T; Secrest, Aaron M; Mackey, Rachel H et al. (2010) Augmentation pressure and subendocardial viability ratio are associated with microalbuminuria and with poor renal function in type 1 diabetes. Diab Vasc Dis Res 7:216-24
Secrest, Aaron M; Becker, Dorothy J; Kelsey, Sheryl F et al. (2010) Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes 59:3216-22
Orchard, T J; Secrest, A M; Miller, R G et al. (2010) In the absence of renal disease, 20ýýyear mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetologia 53:2312-9

Showing the most recent 10 out of 14 publications