Diabetes Care
e1
High Illicit Drug Abuse and Suicide in
Organ Donors With Type 1 Diabetes
https://doi.org/10.2337/dc17-0996
embolism, or cerebral edema. Deaths
due to anoxia coincide with a history of
illicit substance abuse in 26% (15/57) of
cases, and the majority of individuals had
positive toxicology upon arrival to medical care. Acidosis (pH ,7.3 or HCO2
3 ,15
mEq/L) was present on admission in 71%
(56/79). Those with acidosis were younger (27 vs. 33 years, P , 0.05) and had
shorter disease duration (14 vs. 20 years,
P , 0.05) than those without acidosis.
Documented suicide was found in 8% of
the donors, with an average age at death
of 21 years and average diabetes duration
of 9 years. Three donors were under the
age of 18 years and committed suicide via
insulin overdose or a self-inflicted gunshot wound.
Similarly, a type 1 diabetes registry
from the U.K. found that 6% of subjects’
deaths were attributed to suicide (2). In
the U.S. in 2014, suicide was the 10th
leading cause of death in people of all
ages and the 2nd leading cause of death
in individuals aged 10–34 years (3). Additionally, we observed a high rate of illicit
substance abuse: 32% of donors reported
or tested positive for illegal substances
(excluding marijuana), and multidrug
use was common. Cocaine was the most
frequently abused substance. Alcohol use
was reported in 35% of subjects, with
marijuana use in 27%. By comparison,
16% of deaths in the U.K. study were
deemed related to drug misuse (2).
We fully recognize the implicit biases of
an organ donor–based population, which
may not be directly comparable to the
general population. Nevertheless, the
high rate of suicide and drug use should
continue to spur our energy and resources toward caring for the emotional
and psychological needs of those living
with type 1 diabetes. The burden of
type 1 diabetes extends far beyond
checking blood glucose and administering
insulin. The American Diabetes Association’s
2017 guidelines include recommendations for depression and diabetes-specific
distress screening (4,5). Still, more needs
to be done; when signs of depression,
difficulty coping, disordered eating, drug
use, or other self-harm behaviors are
identified, available mental health
care providers, preferably skilled in
type 1 diabetes, are needed.
Acknowledgments. The authors acknowledge
the nPOD staff members and organ procurement
organizations that partner with nPOD to recover
organ donors. Additional donor details can be
obtained through the JDRF nPOD website (www
.jdrfnpod.org). Donor data sets are available
through nPOD DataShare, an online database
1
Department of Pediatrics, University of Florida, Gainesville, FL
Diabetes Institute, University of Florida, Gainesville, FL
Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
4
Department of Pathology, University of Florida, Gainesville, FL
5
Department of Information Sciences, City of Hope National Medical Center, Duarte, CA
6
Department of Medicine, University of Miami, Miami, FL
2
3
Corresponding author: Desmond A. Schatz schatz@ufl.edu.
Received 17 May 2017 and accepted 13 June 2017.
© 2017 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit,
and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.
Diabetes Care Publish Ahead of Print, published online July 5, 2017
e-LETTERS – OBSERVATIONS
Organ donors with type 1 diabetes
represent a unique population for research. Through a combination of immunological, metabolic, and physiological
analyses, researchers utilizing such tissues seek to understand the etiopathogenic events that result in this disorder.
The Network for Pancreatic Organ Donors
with Diabetes (nPOD) program collects,
processes, and distributes pancreata and
disease-relevant tissues to investigators
throughout the world for this purpose
(1). Information is also available, through
medical records of organ donors, related
to causes of death and psychological factors, including drug use and suicide, that
impact life with type 1 diabetes.
We reviewed the terminal hospitalization records for the first 100 organ donors
with type 1 diabetes in the nPOD database, noting cause, circumstance, and
mechanism of death; laboratory results;
and history of illicit drug use. Donors were
45% female and 79% Caucasian. Mean
age at time of death was 28 years (range
4–61) with mean disease duration of
16 years (range 0.25–52). Causes of
death, based on death certificate, are
presented in Table 1. Anoxia was the
most common notation, precipitated
by a variety of events including drug overdose, myocardial infarction, pulmonary
Laura M. Jacobsen,1,2
Michael J. Haller,1,2 Alice Parish,3
Matthew J. Gurka,3 S. Robert Levine,1
Clive Wasserfall,2,4
Martha Campbell-Thompson,2,4
John Kaddis,5 Alberto Pugliese,6
Mark A. Atkinson,1,2,4 and
Desmond A. Schatz1,2
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Diabetes Care
Drug Abuse, Suicide, and Type 1 Diabetes
Table 1—Causes of death and prevalence of illicit drug abuse in the first 100 nPOD donors with type 1 diabetes
Donors, n
#18 years, n
.18 years, n
Male, n
Female, n
Mean type 1 diabetes duration, years
Cause of death
Anoxia
Cerebrovascular
Trauma
Renal disease
Suicide
Total
57
17
17
1
8
100
14
1
3
28
11
11
3
21
43
16
14
1
5
79
5
55
29
6
6
1
3
45
15
27
12
17
9
Illicit drug abuse
32
2
30
19
13
19
for collaborative communication organized
around the nPOD specimen repository.
Funding. This research was performed with the
support of the Network for Pancreatic Organ Donors
with Diabetes (nPOD), a collaborative type 1 diabetes research project sponsored by JDRF. Organ
procurement organizations partnering with nPOD
to provide research resources are listed at http://
www.jdrfnpod.org/for-partners/npod-partners/.
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
Author Contributions. L.M.J. researched the
data and wrote the manuscript. M.J.G. and A.P.
analyzed the data and reviewed and edited the
manuscript. M.J.H., S.R.L., C.W., M.C.-T., J.K.,
A.P., and M.A.A. contributed to the discussion
and reviewed and edited the manuscript. D.A.S.
conceptualized the project, contributed to the
discussion, and reviewed and edited the manuscript. D.A.S. is the guarantor of this work and, as
such, had full access to all the data in the study
and takes responsibility for the integrity of the
data and the accuracy of the data analysis.
Prior Presentation. Parts of this study were
presented at the 76th Scientific Sessions of the
American Diabetes Association, New Orleans,
LA, 10–14 June 2016.
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