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Aims: There are few cohorts of type 1 diabetes that follow individuals over more than half a century in terms of health outcomes. The aim of this study was to examine associations between type 1 diabetes, diagnosed before age 18, and long-term morbidity and mortality, and to investigate whether cognitive ability plays a role in long-term morbidity and mortality risk. Methods: In a Swedish cohort, 120 men with type 1 diabetes and 469 without type 1 diabetes were followed between 18 and 77 years of age as regards morbidity and mortality outcomes, and impact of cognitive ability at military conscription for the outcomes. In Cox regression analyses and Kaplan-Meier analyses with log-rank tests, associations between diabetes and cognitive ability respectively, and outcomes (mortality, cardiovascular morbidity and diabetes complications) were investigated. Results: Men with type 1 diabetes suffered from dramatically higher mortality (HR 4.62, 95% CI: 3.56–5.60), cardiovascular mortality (HR 5.60, 95% CI: 3.27–9.57), and cardiovascular events (HR 3.97, 95% CI: 2.79–5.64) compared to men without diabetes. Higher cognitive ability at military conscription was associated with lower mortality in men without diabetes, but was not associated with any outcome in men with diabetes. Conclusions: In this historical cohort study with 60 years of follow-up time and a less effective treatment of diabetes than today, mortality rates and cardiovascular outcomes were high for men with type 1 diabetes. Morbidity or mortality did not differ between those that had low to normal or high cognitive ability among men with type 1 diabetes. CC BY-NC 4.0Correspondence Address: Dybjer, E.; Department of Clinical Sciences Malmö, Sweden; email: elin.dybjer@med.lu.seFirst published: 07 February 2022Funding informationthe Ernhold Lundström Foundation; The Anders Pålsson Foundation; Alzheimerfonden; the Regional Agreement on Medical Training and Clinical Research (ALF) between Skåne County Council and Lund University; Diabetesfonden; Novo Nordisk; Region Jönköpings läns; Vetenskapsrådet, Grant/Award Number: K2011- 65X- 20752- 04-6; Region Skåne

Studies on patients with long-term diabetes survival without severe complications can give information about protective factors. Therefore, the present study aims to describe the long-term survival of patients with diabetes during successive periods following the introduction of insulin therapy in 1923. After registration in 1973 of the first local diabetic patient in Jönköping with a fifty-year survival, this group has successively increased. Of those who were diagnosed during the period 1940 through 1949 there was a fifty-year survival in about one third. The successively better survival emphasises the importance of therapeutic progress. The study found no difference in diabetes control between those surviving 50 years and those with an age-matched group with a survival of 15 years. The insulin dose tended to decrease after 30 years duration. Peripheral vibration sensibility as well as renal function deteriorated by longer duration. The serum ratio of HDL-cholesterol to triglycerides increased. The frequency of glaucoma, cataract, and a history of myocardial infarction increased. In spite of long duration, one third of the sample had escaped serious retinopathy.