Risk of Cardiovascular Disease and Total Mortality in Adults with Type 1 Diabetes: Scottish Registry Linkage Study

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Background:
Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.

Methods and Findings:
The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4–3.8, p<0.001) than men (2.3: 2.0–2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, p<0.001) in men and 2.7 (2.2–3.4, p<0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ≥40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA_1c of <7% and 37% had very poor (≥9%) glycaemic control. Among those aged ≥40, 37% had blood pressures above even conservative targets (≥140/90 mmHg) and 39% of those ≥40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.

Conclusions:
Although the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Risk of Cardiovascular Disease and Total Mortality in Adults with Type 1 Diabetes: Scottish Registry Linkage Study. PLoS Med 9(10): e32767. doi:10.1371/journal.pmed.1001321
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001321

Souhrn

Zdroje

1. OrchardTJ, CostacouT, KretowskiA, NestoRW (2006) Type 1 diabetes and coronary artery disease. Diabetes Care 29: 2528–2538.

2. The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New Engl J Med 329: 977–986.

3. NathanDM, ClearyPA, BacklundJ-YC, GenuthSM, LachinJM, et al. (2005) Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. New Engl J Med 353: 2643–2653.

4. American Diabetes Association (2011) Standards of medical care in diabetes—2011. Diabetes Care 34: S11–S61.

5. Scottish Intercollegiate Guidelines Network (2010) SIGN 116: management of diabetes. A national clinical guideline. Available: http://www.sign.ac.uk/pdf/sign116.pdf. Accessed 14 March 2012.

6. Soedamah-MuthuSS, FullerJH, MulnierHE, RaleighVS, LawrensonRA, et al. (2006) High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care 29: 798–804.

7. SecrestAM, BeckerDJ, KelseySF, LaPorteRE, OrchardTJ (2010) All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes Care 33: 2573–2579.

8. MossSE, KleinR, KleinBE (1991) Cause-specific mortality in a population-based study of diabetes. Am J Public Health 81: 1158–1162.

9. Soedamah-MuthuSS, FullerJH, MulnierHE, RaleighVS, LawrensonRA, et al. (2006) All-cause mortality rates in patients with type 1 diabetes mellitus compared with a non-diabetic population from the UK general practice research database, 1992–1999. Diabetologia 49: 660–666.

10. NHS Connecting for Health (2011) Read codes. Available: http://www.connectingforhealth.nhs.uk/systemsandservices/data/uktc/readcodes. Accessed 14 March 2012.

11. The Scottish Government (2009) Scottish Health Survey, 2008. Available: http://scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-health-survey/Publications Accessed 14 March 2012.

12. KendrickS (1993) The Scottish Record Linkage System. Health Bulletin 51: 72–79.

13. RoperNA, BilousRW, KellyWF, UnwinNC, ConnollyVM (2002) Cause-specific mortality in a population with diabetes: South Tees Diabetes Mortality Study. Diabetes Care 25: 43–48.

14. RydénL, StandlE, BartnikM, Van den BergheG, BetteridgeJ, et al. (2007) Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: Executive summary. Eur Heart J 28: 88–136.

15. SchwabKO, DoerferJ, HeckerW, Grulich-HennJ, WiemannD, et al. (2006) Spectrum and prevalence of atherogenic risk factors in 27,358 children, adolescents, and young adults with type 1 diabetes: cross-sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care 29: 218–225.

16. World Health Organization (2011) WHO report on the global tobacco epidemic, 2011. Available: http://www.who.int/tobacco/surveillance/policy/country_profile/deu.pdf. Accessed 13 August 2012.

17. Centre for Disease Control (2008) Prevalence and trends data: nationwide (states, DC, and territories) - 2008 tobacco use. Available: http://apps.nccd.cdc.gov/brfss/display.asp?yr=2008&cat=TU&qkey=4396&state=US. Accessed 13 August 2012.

18. DeStefanoF, FordES, NewmanJ, StevensonJM, WetterhallSF, et al. (1993) Risk factors for coronary heart disease mortality among persons with diabetes. Ann Epidemiol 3: 27–34.

19. LaingSP, SwerdlowAJ, SlaterSD, BurdenAC, MorrisA, et al. (2003) Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 46: 760–765.

20. SkrivarhaugT, BangstadHJ, SteneLC, SandvikL, HanssenKF, et al. (2006) Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway. Diabetologia 49: 298–305.

21. HarjutsaloV, ForsblomC, GroopP-H (2011) Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. BMJ 343: d5364.

22. SecrestAM, BeckerDJ, KelseySF, LaPorteRE, OrchardTJ (2010) Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes 59: 3216–3222.

23. LaingSP, SwerdlowAJ, SlaterSD, BothaJL, BurdenAC, et al. (1999) The British Diabetic Association Cohort Study, I: all-cause mortality in patients with insulin-treated diabetes mellitus. Diabetic Med 16: 459–465.

24. PambiancoG, CostacouT, OrchardTJ (2007) The prediction of major outcomes of type 1 diabetes: a 12-year prospective evaluation of three separate definitions of the metabolic syndrome and their components and estimated glucose disposal rate: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes Care 30: 1248–1254.

25. DonovanPJ, McIntyreHD (2010) Achievement of cardiovascular risk factor targets in young adults with diabetes mellitus. Diabetes Metab Syndr Obes 16: 387–394.

26. SaundersSA, WallymhamedM, MacfarlaneIA (2009) Improvements in glycaemic control and cardiovascular risk factors in a cohort of patients with type 1 diabetes over a 5-year period. QJM 102: 29–34.

27. CalvertM, ShankarA, McManusRJ, LesterH, FreemantleN (2009) Effect of the quality and outcomes framework on diabetes care in the United Kingdom: retrospective cohort study. BMJ 338: b1870.

28. Soedamah-MuthuS, ChaturvediN, WitteD, StevensL, PortaM, et al. (2008) Relationship between risk factors and mortality in type 1 diabetic patients in Europe: the EURODIAB Prospective Complications Study (PCS). Diabetes Care 31: 1360–1366.

29. TolonenN (2008) Relationship between lipid profiles and kidney function in patients with type 1 diabetes. Diabetologia 51: 12–20.

30. CederholmJ, EliassonB, NilssonPM, WeissL, GudbjörnsdottirS (2005) Microalbuminuria and risk factors in type 1 and type 2 diabetic patients. Diabetes Res Clin Pract 67: 258–266.

31. ColhounHM, RubensMB, UnderwoodSR, FullerJH (2000) The effect of type 1 diabetes mellitus on the gender difference in coronary artery calcification. J Am Coll Cardiol 36: 2160–2167.

32. Scottish Diabetes Survey Monitoring Group (2010) Scottish diabetes survey 2010. Available: http://www.diabetesinscotland.org.uk/Publications/SDS%202010.pdf. Accessed 14 March 2012.

33. The Scottish Government (2011) Increase in insulin pumps. Available: http://www.scotland.gov.uk/News/Releases/2011/10/21153640. Accessed 14 March 2012.

34. Juvenile Diabetes Research Foundation (2011) JDRF-Funded study seeks to reduce cardiovascular risk in adults with Type 1 diabetes. Available: http://www.jdrf.org/index.cfm?page_id=116707. Accessed 14 March 2012.

35. Adolescent type 1 Diabetes cardio-renal Intervention Trial Research Group (2009) Adolescent type 1 Diabetes Cardio-renal Intervention Trial (AdDIT). BMC Pediatr 9: 79.