Type 1 Diabetes

Type 1 Diabetes: Younger Age at Diagnosis Heightens CV, Mortality Risks

In patients with type 1 diabetes, younger age at diabetes onset is associated with worse cardiovascular (CV) outcomes and mortality, according to new research.

 

This finding emerged from a study of 27,195 individuals with type 1 diabetes from the Swedish National Diabetes Register and 135,178 matched controls from the general population. Median follow-up lasted 10 years.

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Patients with type 1 diabetes were categorized into 1 of 5 groups based on age at diagnosis:

 

  • 0 years to 10 years
  • 11 years to 15 years
  • 16 years to 20 years
  • 21 years to 25 years
  • 26 years to 30 years

 

Cox regression was used to estimate the excess risk of all-cause mortality, CV mortality, non-CV mortality, acute myocardial infarction (MI), stroke, coronary heart disease, heart failure (HF), atrial fibrillation (AF), and cardiovascular disease (CVD)—defined as a composite of acute MI and stroke. Results were adjusted for diabetes duration.

 

Over the course of follow-up, 959 patients with type 1 diabetes and 1501 controls had died. Findings from the study indicated that the risks for CV events and mortality were highest among patients who were younger at the time of diabetes diagnosis.

 

Among patients who were aged 0 to 10 years at the onset of type 1 diabetes, hazard ratios were:

 

  • 4.11 for all-cause mortality
  • 7.38 for CV mortality
  • 3.96 for non-CV mortality
  • 11.44 for CVD
  • 30.50 for coronary heart disease
  • 30.95 for acute MI
  • 6.45 for stroke
  • 12.90 for HF
  • 1.17 for AF

 

The overall incidence rate for all-cause mortality was 1.9 per 100,000 person-years for patients with type 1 diabetes. This was the highest overall incidence rate observed in the study.

 

Perhaps most notably, women and men who developed type 1 diabetes before age 10 years lost approximately 17.7 life-years and 14.2 life-years, respectively.

 

“Age at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in women,” the researchers concluded. “Greater focus on cardioprotection might be warranted in people with early-onset type 1 diabetes.”

 

—Christina Vogt

 

Reference:

Rawshani A, Sattar N, Franzén S, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018;392(10146):477-486. https://doi.org/10.1016/S0140-6736(18)31506-X.