February 05, 2018
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Ischemic heart disease risk four times higher in adults with type 1 diabetes vs. without diabetes

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In the first 10 years after a type 1 diabetes diagnosis the risk for death from acute diabetes complications is increased, and in the years following, those who remain free of albuminuria have four times the risk for death from ischemic heart disease compared with adults without diabetes, study data show.

Per-Henrik Groop, MD, PhD, professor of nephrology at the University of Helsinki in Finland, and colleagues evaluated data from a population-based Finnish register on 10,737 adults diagnosed with type 1 diabetes during childhood between 1980 and 2005 who were followed for 10 years (early diabetes cohort) and data from the Finnish Diabetic Nephropathy Study (FinnDiane) on 2,544 adults with long-standing diabetes. The general Finnish population and 6,655 controls without diabetes were used to compare mortality rates. Researchers sought to determine whether the risk for mortality in patients with type 1 diabetes without signs of albuminuria is different from that of the general population and controls without diabetes.

Participants from the early diabetes cohort had a median age of 18.3 years and median age of diabetes onset of 8.3 years. There were 84 deaths in the 10 years following diagnosis, for a mortality rate of 7.85 deaths per 10,000 person-years. The standardized mortality ratio (SMR) increased during the first 10 years after diagnosis when the group was compared with the age- and sex-matched Finnish population (SMR = 2.58; 95% CI, 2.07-3.18; P < .001). Acute diabetes complications were the main cause of death.

Participants from the FinnDiane study had a median age of 36.3 years and median duration of diabetes of 16.2 years. There were 117 deaths over a median follow-up of 14 years for a mortality rate of 33.9 deaths per 10,000 person-years. No difference was observed for deaths between FinnDiane participants and the general Finnish population; however, FinnDiane participants had a higher risk for mortality compared with controls without diabetes (SMR = 1.33; 95% CI, 1.06-1.66; P = .01). Ischemic heart disease was the most frequent cause of death in FinnDiane participants, and the risk was four times higher compared with controls without diabetes (SMR = 4.34; 95% CI, 2.49-7.57; P < .0001). Deaths due to “risk-taking” behaviors were lower in the adults with type 1 diabetes compared with controls without diabetes (SMR = 0.42; 95% CI, 0.22-0.79; P = .006).

“These findings reinforce the importance of early strategies for preventing, slowing, arresting or reversing all diabetes complications,” the researchers wrote. “Hypoglycemia and ketoacidosis remain major barriers both in early and advanced diabetes — in childhood and in adulthood. In long-term diabetes, avoiding chronic complications may be associated with mortality rates comparable with those of the general population; although death from [ischemic heart disease] remains increased, this is offset by reduced risk-taking behavior, especially in men.” – by Amber Cox

Disclosures: Groop reports he receives lecture honorariums from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Elo Water, Genzyme, Merck Sharp & Dohme and Novartis and is an advisory board member of AbbVie, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme and Novartis. Please see the study for all other authors’ relevant financial disclosures.