This major observational study shows that the tight control of risk factors is associated with much lower rates of cardiovascular events and total mortality in patient with type 1 diabetes. Such factors are hyperglycemia, systolic blood pressure, protein in the urine, and the “bad” cholesterol (A1c, sBP, McAlb, LDLc).
This association has already been seen in adults with type 2 diabetes. For a practitioner, this study calls for a tight control of the above risk factors in patients with type 1 diabetes as in those with type 2. A group of 30,000 DM1 individuals were followed for about 10 years
The strength of association and optimal levels for risk factors related to excess risk of death and cardiovascular outcomes in type 1 diabetes have been sparsely studied.
In a national observational cohort study from the Swedish National Diabetes Register from 1998-2014, we assess relative prognostic importance of 17 risk factors for death and cardiovascular outcomes in persons with type 1 diabetes.
We used Cox regression and machine learning analyses. In addition, we examined optimal cut-point levels for glycated hemoglobin, systolic blood pressure and low-density lipoprotein cholesterol. Patients with type 1 diabetes were followed until death or study end on December 31, 2013.
The primary outcomes were death from all causes, fatal/non-fatal acute myocardial infarction, fatal/non-fatal stroke and hospitalization for heart failure.
Of 32,611 patients with type 1 diabetes, 1,809 (5.5 %) died during follow-up over 10.4 years.
- The strongest predictors for death and cardiovascular outcomes were A1c, albuminuria, duration of diabetes, systolic blood pressure and LDLc.
- Glycated hemoglobin displayed approximately 22% per % HbA1c difference, whereas LDLc was associated with 35-50% greater risk for each ~40 mg/dL increase.
- Micro- or macro-albuminuria was associated with 2-4 times greater risk for cardiovascular complications and death.
- A1c <7.0%, sBP <140 mmHg and LDLc <100 mg/dL were associated with significantly lower risk for outcomes observed.
Glycated hemoglobin, albuminuria, duration of diabetes, systolic blood pressure and low-density lipoprotein cholesterol appear the most important predictors for mortality and cardiovascular outcomes in patients with type 1 diabetes.
LOWER levels for glycated hemoglobin, systolic blood pressure and low-density lipoprotein cholesterol than contemporary guideline target levels appear to be associated with significantly lower risk for outcomes.