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
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Circulation
Observational
February 2019
Background
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.
Methods
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.
Results
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.
Conclusions
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.
