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Cardiovascular and Renal Disease Burden in Type 1 Compared With Type 2 Diabetes: A Two-Country Nationwide Observational Study

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posted on 02.03.2021, 17:31 by Robin Kristófi, Johan Bodegard, Anna Norhammar, Marcus Thuresson, David Nathanson, Thomas Nyström, Kåre I Birkeland, Jan W Eriksson
Objective: Type 1 (T1D) and type 2 diabetes (T2D) increase risks of cardiovascular and renal disease (CVRD) compared to diabetes-free populations. Direct comparisons between T1D and T2D are scarce. We examined this by pooling full-population cohorts in Sweden and Norway.

Research Design and Methods: 59,331 T1D and 484,241 T2D patients, aged 18-84 years, were followed over a mean period of 2.6 years from December 31, 2013. Patients were identified in nationwide prescribed drug and hospital registries in Norway and Sweden. Prevalence and event rates of myocardial infarction (MI), heart failure (HF), stroke, chronic kidney disease (CKD), all-cause death and cardiovascular death were assessed following age stratification in 5-year intervals. Cox regression analyses were used to estimate risk.

Results: The prevalence of cardiovascular disease was similar in T1D and T2D across age strata, whereas CKD was more common in T1D. Age-adjusted event-rates comparing T1D versus T2D showed that HF risk was increased between the ages 65-79 years, MI between 55-79 years and stroke between 40-54 years, 1.3-1.4-fold, 1.3-1.8-fold and 1.4-1.7 fold respectively. CKD risk was 1.4-3.0-fold higher in T1D at all ages. The all-cause death risk was 1.2-1.5-fold higher in T1D above 50 years, with a similar trend for CV death.

Conclusions: Adult T1D compared to T2D patients had an overall greater risk of cardiorenal disease (heart failure and CKD) across ages, of MI and all-cause death at middle-older ages and of stroke at younger ages. The total age-adjusted CVRD burden and risks were greater among T1D patients compared to T2D, highlighting their need for improved prevention strategies.

Funding

This work was sponsored and funded by AstraZeneca.

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