Researchers suggest implementation of cardioprotective medications sooner than current guideline recommendations.
Scientists in Sweden and the UK found in a recent study that women who were diagnosed with type 1 diabetes before the age of 10 had a shorter life span by an average of 17.7 years (95% CI 14.5-20.4). Men who were diagnosed before the age of 10 lost an average of 14.2 years off their life (95% CI 12.1-18.2) compared to people without diabetes. Later development of the disease, from ages 26–30, showed an average reduction in lifespan by 10 years for both men and women.
“These are disappointing and previously unknown figures,” says Araz Rawshani, M.D., Ph.D., from Sahlgrenska Academy, University of Gothenburg. “The study suggests that we must make an even greater effort to aggressively treat patients diagnosed at an early age to reduce the risk of complications and premature death.”
Researchers analyzed data from over 27,000 patients in the Swedish National Diabetes Register and grouped them into five categories based on age at the diagnosis of type 1 diabetes: 1–10 years, 11–15 years, 16–20 years, 21–25 years, and 26–30 years. Scientists investigated the related risk of T1D to all-cause mortality, cardiovascular and noncardiovascular mortality, acute myocardial infarction, stroke, cardiovascular disease, coronary artery disease, heart failure, and atrial fibrillation. The results were as follows:
- Cardiovascular mortality: HR 7.38 (95% CI 3.65-14.94)
- Cardiovascular disease: HR 11.44 (95% CI 7.95-16.44)
- Coronary heart disease: HR 30.50 (95% CI 19.98-46.57)
- Acute MI: HR 30.95 (95% CI 17.59-54.45)
- Stroke: HR 6.45 (95% CI 4.04-10.31)
- Heart failure: HR 12.90 (95% CI 7.39-22.51)
- Atrial fibrillation: HR 1.17 (95% CI 0.62-2.20)
The majority of cardiovascular disease was more common in women than men. Shockingly, women diagnosed with T1D before the age of 10 had a nearly 60-times higher risk for coronary heart disease (HR 58.73, 95% CI 28.86-119.55), and more than 92-times higher risk for acute MI (HR 92.07, 95% CI 32.72-253.47) when compared to patients without diabetes.
Despite age of diagnosis, all patients with type 1 diabetes had a higher risk for all-cause mortality. Therefore, researchers suggest initiating cardioprotective medications, such as statins and drugs that lower blood pressure, sooner than what current guidelines recommended. Educating patients on the importance of smoking cessation, when warranted, is also recommended.
Future studies point to alternative ways to lower cardiovascular risk in patients diagnosed with type 1 at a young age. An earlier initiation of non-insulin adjunctive medications, such as Invokana, can improve glucose levels and reduce risk of cardiovascular disease without the side effect of weight gain. “Management of type 1 diabetes is nowadays highly sophisticated, with modern tools for glucose monitoring, delivery of insulin and management of cardiovascular risk factors,” Dr. Rawshani commented. “Those who live with diabetes today, and those who will acquire the disease, will enjoy longer and healthier lives in the years to come.”
- Women who were diagnosed with T1D before the age of 10 had a shorter life span by an average of 17.7 years and men who were diagnosed before the age of 10 lost an average of 14.2 years off their lives compared to people without diabetes.
- Women were shown to have an alarmingly higher risk of heart-related complications compared to men after diagnosis with T1D before the age of 10
- Researchers suggest starting patients with type 1 on cardioprotective medications sooner than the current guidelines recommend (< 30 years old).
- This new evidence suggests that survival largely depends on the age at which the T1D is diagnosed.
Rawshani A, 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: 477-486.
Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy