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Type 1 Diabetes and Cardiovascular Disease

Apr 20, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: A'Kira Shavers,  PharmD Candidate, South College School of Pharmacy

Type 1 diabetes increases the risk of premature death from cardiovascular disease.

At the virtual 56th European Association for the Study of Diabetes (EASD) Annual Meeting, researchers stated the statistical fact that Australian adults who are diagnosed with type 1 diabetes most commonly die seven years earlier than patients without diabetes.  The researchers discovered the common denominator of this statistic was cardiovascular disease (CVD).  Timothy Davis, from the University of Western Australia in Fremantle, gave a thorough presentation about the risk of patients with type 1 diabetes compared to patients without diabetes for cardiovascular disease.  According to the American Heart Association, patients with insulin resistance combined with one or more heart disease risk factors are at even greater risk of heart disease.  Sixty-eight percent of patients with diabetes age 65 or older die from heart disease or stroke.   

 

Davis strongly voiced the concerning risk of premature death, and that “the need for optimal CVD risk reduction in patients with type 1 diabetes” is essential. The Fremantle Diabetes Study Phase I study was a longitudinal observational study design. This study had 121 participants diagnosed with type 1 diabetes and 484 without known diabetes but who matched the qualification of heart disease risk factors. In this specific study, the control group was selected based on their age, sex, and postcode. The average age of all the participants of the study was 43.1 years of age. The patients with diabetes were classified by their average age of diagnosis (29.5 years of age) and how long they have had type 1 diabetes (12 years average). In the study presentation, Davis concluded that 45.5 percent of patients with type 1 diabetes’ deaths were related to cardiovascular disease, compared to only 32.7% of the patients without type 1 diabetes.  One out of eight deaths were patients younger than 55 years old.   

The study had a mean 20.7-year follow-up (12,541 person-years) to analyze the risk of death, and it was found that patients with diabetes were three times more likely to die than the patients without diabetes. This correlates with the American Heart Association assessment of a patient with diabetes being two to four times more likely to die from cardiovascular disease.  Forty-five and a half percent of patients with type 1 diabetes and eighteen percent of patients without cardiovascular disease died during the follow-up.  The mortality rate of patients with diabetes was 25.7 per 1000 vs. 8.5 per 1000 patients without type 1 diabetes. Davis elaborated on the mortality rate, saying that the highest rate of excess mortality was noticed in patients between the ages of 35-44 years old.  This mortality rate lowered with an increase in age.  It was also seen that no deaths were younger than 35 years old in patients with type 1 diabetes.  During the study, there were three deaths from patients without diabetes due to suicide or drug misuse.  Davis also noted that the average age of death for diabetes patients was 6.6 years younger than the average age of death of patients without diabetes. This is less than the estimated 10-year loss in life expectancy of patients with type 1 diabetes and may be due to the older age at diagnosis in this study’s cohort.   

Davis concluded his presentation stating, “cardiovascular disease as the major cause of death, including at a relatively young age, is a concern and further justifies appropriately intensive risk management of glycemia and other nonglycemic cardiovascular risk factors in adults with type 1 diabetes.” Davis agrees with the American Heart Association on the importance of cardiovascular protection.  His trial emphasizes the need for protection and monitoring at an age lower than 65.   

 

Practice Pearls:  

  • Type 1 diabetes patients should be checked for cardiovascular diseases starting at age 35.   
  • Type 1 diabetes patients are more likely to die from cardiovascular disease than a patient without diabetes.   
  • It is essential to discuss cardiovascular risk factors with all patients but specifically those with type 1 diabetes.  These risk factors include high blood pressure, high triglycerides, abnormal cholesterol, obesity, lack of physical activity, and smoking.  

 

T.M.E. Davis et al, Mortality in community-based adults with type 1 diabetes and matched people without diabetes: the Fremantle Diabetes Study Phase I. EASD virtual meeting; 21–25 September 2020 

American Heart Association. Cardiovascular Disease and Diabetes. Retrieved October 07, 2020 

Laura Cowen, M. (2020, September 30). Community study quantifies excess mortality in type 1 diabetes. Retrieved October 07, 2020 

 

AKira Shavers, PharmD. Candidate, South College School of Pharmacy