medwireNews: Adults with type 1 diabetes have a greater exposure to cardiovascular and kidney disease (CVRD) than adults with type 2 diabetes, researchers report.
Johan Bodegard (AstraZeneca, Oslo, Norway) and colleagues used the full population registers in Sweden and Norway to calculate CVRD rates in 59,331 people with type 1 diabetes and 484,241 people with type 2 diabetes between 2013 and 2015-2016 to rate. The overall baseline CV disease rates were 13.3% and 26.2% in patients with type 1 and type 2 diabetes, respectively, and the corresponding chronic kidney disease (CKD) rates were 4.3% and 3, respectively , 3%.
In age-stratified analyzes, Bodegard et al. Noted that the baseline prevalence of CV diseases, including myocardial infarction, heart failure and stroke, was similar in people with type 1 and type 2 diabetes of all ages, with a “marked increase”. in prevalence rates among people aged 40 and over in both groups.
In contrast, they say the age-related increase in the base prevalence of CKD in people with type 1 diabetes “occurred earlier” compared to type 2 diabetes and “remained consistently higher in all age groups in people with type 1 diabetes “.
The researchers then assessed the incidence rates of CVRD events during an average follow-up of 2.6 years and found that the overall risk for each event was significantly higher in people with type 1 diabetes compared to type 2 diabetes regardless of age where the hazard ratios (HRs) ranged from 1.20 to 1.60 for the different age groups.
Heart failure was significantly more common in type 1 diabetes compared to type 2 diabetes between ages 65 and 79, with HRs ranging from 1.31 to 1.39. There was a similar pattern of outcomes for myocardial infarction in people aged 55 to 79 years with HRs of 1.30 to 1.79, but stroke frequency was only in the type 1 diabetes group in younger people aged 40 to 54 years HRs of 1.35 increased -1.72.
Consistent with baseline results, the follow-up incidence of CKD was higher in people with type 1 diabetes compared to type 2 diabetes in all age groups. However, the researchers note that “the differences between groups generally decreased with age,” with a HR of 2.95 for 40-44 year olds and 1.53 for 80-84 year olds.
In a subgroup analysis, Bodegard and colleagues found that the presence of a pre-existing CVRD at the start of the study changed the risk of future events, with the type 1 and type 2 diabetes groups having “almost the same risk” if no CVRD was present at the start of the study. On the other hand, the future risk of CVRD was increased in people with pre-existing disease with type 1 diabetes compared to type 2 diabetes.
Taken together, these results indicate that “patients with [type 1 diabetes] will benefit from a more intense strategy for both the primary and, in particular, the secondary prevention of CVRD, ”the Diabetes Care researchers conclude.
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Diabetes Care 2021; doi: 10.2337 / dc20-2839
