Adult-Onset Type 1 Diabetes Increases Risk of Cardiovascular Disease
Investigators also find that patients diagnosed with type 1 diabetes later in life do not have a better prognosis compared to those diagnosed earlier.
Patients who develop type 1 diabetes in adulthood have an increased risk of cardiovascular disease and death, according to results of a study published in the European Heart Journal. Further, patients that are diagnosed later in life do not have a better prognosis compared to those diagnosed earlier.1,2
Investigators also find that patients diagnosed with type 1 diabetes later in life do not have a better prognosis compared to those diagnosed earlier. | Image Credit: Michael O'Neill - stock.adobe.com
“The main reasons for the poor prognosis are smoking, overweight/obesity, and poor glucose control. We found that they were less likely to use assistive devices, such as insulin pumps,” Yuxia Wei, postdoctoral fellow at the Institute of Environmental Medicine, Karolinska Institutet, said in a news release.2
A recent study has shown that initiating treatment with angiotensin-converting enzyme (ACE) inhibitors, a known medication to reduce the risk of major adverse cardiac events (MACE), in older patients with type 2 diabetes lowered the trend in the risk of MACE compared with angiotensin II receptor blockers (ARB). ACEs and ARBs are used to treat heart failure, hypertension, chronic kidney disease, and coronary artery diseases. ACEs have been used to decrease MACE for patients with hypertension, increased cardiovascular risk, and diabetes.3
In another study, sodium-glucose cotransporter 2 inhibitor usage increased for patients with type 2 diabetes who were previously hospitalized with heart failure.4 There is a clear link between the risk of cardiovascular disease and diabetes; therefore, it is possible that some cardiovascular medications might benefit patients with type 1 diabetes, particularly those diagnosed later in life.
In the current study, investigators aimed to determine the prognosis of adult-onset type 1 diabetes, especially for patients 40 years and older. They used data from Sweden from 2001 to 2022, including all-cause mortality, cause-specific mortality, and incidence of cardiovascular disease for adult-onset type 1 diabetes, type 2 diabetes, and population controls.1
All patients with type 1 diabetes were matched by age, sex, and county to 50 population controls who did not have diabetes. The total population included 10,184 patients with type 1 diabetes, 373,523 with type 2 diabetes, and 509,172 population controls. Patients with cardiovascular disease at the start of the study were excluded for the cardiovascular analysis.1
Among the patients with type 1 diabetes, 40.3% were diagnosed at age 18 to 29 years, 21.3% at 30 to 39 years, and 38.3% at 40 years and older. For patients 40 years and older, they were more likely to be female and smokers and had higher blood pressure, triglycerides, and hemoglobin A1c. They were also more likely to have worse kidney function and more severe insulin resistance. Patients with type 1 diabetes were more likely to have higher hemoglobin A1c but lower prevalence of smoking and physical inactivity, as well as lower body mass index, blood pressure, and triglycerides compared to patients with type 2 diabetes.1
There were 816 deaths—with 202 from cardiovascular causes—and 361 MACE events for patients with type 1 diabetes compared with 26,888 deaths and 14,034 MACE events for controls and 90,921 deaths and 48,374 MACE events for patients with type 2 diabetes during a median follow-up of 10.2 years. For type 1 diabetes, the leading cause of death was diabetic coma or ketoacidosis for patients aged less than 40 and cardiovascular disease and cancer for those 40 years or older, compared with cardiovascular disease and cancer for both the population control and type 2 diabetes groups.1
All-cause mortality and most cause-specific mortality rates were high in the type 1 diabetes group compared to the controls as well as incidence of MACE. Death from diabetic coma or ketoacidosis for type 1 diabetes was approximately 7 times as high as patients with type 2 diabetes and was seen across all age groups and sexes. The investigators found that risk factors associated with all-cause mortality included smoking, having an unhealthy weight, physical inactivity, albuminuria, and an out of target hemoglobin A1c, blood pressure triglycerides, and eGFR.1
“Our findings imply that adult-onset T1D is characterized by a dual burden of acute and chronic complications. People diagnosed with T1D at age ≥40 years were more insulin resistant, had worse glycaemic control, were more likely to smoke, and less likely to use insulin pumps compared with those diagnosed at a younger age,” the study authors concluded.1 “We found that smoking, BMI, and HbA1c are the key contributors to adverse outcomes, accounting for ∼40% of cardiovascular events and 20% of deaths in people with adult-onset T1D.”
READ MORE: Diabetes Resource Center
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