Risk of cardiovascular disease and total mortality in adults with type 1 diabetes

Scottish registry linkage study

Shona J Livingstone, Helen C Looker, Eleanor J Hothersall, Sarah H Wild, Robert S Lindsay, John Chalmers, Stephen Cleland, Graham P Leese, John McKnight, Andrew D Morris, Donald W M Pearson, Norman R Peden, John R Petrie, Sam Philip, Naveed Sattar, Frank Sullivan, Helen M Colhoun

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Abstract

Background
Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.

Methods and Findings
The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged =20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4–3.8, p<0.001) than men (2.3: 2.0–2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, p<0.001) in men and 2.7 (2.2–3.4, p<0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were =40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA1c of <7% and 37% had very poor (=9%) glycaemic control. Among those aged =40, 37% had blood pressures above even conservative targets (=140/90 mmHg) and 39% of those =40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.

Conclusions
Although the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.
Original languageEnglish
Article numbere1001321
Number of pages11
JournalPLoS Medicine
Volume9
Issue number10
DOIs
Publication statusPublished - 2 Oct 2012

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Type 1 Diabetes Mellitus
Registries
Cardiovascular Diseases
Mortality
Population
Incidence
Databases
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Diabetic Ketoacidosis
Risk Management
Scotland
Coma
Developed Countries
Cause of Death
Insulin
Blood Pressure
Glucose
Therapeutics

Cite this

Livingstone, S. J., Looker, H. C., Hothersall, E. J., Wild, S. H., Lindsay, R. S., Chalmers, J., ... Colhoun, H. M. (2012). Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study. PLoS Medicine, 9(10), [e1001321]. https://doi.org/10.1371/journal.pmed.1001321

Risk of cardiovascular disease and total mortality in adults with type 1 diabetes : Scottish registry linkage study. / Livingstone, Shona J; Looker, Helen C; Hothersall, Eleanor J; Wild, Sarah H; Lindsay, Robert S; Chalmers, John; Cleland, Stephen; Leese, Graham P; McKnight, John; Morris, Andrew D; Pearson, Donald W M; Peden, Norman R; Petrie, John R; Philip, Sam; Sattar, Naveed; Sullivan, Frank; Colhoun, Helen M.

In: PLoS Medicine, Vol. 9, No. 10, e1001321, 02.10.2012.

Research output: Contribution to journalArticle

Livingstone, SJ, Looker, HC, Hothersall, EJ, Wild, SH, Lindsay, RS, Chalmers, J, Cleland, S, Leese, GP, McKnight, J, Morris, AD, Pearson, DWM, Peden, NR, Petrie, JR, Philip, S, Sattar, N, Sullivan, F & Colhoun, HM 2012, 'Risk of cardiovascular disease and total mortality in adults with type 1 diabetes: Scottish registry linkage study', PLoS Medicine, vol. 9, no. 10, e1001321. https://doi.org/10.1371/journal.pmed.1001321
Livingstone, Shona J ; Looker, Helen C ; Hothersall, Eleanor J ; Wild, Sarah H ; Lindsay, Robert S ; Chalmers, John ; Cleland, Stephen ; Leese, Graham P ; McKnight, John ; Morris, Andrew D ; Pearson, Donald W M ; Peden, Norman R ; Petrie, John R ; Philip, Sam ; Sattar, Naveed ; Sullivan, Frank ; Colhoun, Helen M. / Risk of cardiovascular disease and total mortality in adults with type 1 diabetes : Scottish registry linkage study. In: PLoS Medicine. 2012 ; Vol. 9, No. 10.
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abstract = "BackgroundRandomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.Methods and FindingsThe Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged =20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95{\%} CI 2.4–3.8, p<0.001) than men (2.3: 2.0–2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, p<0.001) in men and 2.7 (2.2–3.4, p<0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were =40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28{\%} of those with T1DM were current smokers, 13{\%} achieved target HbA1c of <7{\%} and 37{\%} had very poor (=9{\%}) glycaemic control. Among those aged =40, 37{\%} had blood pressures above even conservative targets (=140/90 mmHg) and 39{\%} of those =40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.ConclusionsAlthough the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.",
author = "Livingstone, {Shona J} and Looker, {Helen C} and Hothersall, {Eleanor J} and Wild, {Sarah H} and Lindsay, {Robert S} and John Chalmers and Stephen Cleland and Leese, {Graham P} and John McKnight and Morris, {Andrew D} and Pearson, {Donald W M} and Peden, {Norman R} and Petrie, {John R} and Sam Philip and Naveed Sattar and Frank Sullivan and Colhoun, {Helen M}",
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TY - JOUR

T1 - Risk of cardiovascular disease and total mortality in adults with type 1 diabetes

T2 - Scottish registry linkage study

AU - Livingstone, Shona J

AU - Looker, Helen C

AU - Hothersall, Eleanor J

AU - Wild, Sarah H

AU - Lindsay, Robert S

AU - Chalmers, John

AU - Cleland, Stephen

AU - Leese, Graham P

AU - McKnight, John

AU - Morris, Andrew D

AU - Pearson, Donald W M

AU - Peden, Norman R

AU - Petrie, John R

AU - Philip, Sam

AU - Sattar, Naveed

AU - Sullivan, Frank

AU - Colhoun, Helen M

PY - 2012/10/2

Y1 - 2012/10/2

N2 - BackgroundRandomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.Methods and FindingsThe Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged =20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4–3.8, p<0.001) than men (2.3: 2.0–2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, p<0.001) in men and 2.7 (2.2–3.4, p<0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were =40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA1c of <7% and 37% had very poor (=9%) glycaemic control. Among those aged =40, 37% had blood pressures above even conservative targets (=140/90 mmHg) and 39% of those =40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.ConclusionsAlthough the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.

AB - BackgroundRandomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.Methods and FindingsThe Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged =20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4–3.8, p<0.001) than men (2.3: 2.0–2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, p<0.001) in men and 2.7 (2.2–3.4, p<0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were =40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA1c of <7% and 37% had very poor (=9%) glycaemic control. Among those aged =40, 37% had blood pressures above even conservative targets (=140/90 mmHg) and 39% of those =40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.ConclusionsAlthough the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.

U2 - 10.1371/journal.pmed.1001321

DO - 10.1371/journal.pmed.1001321

M3 - Article

VL - 9

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 10

M1 - e1001321

ER -