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Diabetologia

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01-04-2019 | Type 1 Diabetes | Article

Effect of duration and burden of microvascular complications on mortality rate in type 1 diabetes: an observational clinical cohort study

Authors: Lasse Bjerg, Adam Hulman, Bendix Carstensen, Morten Charles, Daniel R. Witte, Marit E. Jørgensen

Published in: Diabetologia | Issue 4/2019

Abstract

Aims/hypothesis

The role of burden and duration of multiple microvascular complications on mortality rate has not been explored in detail in type 1 diabetes. Taking complication burden and time-updated duration into account we aimed to quantify mortality rate in individuals with and without microvascular complications.

Methods

This observational clinical cohort included 3828 individuals with type 1 diabetes attending the Steno Diabetes Center Copenhagen in 2001–2013. We used information on mortality and detailed clinical measures of microvascular complications from electronic patient records. Poisson models were used to model mortality rates according to complication burden.

Results

During 26,665 person-years of follow-up, 503 deaths occurred. Compared with individuals without microvascular complications, the mortality rate ratio was 2.20 (95% CI 1.79, 2.69) for individuals with diabetic kidney disease, 1.72 (95% CI 1.39, 2.12) for individuals with neuropathy and 1.02 (95% CI 0.77, 1.37) for individuals with retinopathy, all adjusted for calendar time (year/month/day), age, duration of diabetes, sex, HbA_1c, LDL-cholesterol, BMI, smoking status, systolic blood pressure, use of antihypertensive and lipid-lowering medication, and cardiovascular disease status. In individuals with two complications or more, the risk of mortality did not exceed the combined risk from each individual complication. Mortality rate ratios increased immediately after diagnosis of neuropathy and diabetic kidney disease. Mortality rate ratios were independent of the duration of neuropathy and retinopathy, while the mortality rate associated with diabetic kidney disease reached a stable level after approximately 3 years.

Conclusions/interpretation

Neuropathy and diabetic kidney disease are strong and independent risk markers of mortality in type 1 diabetes, whereas no evidence of higher mortality rate was found for retinopathy. We found no indication that the mortality risk with multiple complications exceeds the risk conferred by each complication separately. The duration spent with microvascular complications had only a marginal effect on mortality.

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Title: Effect of duration and burden of microvascular complications on mortality rate in type 1 diabetes: an observational clinical cohort study
Authors: Lasse Bjerg
Adam Hulman
Bendix Carstensen
Morten Charles
Daniel R. Witte
Marit E. Jørgensen
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Keyword: Type 1 Diabetes
Published in: Diabetologia / Issue 4/2019
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-4812-6

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