Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
Top Cited Papers
- 13 April 2017
- journal article
- research article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 376 (15), 1407-1418
- https://doi.org/10.1056/nejmoa1608664
Abstract
Long-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes. We included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population. Among patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, −31.4 (95% confidence interval [CI], −56.1 to −6.7); death from cardiovascular disease, −26.0 (95% CI, −42.6 to −9.4); death from coronary heart disease, −21.7 (95% CI, −37.1 to −6.4); and hospitalization for cardiovascular disease, −45.7 (95% CI, −71.4 to −20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, −69.6 (95% CI, −95.9 to −43.2); death from cardiovascular disease, −110.0 (95% CI, −128.9 to −91.1); death from coronary heart disease, −91.9 (95% CI, −108.9 to −75.0); and hospitalization for cardiovascular disease, −203.6 (95% CI, −230.9 to −176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls. In Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. (Funded by the Swedish Association of Local Authorities and Regions and others.)Keywords
This publication has 37 references indexed in Scilit:
- Trends in Death Rates Among U.S. Adults With and Without Diabetes Between 1997 and 2006Diabetes Care, 2012
- IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030Diabetes Research and Clinical Practice, 2011
- All-Cause Mortality Trends in a Large Population-Based Cohort With Long-Standing Childhood-Onset Type 1 DiabetesDiabetes Care, 2010
- Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalencePopulation Health Metrics, 2010
- Glycemic Control and Cardiovascular Disease in 7,454 Patients With Type 1 DiabetesDiabetes Care, 2010
- Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 DiabetesNew England Journal of Medicine, 2008
- Effect of a Multifactorial Intervention on Mortality in Type 2 DiabetesNew England Journal of Medicine, 2008
- Efficacy of cholesterol-lowering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysisThe Lancet, 2008
- The Effect of Intensive Glycemic Treatment on Coronary Artery Calcification in Type 1 Diabetic Participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) StudyDiabetes, 2006
- Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34)The Lancet, 1998