Duration of diabetes-related complications and mortality in type 1 diabetes : a national cohort study
© The Author(s) 2021; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association..
BACKGROUND: People with type 1 diabetes often live for many years with different combinations of diabetes-related complications. We aimed to quantify how complication duration and total complication burden affect mortality, using data from national registers.
METHODS: This study included 33 396 individuals with type 1 diabetes, registered in the Swedish National Diabetes Register at any time between 2001 and 2012. Each individual was followed and classified according to their time-updated diabetes-related complication status. The main outcomes were all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. Poisson models were used to estimate the rate of these outcomes as a function of the time-updated complication duration.
RESULTS: Overall, 1748 of the 33 396 individuals died during 198 872 person-years of follow-up. Overall, the time-updated all-cause mortality rate ratio (MRR) was 2.25 [95% confidence interval (CI): 1.99-2.54] for patients with diabetic kidney disease, 0.98 (0.82-1.18) for patients with retinopathy and 4.00 (3.56-4.50) for patients with cardiovascular disease relative to individuals without complications. The excess rate was highest in the first period after a diagnosis of CVD, with an 8-fold higher mortality rate, and stabilized after some 5 years. After diagnosis of diabetic kidney disease, we observed an increase in all-cause mortality with an MRR of around 2 compared with individuals without diabetic kidney disease, which stabilized after few years.
CONCLUSIONS: In this cohort we show that duration of diabetes-related complications is an important determinant of mortality in type 1 diabetes, for example the MRR associated with CVD is highest in the first period after diagnosis of CVD. A stronger focus on time-updated information and thorough consideration of complication duration may improve risk stratification in routine clinical practice.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:50 |
|---|---|
| Enthalten in: |
International journal of epidemiology - 50(2021), 4 vom: 30. Aug., Seite 1250-1259 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Bjerg, Lasse [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Diabetes-related complications |
|---|
| Anmerkungen: |
Date Completed 04.10.2021 Date Revised 04.10.2021 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1093/ije/dyaa290 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM320153479 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM320153479 | ||
| 003 | DE-627 | ||
| 005 | 20231225172955.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1093/ije/dyaa290 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1067.xml |
| 035 | |a (DE-627)NLM320153479 | ||
| 035 | |a (NLM)33452524 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Bjerg, Lasse |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Duration of diabetes-related complications and mortality in type 1 diabetes |b a national cohort study |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 04.10.2021 | ||
| 500 | |a Date Revised 04.10.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2021; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association. | ||
| 520 | |a BACKGROUND: People with type 1 diabetes often live for many years with different combinations of diabetes-related complications. We aimed to quantify how complication duration and total complication burden affect mortality, using data from national registers | ||
| 520 | |a METHODS: This study included 33 396 individuals with type 1 diabetes, registered in the Swedish National Diabetes Register at any time between 2001 and 2012. Each individual was followed and classified according to their time-updated diabetes-related complication status. The main outcomes were all-cause mortality, cardiovascular (CV) mortality and non-CV mortality. Poisson models were used to estimate the rate of these outcomes as a function of the time-updated complication duration | ||
| 520 | |a RESULTS: Overall, 1748 of the 33 396 individuals died during 198 872 person-years of follow-up. Overall, the time-updated all-cause mortality rate ratio (MRR) was 2.25 [95% confidence interval (CI): 1.99-2.54] for patients with diabetic kidney disease, 0.98 (0.82-1.18) for patients with retinopathy and 4.00 (3.56-4.50) for patients with cardiovascular disease relative to individuals without complications. The excess rate was highest in the first period after a diagnosis of CVD, with an 8-fold higher mortality rate, and stabilized after some 5 years. After diagnosis of diabetic kidney disease, we observed an increase in all-cause mortality with an MRR of around 2 compared with individuals without diabetic kidney disease, which stabilized after few years | ||
| 520 | |a CONCLUSIONS: In this cohort we show that duration of diabetes-related complications is an important determinant of mortality in type 1 diabetes, for example the MRR associated with CVD is highest in the first period after diagnosis of CVD. A stronger focus on time-updated information and thorough consideration of complication duration may improve risk stratification in routine clinical practice | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Type 1 diabetes | |
| 650 | 4 | |a diabetes-related complications | |
| 650 | 4 | |a epidemiology | |
| 650 | 4 | |a mortality | |
| 700 | 1 | |a Gudbjörnsdottir, Soffia |e verfasserin |4 aut | |
| 700 | 1 | |a Franzén, Stefan |e verfasserin |4 aut | |
| 700 | 1 | |a Carstensen, Bendix |e verfasserin |4 aut | |
| 700 | 1 | |a Witte, Daniel R |e verfasserin |4 aut | |
| 700 | 1 | |a Jørgensen, Marit E |e verfasserin |4 aut | |
| 700 | 1 | |a Svensson, Ann-Marie |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t International journal of epidemiology |d 1975 |g 50(2021), 4 vom: 30. Aug., Seite 1250-1259 |w (DE-627)NLM00011930X |x 1464-3685 |7 nnns |
| 773 | 1 | 8 | |g volume:50 |g year:2021 |g number:4 |g day:30 |g month:08 |g pages:1250-1259 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1093/ije/dyaa290 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 50 |j 2021 |e 4 |b 30 |c 08 |h 1250-1259 | ||