Excess mortality in patients with type 1 diabetes without albuminuriadseparating the contribution of early and late risks

Per Henrik Groop, Merlin Thomas, Maija Feodoroff, Carol Forsblom, Valma Harjutsalo

Research output: Contribution to journalArticleResearchpeer-review

Abstract

OBJECTIVE The current study investigated whether the risk of mortality in patients with type 1 diabetes without any signs of albuminuria is different than in the general population and matched control subjects without diabetes. RESEARCH DESIGN AND METHODS We studied a nationwide, population-based Finnish register of 10,737 patients diagnosed with type 1 diabetes during 1980-2005 and followed for 10 years and 2,544 adults with long-stanDing diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane).Mortality was compared with the general Finnish population and 6,655 control subjects without diabetes. RESULTS The standardized mortality ratio (SMR) was increased during the first 10 years after the diagnosis (2.58 [95% CI 2.07-3.18], P<0.001). Mortality in adults with longstanDing diabetes, but without albuminuria, was no different from that of the general population (1.02 [0.84-1.22], P = 0.83). However, it was higher compared with that of control subjectswithout diabetes (1.33 [1.06-1.66], P = 0.01). Excessmortality was largely due to acute diabetes complications and ischemic heart disease, which remained more than fourfold higher (mortality rate ratio 4.34 [2.49-7.57]) in adults with type 1 diabetes than in control subjectswithout diabetes, despite the absence of albuminuria. By contrast, deaths due to alcohol and drugs were reduced in adults with type 1 diabetes (P = 0.007), especially in men. CONCLUSIONS Excess mortality in type 1 diabetes is the result of its complications. Acute complications drive an increased SMR in the first years. In individuals who remain free of albuminuria, mortality due to ischemic heart disease is still four times higher, and acute complications also occur.

Original languageEnglish
Pages (from-to)748-754
Number of pages7
JournalDiabetes Care
Volume41
Issue number4
DOIs
Publication statusPublished - 1 Apr 2018

Cite this

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title = "Excess mortality in patients with type 1 diabetes without albuminuriadseparating the contribution of early and late risks",
abstract = "OBJECTIVE The current study investigated whether the risk of mortality in patients with type 1 diabetes without any signs of albuminuria is different than in the general population and matched control subjects without diabetes. RESEARCH DESIGN AND METHODS We studied a nationwide, population-based Finnish register of 10,737 patients diagnosed with type 1 diabetes during 1980-2005 and followed for 10 years and 2,544 adults with long-stanDing diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane).Mortality was compared with the general Finnish population and 6,655 control subjects without diabetes. RESULTS The standardized mortality ratio (SMR) was increased during the first 10 years after the diagnosis (2.58 [95{\%} CI 2.07-3.18], P<0.001). Mortality in adults with longstanDing diabetes, but without albuminuria, was no different from that of the general population (1.02 [0.84-1.22], P = 0.83). However, it was higher compared with that of control subjectswithout diabetes (1.33 [1.06-1.66], P = 0.01). Excessmortality was largely due to acute diabetes complications and ischemic heart disease, which remained more than fourfold higher (mortality rate ratio 4.34 [2.49-7.57]) in adults with type 1 diabetes than in control subjectswithout diabetes, despite the absence of albuminuria. By contrast, deaths due to alcohol and drugs were reduced in adults with type 1 diabetes (P = 0.007), especially in men. CONCLUSIONS Excess mortality in type 1 diabetes is the result of its complications. Acute complications drive an increased SMR in the first years. In individuals who remain free of albuminuria, mortality due to ischemic heart disease is still four times higher, and acute complications also occur.",
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Excess mortality in patients with type 1 diabetes without albuminuriadseparating the contribution of early and late risks. / Groop, Per Henrik; Thomas, Merlin; Feodoroff, Maija; Forsblom, Carol; Harjutsalo, Valma.

In: Diabetes Care, Vol. 41, No. 4, 01.04.2018, p. 748-754.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Excess mortality in patients with type 1 diabetes without albuminuriadseparating the contribution of early and late risks

AU - Groop, Per Henrik

AU - Thomas, Merlin

AU - Feodoroff, Maija

AU - Forsblom, Carol

AU - Harjutsalo, Valma

PY - 2018/4/1

Y1 - 2018/4/1

N2 - OBJECTIVE The current study investigated whether the risk of mortality in patients with type 1 diabetes without any signs of albuminuria is different than in the general population and matched control subjects without diabetes. RESEARCH DESIGN AND METHODS We studied a nationwide, population-based Finnish register of 10,737 patients diagnosed with type 1 diabetes during 1980-2005 and followed for 10 years and 2,544 adults with long-stanDing diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane).Mortality was compared with the general Finnish population and 6,655 control subjects without diabetes. RESULTS The standardized mortality ratio (SMR) was increased during the first 10 years after the diagnosis (2.58 [95% CI 2.07-3.18], P<0.001). Mortality in adults with longstanDing diabetes, but without albuminuria, was no different from that of the general population (1.02 [0.84-1.22], P = 0.83). However, it was higher compared with that of control subjectswithout diabetes (1.33 [1.06-1.66], P = 0.01). Excessmortality was largely due to acute diabetes complications and ischemic heart disease, which remained more than fourfold higher (mortality rate ratio 4.34 [2.49-7.57]) in adults with type 1 diabetes than in control subjectswithout diabetes, despite the absence of albuminuria. By contrast, deaths due to alcohol and drugs were reduced in adults with type 1 diabetes (P = 0.007), especially in men. CONCLUSIONS Excess mortality in type 1 diabetes is the result of its complications. Acute complications drive an increased SMR in the first years. In individuals who remain free of albuminuria, mortality due to ischemic heart disease is still four times higher, and acute complications also occur.

AB - OBJECTIVE The current study investigated whether the risk of mortality in patients with type 1 diabetes without any signs of albuminuria is different than in the general population and matched control subjects without diabetes. RESEARCH DESIGN AND METHODS We studied a nationwide, population-based Finnish register of 10,737 patients diagnosed with type 1 diabetes during 1980-2005 and followed for 10 years and 2,544 adults with long-stanDing diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane).Mortality was compared with the general Finnish population and 6,655 control subjects without diabetes. RESULTS The standardized mortality ratio (SMR) was increased during the first 10 years after the diagnosis (2.58 [95% CI 2.07-3.18], P<0.001). Mortality in adults with longstanDing diabetes, but without albuminuria, was no different from that of the general population (1.02 [0.84-1.22], P = 0.83). However, it was higher compared with that of control subjectswithout diabetes (1.33 [1.06-1.66], P = 0.01). Excessmortality was largely due to acute diabetes complications and ischemic heart disease, which remained more than fourfold higher (mortality rate ratio 4.34 [2.49-7.57]) in adults with type 1 diabetes than in control subjectswithout diabetes, despite the absence of albuminuria. By contrast, deaths due to alcohol and drugs were reduced in adults with type 1 diabetes (P = 0.007), especially in men. CONCLUSIONS Excess mortality in type 1 diabetes is the result of its complications. Acute complications drive an increased SMR in the first years. In individuals who remain free of albuminuria, mortality due to ischemic heart disease is still four times higher, and acute complications also occur.

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U2 - 10.2337/dc17-1618

DO - 10.2337/dc17-1618

M3 - Article

VL - 41

SP - 748

EP - 754

JO - Diabetes Care

JF - Diabetes Care

SN - 0149-5992

IS - 4

ER -