Aggressive Treatment Strategy Needed For Early-Diagnosed Type 1 Diabetes

​By Brenda L. Mooney, /alert Contributor
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Surprising new data on shortened lifespans argues for aggressive treatment in type 1 diabetes patients diagnosed in early childhood, especially for women.

The report in The Lancet revealed that women who developed type 1 diabetes before the age of 10 die an average of nearly 18 years earlier than women who do not have diabetes, while, men die prematurely by about 14 years.

Physician checks glucose levels. (Source: Scott Air Force Base)

Swedish researchers pointed out that while the situation is not as dire for patients diagnosed between ages 26 and 30, they also have potentially reduced lifespans, by an average of about a decade.

"These are disappointing and previously unknown figures,” Araz Rawshani, PhD, a researcher at the Department of Internal Medicine, Sahlgrenska Academy, and the Swedish National Diabetes Registry said in a press release. “The study suggests that we must make an even greater effort to aggressively treat patients diagnosed at an early age to reduce the risk of complications and premature death.”

Rawshani pointed out that, even though type 1 diabetes patients are at an increased risk of mortality and cardiovascular disease, current clinical guidelines don’t take age of onset into consideration to stratify risk.

To determine how age of diagnosis affects survival, the study team conducted a nationwide, register-based cohort study of type 1 diabetes patients in the Swedish National Diabetes Register, matching them with controls from the general population. Included were patients with at least one diabetes diagnosis between Jan 1, 1998, and Dec 31, 2012. Adjusting for diabetes duration, the researchers sought to estimate the excess risk of all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, acute myocardial infarction, stroke, cardiovascular disease (a composite of acute myocardial infarction and stroke), coronary heart disease, heart failure, and atrial fibrillation.

Ultimately, 27,195 type 1 diabetes patients and 135,178 matched controls were included in the studies, and participants with T1D were divided into five groups based on age of diagnosis: 0–10 years, 11–15 years, 16–20 years, 21–25 years, and 26–30 years.

During follow-up of a median of a decade, 959 type 1 diabetes patients and 1,501 controls died. Researchers calculated that  patients who developed type 1 diabetes in the youngest age range, 0–10 years, had hazard ratios of:

  • 4.11 (95% CI 3·24–5·22) for all-cause mortality,

  • 7.38 (3·65–14·94) for cardiovascular mortality,

  • 3.96 (3·06–5·11) for non-cardiovascular mortality,

  • 11.44 (7·95–16·44) for cardiovascular disease,

  • 30.50 (19·98–46·57) for coronary heart disease,

  • 30.95 (17·59–54·45) for acute myocardial infarction,

  • 6.45 (4·04–10·31) for stroke,

  • 12.90 (7·39–22·51) for heart failure, and

  • 1.17 (0·62–2·20) for atrial fibrillation.

Hazard ratios were significantly lower for participants who developed type 1 diabetes at the oldest age included, 26–30:

  • 2.83 (95% CI 2·38–3·37) for all-cause mortality,

  • 3.64 (2·34–5·66) for cardiovascular mortality,

  • 2.78 (2·29–3·38) for non-cardiovascular mortality,

  • 3.85 (3·05–4·87) for cardiovascular disease,

  • 6.08 (4·71–7·84) for coronary heart disease,

  • 5.77 (4·08–8·16) for acute myocardial infarction,

  • 3.22 (2·35–4·42) for stroke,

  • 5.07 (3·55–7·22) for heart failure, and

  • 1.18 (0·79–1·77) for atrial fibrillation.

Study authors note that “the excess risk differed by up to five times across the diagnosis age groups. The highest overall incidence rate, noted for all-cause mortality, was 1·9 (95% CI 1·71–2·11) per 100 000 person-years for people with type 1 diabetes.”

“Age at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in women,” Rawshani and colleagues conclude. “Greater focus on cardioprotection might be warranted in people with early-onset type 1 diabetes.”