Higher cardiorenal disease burden in type 1 vs type 2 diabetes
medwireNews: Adults with type 1 diabetes have a greater burden of cardiovascular and renal disease (CVRD) than those with type 2 diabetes, researchers report.
Johan Bodegard (AstraZeneca, Oslo, Norway) and colleagues used full-population registries in Sweden and Norway to evaluate rates of CVRD in 59,331 individuals with type 1 diabetes and 484,241 people with type 2 diabetes between 2013 and 2015–2016. Overall rates of CV disease at baseline were 13.3% and 26.2% for those with type 1 and type 2 diabetes, respectively, and the corresponding rates of chronic kidney disease (CKD) were 4.3% and 3.3%.
In age-stratified analyses, Bodegard et al found that the baseline prevalence of CV disease, including myocardial infarction, heart failure, and stroke, was similar among people with type 1 and type 2 diabetes of all age groups, with “a clear increase” in prevalence rates among those aged 40 years and older in both groups.
By contrast, they say that the age-dependent increase in the baseline prevalence of CKD “appeared earlier” in people with type 1 versus type 2 diabetes, and “remained consistently higher” in those with type 1 diabetes across all age groups.
The researchers then evaluated incidence rates of CVRD events during an average follow-up of 2.6 years, finding that the overall risk for any event was significantly higher among people with type 1 versus type 2 diabetes irrespective of age, with hazard ratios (HRs) ranging from 1.20 to 1.60 for the different age groups.
Heart failure was significantly more common with type 1 versus type 2 diabetes among those aged 65–79 years, with HRs ranging from 1.31 to 1.39. There was a similar pattern of results for myocardial infarction for those aged 55–79 years, at HRs of 1.30–1.79, but stroke incidence was only elevated in the type 1 diabetes group among younger people aged 40–54 years, at HRs of 1.35–1.72.
In accordance with the baseline results, the incidence of CKD during follow-up was higher in people with type 1 versus type 2 diabetes across all age groups, but the researchers note that “intergroup differences generally decreased with increasing age,” with an HR of 2.95 for those aged 40–44 years and 1.53 for those aged 80–84 years.
In a subgroup analysis, Bodegard and colleagues found that the presence of pre-existing CVRD at baseline modified the risk for future events, with the type 1 and type 2 diabetes groups having “an almost equal risk” if there was no CVRD at baseline. On the other hand, future CVRD risk was increased with type 1 versus type 2 diabetes among people with pre-existing disease.
Together, these findings indicate that “patients with [type 1 diabetes] will benefit from a more intensive strategy for both primary and, in particular, secondary prevention of CVRD,” conclude the researchers in Diabetes Care.
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