Age at Onset of Type 1 Diabetes Affects Mortality and Cardiovascular Complications

myocardial infarction, heart attack
myocardial infarction, heart attack
Investigators examined whether age of onset of type 1 diabetes affects mortality and cardiovascular risk.

Children diagnosed with type 1 diabetes before the age of 10 are at greater risk of early mortality and cardiovascular disease, according to a study published in The Lancet.

Researchers of this study selected 27,195 individuals with type 1 diabetes and 135,178 matched controls to analyze risk for all-cause mortality, cardiovascular and non-cardiovascular mortality, and cardiovascular diseases and complications with age of diagnosis. Individuals were followed from baseline until an event, death, or the end of the study.

Individuals were grouped based on age of diagnosis: 0 to 10 years, 11 to 15 years, 16 to 20 years, 21 to 25 years, and 26 to 30 years. In the 0 to 10 years of age at diagnosis group, overall life expectancy was reduced by 16 years (95% CI, 14.0-18.1), with life expectancy of men reduced by 14.2 years (95% CI, 12.1-18.2) and life expectancy of women was reduced by 17.1 years (95% CI, 14.5-20.4). 

All-cause mortality (hazard ratio [HR] 4.11, 95% CI, 3.24-5.22), cardiovascular mortality (HR 7.38, 95% CI, 3.65-14.94), acute myocardial infarction (HR 30.95; 95% CI, 17.59-54.45), stroke (HR 6.45, 95% CI, 4.04-10.31), and heart failure (HR 12.90, 95% CI, 7.39-22.51) had the highest hazard ratio in the 0 to 10 years of age at diagnosis group. Women diagnosed before the age of 10 had a 6-times greater possibility of all-cause mortality. All women had a 60-times greater possibility of coronary artery disease and a 90-times greater possibility of myocardial infarction. Atrial fibrillation was the highest risk for men diagnosed between 21 and 25 years of age.

Researchers conclude that age of diagnosis of type 1 diabetes is an important indicator of life expectancy and risk for cardiovascular disease and cardiovascular events. With these findings, clinicians should take extra precautions with cardioprotective agents to help reduce these risks.

This study was supported by the Swedish Heart and Lung Foundation. Please refer to reference for a complete list of authors’ disclosures.

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Rawshani A, Sattar N, Franzen S, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018; 392: 477–86.