Patients whose type 1 diabetes emerges before 10 years of age are about 30 times more likely to develop coronary heart disease (CHD) and acute myocardial infarction (MI) than matched controls, according to new research in the Lancet.
Researchers matched 27,195 people with type 1 diabetes in the Swedish National Diabetes Register with 135,178 controls from the general population
After adjusting for confounders, patients who developed type 1 diabetes between birth and 10 years of age were four times more likely to die from any cause (hazard ratio [HR] 4.11) or non-cardiovascular causes (HR 3.96) and more than seven times more likely to die from cardiovascular disease (CVD; HR 7.38).
Patients who developed diabetes between 26 and 30 years of age were about three times more likely to die from any cause (HR 2.83), non-cardiovascular causes (HR 2.78) or CVD (HR 3.64).
Patients who developed type 1 diabetes between birth and 10 years of age were at significantly increased risk of stroke (HR 6.45), CVD (HR 11.44) and heart failure (HR 12.90). The risk of CHD (HR 30.50) and acute MI (HR 30.95) was more than 30 times higher. Women are particularly vulnerable, with the risks of CHD and acute MI 58.73 and 92.07 times higher for those who developed diabetes younger than 10 years of age.
Patients who developed type 1 diabetes between 26 and 30 years of age were at significantly increased risk of stroke (HR 3.22), CVD (HR 3.85), heart failure (HR 5.07), CHD (HR 6.08) and acute MI (HR 5.77).
Developing type 1 diabetes before 10 years of age resulted in a loss of 17.7 life-years in women and 14.2 life-years in men. Among patients diagnosed at 26-30 years of age, women and men lost 10.1 and 9.4 life-years respectively.
“Those who develop type 1 diabetes when under 10 years of age experience the greatest losses in life expectancy, compared to healthy controls. This is something we did not fully appreciate before,” says study author Naveed Sattar, professor of metabolic medicine, University of Glasgow.
“People with early onset diabetes should more often be considered for cardioprotective drugs, such as statins and blood pressure lowering medication, when they reach 30-40 years of age,” Professor Sattar adds.
“Improving glycaemic control and smoking cessation programmes could also meaningfully prolong lives. The good news is that recent technological advances are helping younger patients manage their glucose levels better.”