An age-stratified analysis of Swedish national registry data found that myocardial infarction and heart failure rates may even be more prevalent in patients with T1D.
Jan W. Eriksson, MD, PhD
The 400,000-plus patient study could drive research toward improved diagnostics, screening efforts, and therapies for the more uncommon T1D, of which fewer associations are made to cardiovascular disease than T2D.
Led by Jan W. Eriksson, MD, PhD, of the Department of Medicine at Uppsala University, a team of investigators used nationwide healthcare registries spanning 3 years (2013-2016) to assess the prevalence of myocardial infarction (MI), heart failure (HF), stroke, and cardiovascular mortality, and chronic kidney disease (CKD) in patients with either T1D or T2D.
The results—presented in a late-breaking session at the American Diabetes Association (ADA) 2019 Scientific Sessions in San Francisco, CA—showed some comorbidities were actually more prevalent in patients with the inherent T1D condition than those with T2D.
“It’s been long considered type 2 diabetes is part of cardiovascular disease and this metabolic syndrome,” Eriksson told MD Magazine®. “We wanted to see if it were similar or different with type 1 diabetes, which mainly has complications in the small blood vessels—patients get problems with their eyes and kidneys, but not as much their heart.”
The pool included 47,424 patients with T1D and 364,293 patients with T2D. The team used age-stratified categories to compare baseline cardiovascular disease and CKD in patients belonging to either subgroup.
At baseline, patients with T1D were younger (mean age 40.6 years, vs 67.0 years). Cardiovascular disease was indeed more prevalent in patients with T2D than those with T1D (31.0% vs 11.7%, respectively), and CKD was indeed more prevalent in patients with T1D than those with T2D (3.6% vs 3.3%, respectively), as was hypoglycemia (1.7% vs 0.5%).
When stratified for age, the baseline data showed both types of diabetes had similar cardiovascular disease prevalence—MI and stroke were significantly increased in patients aged 55 years and older, and HF was significantly increased in patients aged 60 and older.
Across all ages, CKD was more prevalent in patients with T1D than those with T2D. Cardiovascular event rates were similar across both patient groups, yet slightly greater for HF and MI prevalence in patients with T1D. Eriksson expressed surprise at the findings.
“It highlights that we don’t address cardiovascular disease enough in type 1 diabetes,” Eriksson said. “Now we’re presenting new drugs in type 2 diabetes that reduce death and events in the heart. We need similar studies and interventions for type 1.”
Eriksson said the issue is more so driven by a lack of data than disparity of disease and symptom progression. The T1D patient population is about one-tenth that of the T2D patient population in Sweden; the ratio is even more severe in other countries.
“We need to do bigger studies about these risks, and find the means to interfere,” he said.
If anything, the increasing population of patients with T2D may benefit the oft-overlooked T1D population—new agents such as SGLT-2 inhibitors and GLP-1 agonists have emerged as crucial cardiovascular-preventive therapies in the field in response to the prevalence of disease. Clinicians could follow the history of their clinical development to eventually find similar therapies for T1D, Eriksson suggested.
“They are being used rapidly in type 2 diabetes, but it will be a long time until something like that could happen in type 1 diabetes,” he said.
The study, “Cardiovascular Complications in T1D and T2D Patients Show More Similarities than Differences,” was presented at ADA 2019.