A recent study published in the European Heart Journal reveals that individuals diagnosed with type 1 diabetes in adulthood face an increased risk of cardiovascular disease and death. Moreover, contrary to previous assumptions, late-onset type 1 diabetes does not offer a better prognosis than earlier diagnoses.
Key Findings and Risk Factors
The study highlights that adults with type 1 diabetes, especially those diagnosed after the age of 40, experience worse health outcomes than their younger counterparts. One of the primary factors contributing to this poor prognosis is a combination of smoking, obesity, and inadequate glucose control. Additionally, these patients are less likely to use advanced treatment options such as insulin pumps.
Yuxia Wei, a postdoctoral fellow at the Institute of Environmental Medicine, Karolinska Institutet, noted, “Patients diagnosed with type 1 diabetes in adulthood often struggle with poorer overall health, making it harder to manage their condition effectively.”
Exploring Cardiovascular Risk Management
Previous studies have demonstrated the role of medications like angiotensin-converting enzyme (ACE) inhibitors in reducing the risk of major adverse cardiac events (MACE) in type 2 diabetes patients. Given the strong connection between diabetes and cardiovascular disease, researchers suggest that similar treatments may benefit those with adult-onset type 1 diabetes.
Additionally, newer treatments, such as sodium-glucose cotransporter 2 inhibitors, have proven effective for type 2 diabetes patients with heart failure. This raises the possibility of expanding their use to manage cardiovascular complications in type 1 diabetes as well.
Study Overview: Data and Methodology
To understand the long-term impact of type 1 diabetes diagnosed in adulthood, the study analyzed data from Sweden, spanning from 2001 to 2022. It examined a range of factors, including all-cause mortality, cardiovascular disease incidence, and cause-specific mortality, comparing individuals with adult-onset type 1 diabetes, type 2 diabetes, and healthy controls.
A total of 10,184 type 1 diabetes patients were matched with 50 population controls based on age, sex, and geographic location. The study excluded participants who had cardiovascular disease at the outset.
Findings: Mortality and Disease Burden
The results showed that patients diagnosed with type 1 diabetes after the age of 40 had a significantly higher risk of cardiovascular disease compared to both the control group and patients with type 2 diabetes. Specifically, 816 deaths occurred in the type 1 diabetes group, with 202 of these attributed to cardiovascular causes. Additionally, there were 361 MACE events in the type 1 group.
By contrast, 26,888 deaths and 14,034 MACE events were recorded in the control group, while type 2 diabetes patients experienced 90,921 deaths and 48,374 MACE events during the same follow-up period.
The leading cause of death for younger type 1 diabetes patients was diabetic coma or ketoacidosis, while older patients were more likely to die from cardiovascular disease or cancer, mirroring the trends seen in the type 2 diabetes and control groups.
Contributors to Poor Prognosis
The study also identified several risk factors that significantly contributed to poor health outcomes in adult-onset type 1 diabetes patients. Smoking, obesity, and poor blood sugar control were found to be the primary drivers of adverse cardiovascular events and increased mortality. In fact, these factors accounted for approximately 40% of cardiovascular events and 20% of deaths among patients with adult-onset type 1 diabetes.
“Our findings suggest that adult-onset type 1 diabetes involves a dual burden of both acute and chronic complications,” the researchers concluded. “Patients diagnosed later in life are more likely to experience insulin resistance, suboptimal glucose control, and unhealthy lifestyle choices, all of which compound their risk of adverse outcomes.”
Implications for Treatment
The study emphasizes the importance of early intervention and proactive management in adult-onset type 1 diabetes, particularly for those diagnosed later in life. By addressing risk factors such as smoking, obesity, and poor glucose management, healthcare providers may help mitigate the heightened cardiovascular risks faced by this patient group.
With growing evidence of the connection between diabetes and cardiovascular disease, researchers continue to advocate for the use of cardiovascular medications, such as ACE inhibitors, to improve outcomes in adults with type 1 diabetes.
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