Mortality in Type 1 Diabetes is Increased in the Presence of the Metabolic Syndrome, but Remains Lower than in Young Onset Type 2 Diabetes — ASN Events
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Mortality in Type 1 Diabetes is Increased in the Presence of the Metabolic Syndrome, but Remains Lower than in Young Onset Type 2 Diabetes (#48)

Maria I Constantino 1 2 , Lynda Molyneaux 1 2 , Ted Wu 1 , Dennis Yue 1 2 , Jencia Wong 1 2
  1. Diabetes Centre , Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Discipline of Medicine, University of Sydney, Sydney, NSW, Australia

Youth Onset type 2 diabetes (YT2DM) is associated with an increased mortality risk, higher than in type 1 diabetes (T1DM) of a similar age of onset, and possibly due to the high burden of Metabolic Syndrome (MS) factors so characteristic of YT2DM.  However, as background rates of obesity increase, T1DM associated with MS is a more frequently encountered phenotype whose mortality risks could be as high as for YT2DM, a possibility not yet systematically evaluated.  In this study we examined (a) the impact of the MS on mortality in T1DM and compared (b) mortality outcomes of T1DM and YT2DM of a similar age of onset, both with the MS.  Data were extracted from the RPA electronic database.  For Study(a), T1DM patients were stratified by the ever presence (T1DMms+) or absence (T1DMms-) of the WHO MS. Survival status till 2011 was established by data-linkage with the National Death Index. Age standardised mortality ratios (SMR) were calculated with Australian population as reference. For Study(b), SMR for subgroups of T1DM and YT2DM, onset between 15-30 years-of–age, affected by MS (T1DM15-30ms+ ,YT2DM15-30ms+ respectively) were calculated and clinical features compared.

Altogether, 1160 T1DM patients contributed 14,820 person-years of follow–up with a total of 94 deaths.  There were 22% classified as T1DMms+.   SMR was higher at any attained age (Fig a) and were overall higher in T1DMms+ thanT1DMms- [2.4 (1.7-3.4) and 1.8 (1.3-2.3)]. For study b) 86 T1DM and 259 YT2DM were affected by MS. The SMR for the YT2DM15-30ms+  cohort was higher than the corresponding T1DM15-30ms+ [3.4 (2.4-4.8); 2.7 (1.3-4.8)]. Moreover, peak SMR was observed earlier, in the 3rd decade of life for YT2DM15-30ms+, compared to the 6th decade for T1DM15-30ms+  (Fig b). In the context of the MS, CVD risk factors of HbA1c, HDL, Tg , BMI  were significantly less favourable for YT2DM15-30ms+   than T1DM15-30ms+ (p<0.0001, table).

These data suggest that the presence of the MS is associated with a higher mortality in T1DM. However for YT2DM, the MS is more severe and is still associated with a higher, earlier mortality impact than in T1DM of similar age, even with the MS.

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