People who develop type 1 diabetes in adulthood have an increased risk of cardiovascular disease and death, according to new research by the Karolinska Institute in Sweden.
Patients diagnosed later in life do not have a better prognosis than those diagnosed earlier, the researchers found, with smoking, poor glucose control and obesity being the main risk factors.
There is currently limited research into adult-onset type 1 diabetes, and little is known about prognosis or prognostic factors.
The findings of this study, which are published in the European Heart Journal, highlight the risks associated with a late type 1 diabetes diagnosis.
The researchers used data from the Swedish National Diabetes Register and the Total Population Register in Sweden to assess mortality, major adverse cardiovascular events (MACE), and prognostic factors, particularly in adults diagnosed with type 1 diabetes at 40 years or older.
They identified 10,184 people diagnosed with adult-onset type 1 diabetes between 2001 and 2020 and compared them with 509,172 matched control participants, as well as 375,523 people with adult-onset type 2 diabetes.
The participants with adult-onset type 1 diabetes had a 30% higher risk of experiencing MACE, and the risk of death from any cause was 71% higher in this group compared to the control group. Cause-specific mortality, particularly from cardiovascular diseases, non-cardiovascular diseases, cancer and infections, was also higher in individuals with type 1 diabetes than in the population controls.
Adults who develop type 1 diabetes later in life have a 33% lower incidence of MACE than individuals who develop type 2 diabetes in adulthood. However, the risk of death from a diabetic coma or ketoacidosis was higher for individuals with adult-onset type 1 diabetes compared to those with adult-onset type 2 diabetes.
Causes of poor CVD prognosis in type 1 diabetes
The researchers found the main reasons for the poor prognosis were smoking, overweight/obesity and poor glucose control. In particular, smoking was responsible for 10.7% of deaths and 8.4% of MACE events in individuals with type 1 diabetes, while poor glycaemic control contributed to 10.4% of deaths and 8.8% of MACE events. Overweight and obesity accounted for 19.8% of MACE events.
The study analysis also showed that people who are diagnosed with type 1 diabetes at age 40 or over are less likely to use assistive devices, such as insulin pumps, to help manage their condition.
Dr Yuxia Wei, a postdoctoral fellow at the Karolinska Institute and first author of the study, said: ‘These findings underscore the importance of managing these modifiable risk factors to reduce mortality and cardiovascular events in people with type 1 diabetes.’
Senior author and associate professor, Sofia Carlsson, added: ‘We show that the prognosis can be significantly improved by preventing smoking and obesity and improving glucose control, not least in people diagnosed at older ages.’
A version of this article was originally published by our sister publication Nursing in Practice.
