Early type 1 diabetes trims 18 years from women’s lives
Developing type 1 diabetes before the age of 10 shortens the lifespans of women by almost 18 years and of men by about 14 years, according to a Swedish registry study published in The Lancet.
"These are disappointing and previously unknown figures,” lead author Araz Rawshani, MD, PhD, with the University of Gothenburg, said in a press release. “The study suggests that we must make an even greater effort to aggressively treat patients diagnosed at an early age to reduce the risk of complications and premature death.”
The researchers studied 27,195 individuals with type 1 diabetes and compared them against 135,178 age-matched controls from the general population. They found staggering differences in the risks of mortality and cardiovascular disease outcomes among diabetic patients, particularly those diagnosed at an early age. This is despite current guidelines not considering age of onset as a factor in risk stratification, Rawshani et al. pointed out.
Here are some notable statistics from the study:
- Among those diagnosed with diabetes before turning 10, the risks for coronary heart disease (CHD) and myocardial infarction were increased 30-fold compared to the general population. The relative risk was heightened even further in women—a 60-fold increase for CHD and a 90-fold increase for acute MI.
- For people who developed type 1 diabetes in their late 20s, the comparative risk for CHD and heart attacks dropped to about six times that of the general population.
- Overall, the hazard ratio for any cardiovascular disease was 3.85 for those diagnosed from age 26-30 and 11.44 for those diagnosed before age 10.
- Both sexes combined lost 16 years of life expectancy when diagnosed before age 10. They lost about 10 years of life expectancy when diabetes onset was in their late 20s.
“In light of the fact that around half of individuals with type 1 diabetes are diagnosed before 14 years of age, this study highlights a need to consider age at diagnosis in guidelines,” the authors wrote. “The magnitude of these risk estimates—with point estimates in double figures for several vascular outcomes in the early adult years—appear at least as high as those conferred by familial hypercholesterolemia.”
The findings should prove informative to clinicians and patients alike, Rawshani said.
“Suddenly we can answer questions about complications and life expectancy that we were previously unable to answer,” he said. “Now there is robust evidence that survival largely depends on the age at which the patient develops the disease, and that there is a difference between men and women.”
Even though there were greater excess risks for women versus men with type 1 diabetes in their study, the authors explained that may be due to women having a lower risk of cardiovascular disease in the first place. Therefore, even if the relative risk associated with diabetes is higher in women, that doesn’t necessarily mean the absolute risk is greater.
Rawshani and colleagues said there are likely multiple reasons for their findings. Patients with earlier-onset diabetes may have a more rapid loss of beta cells and the sustained effects of the disease may exact a toll.
“Defined as the cumulative exposure of the vasculature to glucose, glycemic load is a function of diabetes duration and glycemic variability,” the researchers wrote. “The longer the duration of diabetes, the greater the glycemic load and thus the damage.”
The authors reiterated the need for earlier cardioprotective treatment of patients with type 1 diabetes—particularly with blood pressure medications, statins and careful glycemic control.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.