Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes
Open accessAbstract
Aims/hypothesis Although ischaemic heart disease is the predominant cause of mortality in older people with diabetes, age-specific mortality rates have not been published for patients with Type 1 diabetes. The Diabetes UK cohort, essentially one of patients with Type 1 diabetes, now has sufficient follow-up to report all heart disease, and specifically ischaemic heart disease, mortality rates by age.Methods A cohort of 23,751 patients with insulin-treated diabetes, diagnosed under the age of 30 years and from throughout the United Kingdom, was identified during the period 1972 to 1993 and followed for mortality until December 2000. Age- and sex-specific heart disease mortality rates and standardised mortality ratios were calculated.Results There were 1437 deaths during the follow-up, 536 from cardiovascular disease, and of those, 369 from ischaemic heart disease. At all ages the ischaemic heart disease mortality rates in the cohort were higher than in the general population. Mortality rates within the cohort were similar for men and women under the age of 40. The standardised mortality ratios were higher in women than men at all ages, and in women were 44.8 (95%CI 20.5-85.0) at ages 20-29 and 41.6 (26.7-61.9) at ages 30-39.Conclusions/interpretation The risk of mortality from ischaemic heart disease is exceptionally high in young adult women with Type 1 diabetes, with rates similar to those in men with Type 1 diabetes under the age of 40. These observations emphasise the need to identify and treat coronary risk factors in these young patients.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Hypertension, dyslipidaemia, abdominal obesity, and non-alcoholic fatty liver disease commonly coexist with type 2 diabetes and further aggravate risk, which is highest in those with multiple cardiometabolic risk factors.
“Hypertension, dyslipidaemia, abdominal obesity, and non-alcoholic fatty liver disease (NAFLD) commonly coexist with T2DM and further aggravate the risk, which is highest in people with T2DM and multiple cardiometabolic risk factors [406-408].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [406]
Type 1 diabetes is associated with high CVD risk, particularly in patients with microalbuminuria and renal disease.
“Type 1 diabetes is associated with high CVD risk, in particular in patients with microalbuminuria and renal disease.177”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [177]
Type 1 diabetes is associated with high CVD risk, particularly in patients with microalbuminuria and renal disease.
“Type 1 diabetes is associated with high CVD risk, in particular in patients with microalbuminuria and renal disease. 355”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [355]
Type 1 diabetes is associated with high cardiovascular disease risk, particularly in patients with microalbuminuria and renal disease.
“Type 1 diabetes is associated with high CVD risk, in particular in patients with microalbuminuria and renal disease.355”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [355]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Statistical Methods in Cancer Research
Breslow, N. E. (1980) · Cited by 6,695 · see citing works
Stamler, J., Vaccaro, O., Neaton, J. D., Wentworth, D., & The Multiple Risk Factor Intervention Trial Research Group (1993) · Diabetes Care · doi:10.2337/diacare.16.2.434 · Cited by 4,063 · see citing works
Diabetes and cardiovascular disease. The Framingham study
Kannel, W. B. (1979) · JAMA · doi:10.1001/jama.241.19.2035 · Cited by 3,958 · see citing works
Statistical Methods in Cancer Research. Volume II – The Design and Analysis of Cohort Studies
Juul, S. (1989) · Scandinavian Journal of Social Medicine · doi:10.1177/140349488901700214 · Cited by 3,602 · see citing works
Grundy, S. M., Benjamin, I. J., Burke, G. L., Chait, A., Eckel, R. H., Howard, B. V., Mitch, W., Smith, S. C., & Sowers, J. R. (1999) · Circulation · doi:10.1161/01.cir.100.10.1134 · Cited by 2,698 · see citing works
Role of diabetes in congestive heart failure: The Framingham study
Kannel, W. B., Hjortland, M., & Castelli, W. P. (1974) · The American Journal of Cardiology · doi:10.1016/0002-9149(74)90089-7 · Cited by 2,090 · see citing works
Statistical methods in cancer research. Volume II--The design and analysis of cohort studies.
Breslow, N. E., & Day, N. E. (1987) · PubMed · Cited by 1,684 · see citing works
Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow-up study
Garcia, M. J., McNamara, P. M., Gordon, T., & Kannell, W. B. (1974) · Diabetes · doi:10.2337/diab.23.2.105 · Cited by 1,608 · see citing works
Diabetes and cardiovascular disease
Howard, B. V., & Magee, M. F. (2000) · Current Atherosclerosis Reports · doi:10.1007/s11883-000-0046-8 · Cited by 1,386 · see citing works
Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes
and the WHO Multinational Study Group, Morrish, N. J., Wang, S.-L., Stevens, L. K., Fuller, J. H., & Keen, H. (2001) · Diabetologia · doi:10.1007/pl00002934 · Cited by 1,288 · see citing works
Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death.
Schneider, B. A. (1953) · The Quarterly Review of Biology · doi:10.1086/399926 · Cited by 995 · see citing works
Manson, J. E. (1991) · Archives of Internal Medicine · doi:10.1001/archinte.1991.00400060077013 · Cited by 675 · see citing works
Barrett-Connor, E. L. (1991) · JAMA · doi:10.1001/jama.265.5.627 · Cited by 638 · see citing works
Laing, S. P., Swerdlow, A. J., Slater, S. D., Botha, J. L., Burden, A. C., Waugh, N. R., Smith, A. W. M., Hill, R. D., Bingley, P. J., Patterson, C. C., et al. (1999) · Diabetic Medicine · doi:10.1046/j.1464-5491.1999.00075.x · Cited by 427 · see citing works
Self-citationManual of the International Statistical Classification of Diseases, Injuries, and Causes of Death
Guralnick, L. (1959) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.1959.8.83 · Cited by 358 · see citing works
Dorman, J. S., LaPorte, R. E., Kuller, L. H., Cruickshanks, K. J., Orchard, T. J., Wagener, D. K., Becker, D. J., CAVENDER, D. E., & Drash, A. L. (1984) · Diabetes · doi:10.2337/diab.33.3.271 · Cited by 350 · see citing works
Cause-specific mortality in a population-based study of diabetes.
Moss, S. E., Klein, R., & Klein, R. (1991) · American Journal of Public Health · doi:10.2105/ajph.81.9.1158 · Cited by 315 · see citing works
Laing, S. P., Swerdlow, A. J., Slater, S. D., Botha, J. L., Burden, A. C., Waugh, N. R., Smith, A. W. M., Hill, R. D., Bingley, P. J., Patterson, C. C., et al. (1999) · Diabetic Medicine · doi:10.1046/j.1464-5491.1999.00076.x · Cited by 303 · see citing works
Self-citationMORTALITY AMONG DIABETICS IN A NATIONAL SAMPLE
Kleinman, J. C., Donahue, R. P., Harris, M. I., Finucane, F. F., Madans, J. H., & Brock, D. B. (1988) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114979 · Cited by 297 · see citing works
Age of Onset and Type of Diabetes
Laakso, M., & Pyörälà, K. (1985) · Diabetes Care · doi:10.2337/diacare.8.2.114 · Cited by 248 · see citing works
Mortality experience of diabetic patients
Kessler, I. I. (1971) · The American Journal of Medicine · doi:10.1016/0002-9343(71)90299-3 · Cited by 199 · see citing works
Morrish, N. J., Stevens, L. K., Head, J. A., Fuller, J., Jarrett, R. J., & KEEN, H. (1990) · Diabetologia · doi:10.1007/bf00404142 · Cited by 197 · see citing works
Coronary Artery Disease in IDDM
Lloyd, C. E., Kuller, L. H., Ellis, D., BECKER, D. J., Wing, R. R., & Orchard, T. J. (1996) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.16.6.720 · Cited by 147 · see citing works
Mortality from cardiovascular diseases among diabetics
Krolewski, A. S., Czyźyk, A., Janeczko, D., & Kopczyński, J. (1977) · Diabetologia · doi:10.1007/bf01223277 · Cited by 105 · see citing works
Morrish, N. J., Stevens, L. K., Head, J. A., Fuller, J., Jarrett, R. J., & KEEN, H. (1990) · Diabetologia · doi:10.1007/bf00404141 · Cited by 78 · see citing works
Dorman, J. S., LaPorte, R. E., Kuller, L. H., et al. (1984) · Diabetes · doi:10.2337/diabetes.33.3.271 · Cited by 72 · see citing works
Laakso, M., R�nnemaa, T., Lehto, S., Puukka, P. J., Kallio, V., & Py�r�l�, K. (1995) · Diabetologia · doi:10.1007/bf00410288 · Cited by 68 · see citing works
Mortality in Diabetes Mellitus: Experience of a Geographically Defined Population
Wong, J. S., Pearson, D. W. M., Murchison, L. E., Williams, M. J., & Narayan, V. (1991) · Diabetic Medicine · doi:10.1111/j.1464-5491.1991.tb01559.x · Cited by 65 · see citing works
Green, A., & Hougaard, P. (1984) · Diabetologia · doi:10.1007/bf00252405 · Cited by 64 · see citing works
Morrish, N. J., Stevens, L. K., Fuller, J., KEEN, H., & Jarrett, R. J. (1991) · Diabetologia · doi:10.1007/bf00400278 · Cited by 61 · see citing works
Laakso, M. P., R�nnemaa, T., Lehto, S., et al. (1995) · Diabetologia · doi:10.1007/s001250050310 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes
(2005) · New England Journal of Medicine · doi:10.1056/nejmoa052187 · Cited by 5,138 · see citing works
Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., et al. (2019) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2019.08.014 · Cited by 4,854 · see citing works
ESC/EAS Guidelines for the management of dyslipidaemias
Reiner, Ž., Catapano, A. L., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr158 · Cited by 3,549 · see citing works
2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw272 · Cited by 3,162 · see citing works
Mechanisms of Diabetic Complications
Forbes, J. M., & Cooper, M. E. (2013) · Physiological Reviews · doi:10.1152/physrev.00045.2011 · Cited by 2,890 · see citing works
Microvascular and Macrovascular Complications of Diabetes
Fowler, M. J. (2008) · Clinical Diabetes · doi:10.2337/diaclin.26.2.77 · Cited by 1,954 · see citing works
2016 ESC/EAS Guidelines for the Management of Dyslipidaemias
Catapano, A. L., Graham, I., De Backer, G., Wiklund, O., Chapman, M. J., Drexel, H., Hoes, A. W., Jennings, C. S., Landmesser, U., Pedersen, T. R., et al. (2016) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2016.08.018 · Cited by 1,582 · see citing works
Machine learning and data mining methods in diabetes research
Kavakiotis, I., Tsave, O., Salifoglou, A., Maglaveras, N., Vlahavas, I., & Chouvarda, I. (2017) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2016.12.005 · Cited by 1,445 · see citing works
Glycemic Control and Excess Mortality in Type 1 Diabetes
Lind, M., Svensson, A.-M., Kosiborod, M., Gudbjörnsdottir, S., Pivodic, A., Wedel, H., Dahlqvist, S., Clements, M., & Rosengren, A. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1408214 · Cited by 964 · see citing works
Fihn, S. D., Gardin, J. M., Abrams, J., Berra, K., Blankenship, J. C., Dallas, A. P., Douglas, P. S., Foody, J. M., Gerber, T. C., Hinderliter, A. L., et al. (2012) · Circulation · doi:10.1161/cir.0b013e318277d6a0 · Cited by 845 · see citing works
ESC/EAS Guidelines for the management of dyslipidaemias
Catapano, A. L., Reiner, Ž., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.06.028 · Cited by 706 · see citing works
Impact of diabetes on cardiovascular disease: an update
Matheus, A. S. D. M., Tannus, L. R. M., Cobas, R. A., Palma, C. C. S., Negrato, C. A., & Gomes, M. D. B. (2013) · International Journal of Hypertension · doi:10.1155/2013/653789 · Cited by 547 · see citing works
Long-Term Complications and Mortality in Young-Onset Diabetes
Constantino, M. I., Molyneaux, L., Limacher-Gisler, F., Al-Saeed, A., Luo, C., Wu, T., Twigg, S. M., Yue, D. K., & Wong, J. (2013) · Diabetes Care · doi:10.2337/dc12-2455 · Cited by 423 · see citing works
“Given that the traditional focus of diabetes in youth has been on T1DM and that established morbidity and mortality data exist for this group (4,5), a comparison was made with T1DM.”
ResultLong-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway
Skrivarhaug, T., Bangstad, H.-J., Stene, L. C., Sandvik, L., Hanssen, K. F., & Joner, G. (2006) · Diabetologia · doi:10.1007/s00125-005-0082-6 · Cited by 390 · see citing works
Khunti, K., Davies, M., Majeed, A., Thorsted, B. L., Wolden, M. L., & Paul, S. K. (2015) · Diabetes Care · doi:10.2337/dc14-0920 · Cited by 356 · see citing works
Daousi, C., Casson, I. F., Gill, G. V., MacFarlane, I. A., Wilding, J. P. H., & Pinkney, J. H. (2006) · Postgraduate Medical Journal · doi:10.1136/pmj.2005.039032 · Cited by 351 · see citing works
Libby, P., Nathan, D. M., Abraham, K., Brunzell, J. D., Fradkin, J. E., Haffner, S. M., Hsueh, W., Rewers, M., Roberts, B. T., Savage, P. J., et al. (2005) · Circulation · doi:10.1161/circulationaha.104.529651 · Cited by 265 · see citing works
Fear of hypoglycaemia in parents of young children with type 1 diabetes: A systematic review
Barnard, K., Thomas, S., Royle, P., Noyes, K., & Waugh, N. (2010) · BMC Pediatrics · doi:10.1186/1471-2431-10-50 · Cited by 239 · see citing works
Self-citationSex differences in micro- and macro-vascular complications of diabetes mellitus
Maric-Bilkan, C. (2017) · Clinical Science · doi:10.1042/cs20160998 · Cited by 217 · see citing works
Risk Factors for Cardiovascular Disease in Type 1 Diabetes
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group (2016) · Diabetes · doi:10.2337/db15-1517 · Cited by 209 · see citing works
“0032 BMI men (kg/m(2)) 24 (22,25) 23 (22,25) 24 (22,26) 1.”
The use of metformin in type 1 diabetes: a systematic review of efficacy
Vella, S., Buetow, L., Royle, P., Livingstone, S., Colhoun, H. M., & Petrie, J. R. (2010) · Diabetologia · doi:10.1007/s00125-009-1636-9 · Cited by 201 · see citing works
ESC/EAS Guidelines for the management of dyslipidaemias
Catapano, A. L., Reiner, Ž., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.06.012 · Cited by 192 · see citing works
Female reproduction and type 1 diabetes: From mechanisms to clinical findings
Codner, E., Merino, P. M., & Tena-Sempere, M. (2012) · Human Reproduction Update · doi:10.1093/humupd/dms024 · Cited by 182 · see citing works
Zhong, V. W., Juhaeri, J., & Mayer-Davis, E. J. (2018) · Diabetes Care · doi:10.2337/dc17-1583 · Cited by 177 · see citing works
Puberty as an accelerator for diabetes complications
Cho, Y. H., Craig, M. E., & Donaghue, K. C. (2014) · Pediatric Diabetes · doi:10.1111/pedi.12112 · Cited by 145 · see citing works
Steele, A. M., Shields, B. M., Shepherd, M., Ellard, S., Hattersley, A. T., & Pearson, E. R. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2009.02913.x · Cited by 130 · see citing works
Type 1 diabetes in the young: the harvest of sorrow goes on
Gale, E. A. M. (2005) · Diabetologia · doi:10.1007/s00125-005-1833-0 · Cited by 85 · see citing works
The Effect of Intensive Diabetes Treatment on Resting Heart Rate in Type 1 Diabetes
Paterson, A. D., Rutledge, B. N., Cleary, P. A., Lachin, J. M., Crow, R. S., & for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2007) · Diabetes Care · doi:10.2337/dc06-1441 · Cited by 81 · see citing works
Bariatric surgery in obese patients with type 1 diabetes
Kirwan, J. P., Aminian, A., Kashyap, S. R., Burguera, B., Brethauer, S. A., & Schauer, P. R. (2016) · Diabetes Care · doi:10.2337/dc15-2732 · Cited by 80 · see citing works
Collier, A., Ghosh, S., Hair, M., & Waugh, N. (2015) · Diabetes & Metabolism · doi:10.1016/j.diabet.2014.09.004 · Cited by 65 · see citing works
Self-citationMomesso, D. P., Bussade, I., Epifanio, M. A., Schettino, C. D. S., Russo, L. A. T., & Kupfer, R. (2011) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2010.09.037 · Cited by 42 · see citing works
Risk factors for cardiovascular disease in women with diabetes
Maric, C. (2010) · Gender Medicine · doi:10.1016/j.genm.2010.11.007 · Cited by 17 · see citing works
Park, L., & Wexler, D. (2010) · Current Opinion in Lipidology · doi:10.1097/mol.0b013e328332dfaa · Cited by 9 · see citing works
- Authors
- Laing, S. P., Swerdlow, A. J., Slater, S. D., Burden, A. C., Morris, A., Waugh, N. R., Gatling, W., Bingley, P. J., & Patterson, C. C.
- Affiliations
- Institute of Cancer Research (GB)
- Glasgow Victoria Infirmary (GB)
- University of Leicester (GB)
- University of Dundee (GB)
- University of Aberdeen (GB)
- Poole Hospital (GB)
- University of Bristol (GB)
- Queen's University Belfast (GB)
- Corresponding author
- Laing, S. P.
- Venue
- Diabetologia
- Published
- 2003-06-01
- Volume
- 46
- Issue
- 6
- Pages
- 760-765
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2004673584
- Cited by
- 724
- References
- 31
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 20 · 2023: 19 · 2022: 14 · 2021: 26 · 2020: 28 · 2019: 40 · 2018: 44 · 2017: 46 · 2016: 46 · 2015: 54 · 2014: 63 · 2013: 56 · 2012: 45
- FWCI
- 8.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Royal College of Physicians of Edinburgh
- Diabetes UK
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, ischemic heart disease, cardiovascular mortality, insulin-treated diabetes, young adult women, sex differences in mortality, age-specific mortality, standardized mortality ratio, coronary risk factors
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Diabetes Mellitus, Type 1, Diabetic Angiopathies, Female, United Kingdom, Heart Diseases, Humans, Male, Middle Aged, Registries, Sex Characteristics, Cohort Studies, Myocardial Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
