Effect of duration and burden of microvascular complications on mortality rate in type 1 diabetes: an observational clinical cohort study
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Aims/hypothesis The role of burden and duration of multiple microvascular complications on mortality rate has not been explored in detail in type 1 diabetes. Taking complication burden and time-updated duration into account we aimed to quantify mortality rate in individuals with and without microvascular complications.Methods This observational clinical cohort included 3828 individuals with type 1 diabetes attending the Steno Diabetes Center Copenhagen in 2001-2013. We used information on mortality and detailed clinical measures of microvascular complications from electronic patient records. Poisson models were used to model mortality rates according to complication burden.Results During 26,665 person-years of follow-up, 503 deaths occurred. Compared with individuals without microvascular complications, the mortality rate ratio was 2.20 (95% CI 1.79, 2.69) for individuals with diabetic kidney disease, 1.72 (95% CI 1.39, 2.12) for individuals with neuropathy and 1.02 (95% CI 0.77, 1.37) for individuals with retinopathy, all adjusted for calendar time (year/month/day), age, duration of diabetes, sex, HbA 1c, LDL-cholesterol, BMI, smoking status, systolic blood pressure, use of antihypertensive and lipid-lowering medication, and cardiovascular disease status. In individuals with two complications or more, the risk of mortality did not exceed the combined risk from each individual complication. Mortality rate ratios increased immediately after diagnosis of neuropathy and diabetic kidney disease. Mortality rate ratios were independent of the duration of neuropathy and retinopathy, while the mortality rate associated with diabetic kidney disease reached a stable level after approximately 3 years.Conclusions/interpretation Neuropathy and diabetic kidney disease are strong and independent risk markers of mortality in type 1 diabetes, whereas no evidence of higher mortality rate was found for retinopathy. We found no indication that the mortality risk with multiple complications exceeds the risk conferred by each complication separately. The duration spent with microvascular complications had only a marginal effect on mortality.
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Intensive glucose control (A1C <7% in T2D, <7.5% in T1D) lowers risk of incident albuminuria and DKD onset.
“Intensive glucose control (A1C levels <7% in T2D and <7.5% in T1D) in several clinical trials was found to reduce the risk of incident albuminuria (A2) and DKD onset.70,78,90,406–410”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [410]
The Study variables section defines diabetic kidney disease using kidney function and albuminuria, while the Sensitivity analysis examines its association with mortality in type 1 diabetes. Searches for intensive glucose control, the stated A1C targets, and reduced incident albuminuria or DKD onset found no passage addressing those effects; the paper does not report the claimed clinical-trial finding. (LLM, conf=0.75)
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- Authors
- Bjerg, L., Hulman, A., Carstensen, B., Charles, M., Witte, D. R., & Jørgensen, M. E.
- Affiliations
- Aarhus University (DK)
- Steno Diabetes Center Copenhagen (DK)
- University of Southern Denmark (DK)
- Corresponding author
- Bjerg, Lasse
- Venue
- Diabetologia
- Published
- 2019-01-16
- Volume
- 62
- Issue
- 4
- Pages
- 633-643
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2908779813
- Cited by
- 39
- References
- 34
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 6 · 2022: 8 · 2021: 10 · 2020: 6 · 2019: 2
- FWCI
- 5.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Scopus (Elsevier) (submittedVersion)
- Funders
- Amgen
- AstraZeneca
- Innovationsfonden
- Steno Diabetes Center Copenhagen (SDCC 3. B Epidemiology)
- Novo Nordisk
- Novo Nordisk Fonden
- Steno Diabetes Center Aarhus
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 1 diabetes, microvascular complications, mortality, diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, risk indicators, comorbidities
- MeSH terms
- Adolescent, Adult, Antihypertensive Agents, Cardiovascular Diseases, Denmark, Diabetes Mellitus, Type 1, Diabetic Angiopathies, Diabetic Nephropathies, Diabetic Neuropathies, Diabetic Retinopathy, Female, Humans, Male, Microcirculation, Middle Aged, Risk Factors, Young Adult
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