Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Diabetes Care. 2018 Apr;41(4):748-754. doi: 10.2337/dc17-1618. Epub 2018 Jan 29.
The current study investigated whether the risk of mortality in patients with type 1 diabetes without any signs of albuminuria is different than in the general population and matched control subjects without diabetes.
We studied a nationwide, population-based Finnish register of 10,737 patients diagnosed with type 1 diabetes during 1980-2005 and followed for 10 years and 2,544 adults with long-standing diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane). Mortality was compared with the general Finnish population and 6,655 control subjects without diabetes.
The standardized mortality ratio (SMR) was increased during the first 10 years after the diagnosis (2.58 [95% CI 2.07-3.18], < 0.001). Mortality in adults with long-standing diabetes, but without albuminuria, was no different from that of the general population (1.02 [0.84-1.22], = 0.83). However, it was higher compared with that of control subjects without diabetes (1.33 [1.06-1.66], = 0.01). Excess mortality was largely due to acute diabetes complications and ischemic heart disease, which remained more than fourfold higher (mortality rate ratio 4.34 [2.49-7.57]) in adults with type 1 diabetes than in control subjects without diabetes, despite the absence of albuminuria. By contrast, deaths due to alcohol and drugs were reduced in adults with type 1 diabetes ( = 0.007), especially in men.
Excess mortality in type 1 diabetes is the result of its complications. Acute complications drive an increased SMR in the first years. In individuals who remain free of albuminuria, mortality due to ischemic heart disease is still four times higher, and acute complications also occur.
本研究旨在探讨无白蛋白尿的 1 型糖尿病患者的死亡风险是否与普通人群和无糖尿病的匹配对照人群不同。
我们研究了一项全国性的、基于人群的芬兰注册登记，其中包括 1980 年至 2005 年间诊断为 1 型糖尿病的 10737 例患者，并对其进行了 10 年的随访，还纳入了来自芬兰糖尿病肾病研究（FinnDiane）的 2544 例长期糖尿病患者。将死亡率与芬兰普通人群和 6655 名无糖尿病对照者进行比较。
诊断后前 10 年的标准化死亡率比（SMR）升高（2.58 [95%CI 2.07-3.18]，<0.001）。无白蛋白尿的长期糖尿病患者的死亡率与普通人群无差异（1.02 [0.84-1.22]，=0.83）。然而，与无糖尿病对照者相比，其死亡率更高（1.33 [1.06-1.66]，=0.01）。超额死亡率主要归因于急性糖尿病并发症和缺血性心脏病，尽管无白蛋白尿，1 型糖尿病患者的这两种疾病的死亡率仍高出四倍以上（死亡率比 4.34 [2.49-7.57]）。相比之下，1 型糖尿病患者的酒精和药物相关死亡减少（=0.007），尤其是男性。
1 型糖尿病的死亡风险过高是其并发症所致。急性并发症导致前几年 SMR 升高。在无白蛋白尿的个体中，缺血性心脏病导致的死亡率仍高出四倍，且还会发生急性并发症。
