Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden.
AstraZeneca, Oslo, Norway
Diabetes Care. 2021 May;44(5):1211-1218. doi: 10.2337/dc20-2839. Epub 2021 Mar 2.
Type 1 diabetes (T1D) and type 2 diabetes (T2D) increase risks of cardiovascular (CV) and renal disease (CVRD) compared with diabetes-free populations. Direct comparisons between T1D and T2D are scarce. We examined this by pooling full-population cohorts in Sweden and Norway.
A total of 59,331 patients with T1D and 484,241 patients with T2D, aged 18-84 years, were followed over a mean period of 2.6 years from 31 December 2013. Patients were identified in nationwide prescribed drug and hospital registries in Norway and Sweden. Prevalence and event rates of myocardial infarction (MI), heart failure (HF), stroke, chronic kidney disease (CKD), all-cause death, and CV death were assessed following age stratification in 5-year intervals. Cox regression analyses were used to estimate risk.
The prevalence of CV disease was similar in T1D and T2D across age strata, whereas CKD was more common in T1D. Age-adjusted event rates comparing T1D versus T2D showed that HF risk was increased between ages 65 and 79 years, MI between 55 and 79 years, and stroke between 40 and 54 years (1.3-1.4-fold, 1.3-1.8-fold, and 1.4-1.7-fold, respectively). CKD risk was 1.4-3.0-fold higher in T1D at all ages. The all-cause death risk was 1.2-1.5-fold higher in T1D at age >50 years, with a similar trend for CV death.
Adult patients with T1D compared with those with T2D had an overall greater risk of cardiorenal disease (HF and CKD) across ages, MI and all-cause death at middle-older ages, and stroke at younger ages. The total age-adjusted CVRD burden and risks were greater among patients with T1D compared with those with T2D, highlighting their need for improved prevention strategies.
与无糖尿病人群相比，1 型糖尿病（T1D）和 2 型糖尿病（T2D）会增加心血管（CV）和肾脏疾病（CVRD）的风险。T1D 和 T2D 之间的直接比较很少。我们通过在瑞典和挪威的全人群队列中进行研究来检查这一点。
共有 59331 例 T1D 患者和 484241 例 T2D 患者，年龄在 18-84 岁之间，从 2013 年 12 月 31 日起平均随访 2.6 年。在挪威和瑞典，通过全国处方药物和医院登记处确定患者。根据年龄分层，在 5 年间隔内评估心肌梗死（MI）、心力衰竭（HF）、中风、慢性肾脏病（CKD）、全因死亡和心血管死亡的发生率和事件率。使用 Cox 回归分析来估计风险。
在各年龄层，T1D 和 T2D 的 CV 疾病患病率相似，而 T1D 患者的 CKD 更为常见。与 T2D 相比，年龄调整后的 T1D 事件率显示 HF 风险在 65-79 岁之间增加，MI 在 55-79 岁之间增加，中风在 40-54 岁之间增加（分别为 1.3-1.4 倍、1.3-1.8 倍和 1.4-1.7 倍）。T1D 在所有年龄段的 CKD 风险均增加 1.4-3.0 倍。T1D 在年龄>50 岁时的全因死亡风险增加 1.2-1.5 倍，心血管死亡也有类似趋势。
与 T2D 相比，成年 T1D 患者在各年龄段的心脏肾脏疾病（HF 和 CKD）、中年以上的 MI 和全因死亡以及年轻患者的中风风险总体上更高。与 T2D 相比，T1D 患者的总年龄调整后的 CVRD 负担和风险更高，这凸显了他们需要更好的预防策略。
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