Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France.
Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France.
Cardiovasc Diabetol. 2022 May 9;21(1):71. doi: 10.1186/s12933-022-01487-8.
Cardiovascular disease (CVD) and nontraumatic lower-limb amputation (LLA) each results in reduced life expectancy in patients with type 1 diabetes, but the differential burden between these conditions is unknown. We compared the effects of CVD and LLA on the risk of mortality in people with type 1 diabetes.
We used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data were divided into: 1/absence of CVD (myocardial infarction and/or stroke) nor LLA, 2/history of CVD alone without LLA, 3/LLA alone without CVD or 4/both conditions at baseline. Participants with baseline history of peripheral artery disease were excluded from groups 1 and 2. The study endpoint was any death occurring during follow-up, regardless of the causes.
Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA or both were present at baseline in 49 (4.2%), 62 (5.3%) and 20 (1.7%) subjects, respectively. All-cause death occurred in 304 (26%) participants during 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 (95%CI, 15-18) per 1000 person-years. The risk of death increased in individuals with baseline history of CVD (adjusted HR 2.00 [95% CI 1.34-3.01], p = 0.0008) or LLA (2.26 [1.56-3.28], p < 0.0001), versus no condition, with an additive effect in people with both conditions (5.32 [3.14-9.00], p < 0.0001). No incremental risk of death was observed in people with CVD versus LLA (0.87 [0.54-1.41]). Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 (95% CI 1.26-4.32) and 3.38 (1.87-4.88) years, respectively. Combined conditions expose to 7.04 (4.76-9.31) less years of life expectancy (all p < 0.0001).
CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes population. Our findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments and prevention.
心血管疾病 (CVD) 和非创伤性下肢截肢 (LLA) 都会导致 1 型糖尿病患者预期寿命缩短，但这两种情况的负担差异尚不清楚。我们比较了 CVD 和 LLA 对 1 型糖尿病患者死亡风险的影响。
我们使用了 SURGENE、GENEDIAB 和 GENESIS 前瞻性队列研究的数据。数据分为：1/无 CVD（心肌梗死和/或中风）和 LLA，2/CVD 病史但无 LLA，3/仅 LLA 而无 CVD 或 4/基线时存在两种情况。有基线周围动脉疾病史的参与者被排除在第 1 组和第 2 组之外。研究终点为随访期间发生的任何死亡，无论原因如何。
在 1169 名参与者（男性 55%，年龄 40±13 岁，糖尿病病程 23±11 年）中，基线时有 49 名（4.2%）、62 名（5.3%）和 20 名（1.7%）分别患有 CVD、LLA 或两者兼有。在 17 年的随访中，共有 304 名（26%）参与者死亡，共 18426 人年，发生率为 16（95%CI，15-18）/1000 人年。与无疾病状态相比，基线时患有 CVD（调整后的 HR 2.00 [95%CI 1.34-3.01]，p=0.0008）或 LLA（2.26 [1.56-3.28]，p<0.0001）的个体死亡风险增加，且具有叠加效应（2.00 [1.34-3.01]，p=0.0008）。与无疾病状态相比，患有 CVD 的个体与患有 LLA 的个体（0.87 [0.54-1.41]）相比，死亡风险无明显增加。与 LLA 相比，CVD 并没有增加死亡风险（0.87 [0.54-1.41]）。与无疾病状态相比，CVD 和 LLA 在随访期间均与预期寿命缩短相关：分别为 2.79（95%CI 1.26-4.32）和 3.38（1.87-4.88）年。同时患有两种疾病的个体预期寿命减少 7.04（4.76-9.31）年（所有 p<0.0001）。
CVD 和 LLA 对 1 型糖尿病患者的死亡率有相似的影响。我们的研究结果鼓励对患有 1 型糖尿病和 LLA 的患者进行谨慎评估，就管理危险因素、治疗和预防而言，应给予他们与 CVD 患者同样的重视。
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