A new study published in the European Heart Journal reveals that adults diagnosed with type 1 diabetes face a heightened risk of cardiovascular disease and death, with no better prognosis than those diagnosed in childhood
Research on type 1 diabetes in adults remains limited, prompting researchers at Karolinska Institutet to investigate the risks of cardiovascular disease and mortality in affected individuals. The study reveals the impact of smoking, poor glucose control, and obesity are the main risk factors for a heightened chance of cardiovascular disease and death.
Analysing health data of over 10,000 people
The registry-based study identified 10,184 people diagnosed with type 1 diabetes in adulthood between 2001 and 2020 and compared them to 509,172 matched people in the control group.
Within the 10,184 individuals, 40.4% were diagnosed with the condition between the ages of 18–29, 21.3% between 30–39, and 38.3% at age 40 or older (ranging from 40 to 102 years).
Those diagnosed at age 40 or older were more likely to be female and smokers, and they also had higher blood pressure, triglycerides, and HbA1c levels, as well as worse kidney function and more severe insulin resistance compared to those diagnosed at younger ages. These individuals also had higher body mass indexes (BMI) and were less likely to experience diabetic coma or ketoacidosis compared to those diagnosed between the ages of 18–29.
When comparing men and women with type 1 diabetes, no significant differences were observed in key clinical biomarkers like HbA1c. Compared to controls, a higher percentage of those with type 1 diabetes were born in Sweden, but they had slightly lower levels of education. People with type 1 diabetes had higher HbA1c levels but a lower prevalence of smoking and physical inactivity, as well as lower BMI, blood pressure, and triglycerides than individuals with type 2 diabetes diagnosed at similar ages.
“The main reasons for the poor prognosis are smoking, overweight/obesity and poor glucose control. We found that they were less likely to use assistive devices, such as insulin pumps,” says first author Yuxia Wei, a postdoctoral fellow at the Institute of Environmental Medicine, Karolinska Institutet.
Improved management key to better outcomes in adult-onset type 1 diabetes, researchers say
The researchers emphasise the seriousness of type 1 diabetes.
“But we show that the prognosis can be significantly improved by preventing smoking and obesity and improving glucose control, not least in people diagnosed at older ages,” explained senior author Sofia Carlsson, senior lecturer and associate professor at the same department.
The researchers hope to continue investigating adult-onset type 1 diabetes, including risk factors for developing the disease and the prognosis of other outcomes, such as microvascular complications.
The team also plan to investigate optimal treatment in adult-onset type 1 diabetes, including the effect of pump use and other advanced technologies. They also highlight the need for increased awareness amongst clinicians to identify and manage adult-onset type 1 diabetes more effectively, ensuring timely diagnosis and tailored treatment strategies to reduce long-term health risks.
“We hope to shed light on these issues in the coming years,” concluded Sofia Carlsson.
The Swedish Research Council and the Swedish Diabetes Foundation, among others, funded the study. The researchers report that there are no conflicts of interest.
