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Heart, eye disease rates unchanged in patients with type 1 diabetes
Premature death rates and some complications have declined in recent decades.
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PITTSBURGH – Although cases of premature death and several other complications of type 1 diabetes have declined, rates of other serious diabetes-related disorders such as heart and eye disease have not improved during the last 25 to 30 years, according to researchers at the University of Pittsburgh Graduate School of Public Health.
“Doctors have long considered type 1 diabetes a small blood vessel problem, so they have traditionally not focused on the potential large blood vessel complications, such as cardiovascular disease,” said Georgia Pambianco, MS, MPH, department of epidemiology at the University of Pittsburgh Graduate School of Public Health. “However, our study suggests that doctors and their patients need to pay more attention to factors that affect the larger blood vessels, such as lipids and blood pressure,” Pambianco said in a press release.
The study was conducted with patients who were part of the Pittsburgh Epidemiology of Diabetes Complications Study, an ongoing investigation to document long-term complications of type 1 diabetes among juveniles and adolescents who were patients at Children’s Hospital of Pittsburgh between 1950 and 1980.
Decade differences
Participants were divided into five groups, according to the year their diabetes was first diagnosed: 1950 to 1959, 1960 to 1964, 1965 to 1969, 1970 to 1974 and 1975 to 1980. Lifespan and illness data were then analyzed for three separate time intervals: 20, 25 and 30 years post-diagnosis.
Patients diagnosed in later years lived longer, whereas patients diagnosed in the 1950s had a fivefold higher early rate of death at 25 years post-diagnosis than those diagnosed in the 1970s (P<.05).
Kidney failure rates also declined for those diagnosed more recently. At 20 years post-diagnosis, 4% of those diagnosed after 1964 developed renal failure, compared with 16% among those diagnosed in the 1950s. At 30 years post-diagnosis, renal failure rates dropped from 31% in the 1950s to 18% in the 1960s.
No differences existed across cohorts for rates of cardiovascular disease events and cardiac intervention procedures. Even when the researchers considered that revascularization procedures, such as balloon angioplasty and stenting, have become more common in later decades than they were in the 1950s or 1960s, they found no differences in cardiovascular disease among the study population at either 20 or 30 years’ duration.
No differences were found between groups in rates of kidney dysfunction (P<.13) or proliferative retinopathy (P<.16), a major cause of blindness in type 1 diabetes at 20 and 25 years post-diagnosis.
“We were, in fact, surprised and disappointed that there were no improvements in cardiovascular and retinopathy disease rates, particularly because other complications improved so dramatically,” said Trevor Orchard, MD, professor of epidemiology, medicine, and pediatrics at the University of Pittsburgh Graduate School of Public Health. “Our data show that focusing solely on blood-glucose control is only postponing, not preventing, some of the more significant complications of this disease.”
For more information:
- Pambianco G, Costacou T, Ellis D, et al. The 30-year natural history of type 1 diabetes complications: The Pittsburgh Epidemiology of Diabetes Complications Study Experience. Diabetes. 2006;55:1463-1469.