Increased mortality risk for men with type 1 diabetes, regardless of cognitive ability
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Swedish men diagnosed with type 1 diabetes in youth had higher all-cause and cardiovascular mortality risks compared with those without diabetes, and cognitive ability did not influence the associations, according to study data.
“The study shows how the prognosis of type 1 diabetes has developed during 60 years of time, showing high mortality rates for people with the disease compared to those without,” Elin Dybjer, MD, a PhD student in the department of clinical sciences at Lund University in Malmö, Sweden, told Healio. “Cognitive ability at age 18 years did not predict mortality in people with diabetes, which may be because effects of mortality were strong and overpowered such effects.”
Researchers conducted a retrospective study of 120 men with type 1 diabetes born from 1934 to 1943 with data available in hospital and military records in the region of Scania in southern Sweden. The group with diabetes was compared with a control group of 469 men without diabetes. Baseline data were collected from 1959 to 1961. Cognition was measured through intelligence test results for 95 men in the diabetes group and 456 in the control cohort during military conscription. Each participant received a cognition score ranging from 1 to 9, with nine representing the highest level of cognition. Morbidity and mortality data were collected for a 60-year follow-up period until the participants reached a maximum age of 77 years. Mortality data were obtained from the Swedish Cause of Death Registry from 1961 until Dec. 31, 2018, and data on medical diagnoses were obtained from the Swedish National Patient Register from 1964 until Dec. 31, 2016.
The findings were published in Diabetic Medicine.
At the end of the follow-up period, 80% of the men in the diabetes group had died compared with 31% of the control group. Of those with diabetes, 32% died before age 50 years compared with 5% of controls. Men with diabetes also had a higher incidence rate of CV events (39% vs. 21%) and heart failure (23% vs. 10%) compared with those without diabetes.
“The substantially increased risk in these individuals could be explained by the less than optimal treatment profile of type 1 diabetes 60 years ago, based on the use of non-human insulin preparations that were given only once daily in most cases,” the researchers wrote. “Besides, no effective treatment for lipid disturbances was available and smoking habits were widespread among young men.”
The average cognition score was higher for men with type 1 diabetes compared with those without diabetes (5.24 vs. 4.51; P < .001). Men without diabetes and a higher cognitive score at military conscription had a lower risk for all-cause mortality than those with a lower score (HR = 0.59; 95% CI, 0.39-0.9). However, cognitive ability was not associated with mortality risk for men with type 1 diabetes.
“There is a need of studies on larger and later-born cohorts of type 1 diabetes to detect possible associations between early cognitive ability and prognosis later in life,” Dybjer said.
For more information:
Elin Dybjer, MD, can be reached at elin.dybjer@med.lu.se.
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