OBJECTIVEType 1 diabetes is associated with a markedly increased risk of stroke, but only a few studies on the incidence of stroke in type 1 diabetes exist. Therefore, we assessed the incidence of stroke in patients with type 1 diabetes and studied the impact of diabetic nephropathy (DN) and severe diabetic retinopathy (SDR) on this risk.RESEARCH DESIGN AND METHODSWe studied 4,083 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. Mean age was 37.4 ± 11.8 years, duration of diabetes was 21.6 ± 12.1 years, and 52% were men. Strokes were identified from medical records, death certificates, and the National Hospital Discharge Register and classified based on medical files and brain images.RESULTSDuring 36,680 person-years of follow-up, 149 (4%) patients suffered an incident stroke (105 infarctions and 44 hemorrhages). Of the infarctions, 58 (55%) were lacunar. The incidence of stroke, cerebral infarction, and cerebral hemorrhage was 406 (95% CI 344–477), 286 (234–347), and 120 (87–161) per 100,000 person-years, respectively. In an adjusted analysis, microalbuminuria increased the risk of stroke with a hazard ratio (HR) of 3.2 (1.9–5.6), macroalbuminuria 4.9 (2.9–8.2), and end-stage renal disease 7.5 (4.2–13.3), and SDR increased the risk with an HR of 3.0 (1.9–4.5). The risk of cerebral infarction, cerebral hemorrhage, and lacunar infarction increased in a similar manner. The proportion of lacunar versus nonlacunar infarction did not change across DN groups.CONCLUSIONSThe presence of SDR and DN, independently, increases the risk of stroke, cerebral infarction, and cerebral hemorrhage in patients with type 1 diabetes.

OBJECTIVE This study investigated the prevalence of nonalbuminuric chronic kidney disease in type 1 diabetes to assess whether it increases the risk of cardiovascular and renal outcomes as well as all-cause mortality. RESEARCH DESIGN AND METHODS This was an observational follow-up of 3,809 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. All patients were Caucasians and thoroughly examined at baseline. Their mean age was 37.6 ± 11.8 years and duration of diabetes 21.2 ± 12.1 years. Follow-up data on cardiovascular and renal outcomes and mortality were retrieved from registers. During 13 years of median follow-up, 378 developed end-stage renal disease, 415 suffered an incident cardiovascular event, and 406 died. RESULTS At baseline, 78 (2.0%) had nonalbuminuric chronic kidney disease. This was associated with older age, female sex, history of retinal laser treatment, cardiovascular events, and the number of antihypertensive drugs in use, but not with blood pressure levels or specific antihypertensive agents. Nonalbuminuric chronic kidney disease did not increase the risk of albuminuria (hazard ratio [HR] 2.0 [95% CI 0.9–4.4]) or end-stage renal disease (HR 6.4 [0.8–53.0]) but did increase the risk of cardiovascular events (HR 2.0 [1.4–3.5]) and all-cause mortality (HR 2.4 [1.4–3.9]). The highest risk of cardiovascular and renal end points was observed in the patients with albuminuria. CONCLUSIONS Nonalbuminuric chronic kidney disease is not a frequent finding in patients with type 1 diabetes, but when present, it is associated with an increased risk of cardiovascular morbidity and all-cause mortality but not with renal outcomes.

W orldwide, cerebrovascular disease is the second leading cause of death not only in high-income but also in lowincome countries. Patients with type 1 diabetes mellitus have a markedly increased risk of stroke compared with nondiabetic subjects, 1 and it is of note that these patients are at a high risk of stroke 10 to 15 years earlier than nondiabetic subjects. 2 Age, hypertension, atrial fibrillation, smoking, and diabetes mellitus are well-known risk factors for stroke in the general population. [2][3][4][5] In patients with type 2 diabetes mellitus, similar risk factors have been observed. 6 Furthermore, the metabolic syndrome and its components have also been shown to increase the risk of stroke, especially in patients with type 2 diabetes mellitus. Although the risk factors for stroke in patients with type 2 diabetes mellitus have been assessed in several studies, few studies on the risk factors for stroke and stroke subtypes in patients with type 1 diabetes mellitus exist. No sex difference has been observed for the risk of stroke in type 1 diabetes mellitus, which is in contrast to the general population in which premenopausal women are protected from cardiovascular disease and stroke.1,2 Stroke is usually divided into 2 subgroups: ischemic stroke and hemorrhagic stroke. Ischemic stroke can be further subgrouped into lacunar and nonlacunar infarction, whereas hemorrhagic stroke includes intracerebral and subarachnoid hemorrhage. We have earlier shown that both the severity of diabetic nephropathy (DN) and the presence of severe diabetic retinopathy (SDR) increase the risk of any stroke, ischemic stroke, lacunar infarction, and hemorrhagic stroke. 8 However, comprehensive studies on independent risk factors for each subtype of stroke are still missing.Therefore, we aimed to study the independent risk factors for stroke, and also for the subtypes ischemic stroke, lacunar Background and Purpose-Despite the fact that patients with type 1 diabetes mellitus have a markedly increased risk of experiencing a stroke, independent risk factors for stroke and its subtypes in these patients have remained unclear. Methods-A total of 4083 patients with type 1 diabetes mellitus from the Finnish Diabetic Nephropathy (FinnDiane) Study, without a history of stroke at baseline, were included. Strokes were classified based on medical files and brain imaging. At baseline, mean age was 37.4±11.8 years, duration of diabetes mellitus was 20.0 (11.0-30.0) years, and 51% were men. During 9.0±2.7 years (36 680 patient-years) of follow-up, 105 patients experienced an ischemic stroke and 44 a hemorrhagic stroke. Cox proportional hazards analyses were performed to determine independent risk factors. Results-Independent risk factors for ischemic stroke were duration of diabetes mellitus, presence of diabetic nephropathy, higher hemoglobin A 1c , higher systolic blood pressure, insulin resistance, and history of smoking, whereas sex, lipids, high-sensitivity C-reactive protein, and the metabolic syndrome were not associated with an incre...

OBJECTIVETo estimate for the first time the incidence of subarachnoid hemorrhage (SAH) in type 1 diabetes.RESEARCH DESIGN AND METHODSUsing the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study cohort of 4,083 patients with type 1 diabetes (mean age of 37.4 ± 11.8 years at enrollment), we analyzed the incidence of first-ever SAH events.RESULTSDuring the follow-up time of 36,680 person-years (median 9.4 years), 15 patients with type 1 diabetes experienced an aneurysmal or nonaneurysmal SAH, and thus the crude incidence of SAH was 40.9 (95% CI 22.9–67.4) per 100,000 person-years. One patient had a verified aneurysmal SAH, and four patients died suddenly of an SAH, which was most likely caused by an aneurysm. SAHs in 10 out of 15 patients were classified as nonaneurysmal SAH, and thus the crude incidence of nonaneurysmal SAH was 27.3 (13.1–50.1) per 100,000 person-years. None of the nonaneurysmal SAHs were fatal. In univariate analysis, current smokers had a hazard ratio of 4.82 (95% CI 1.31–17.81) for nonaneurysmal SAH.CONCLUSIONSThe incidence of nonaneurysmal SAH is high among patients with type 1 diabetes. Our findings suggest that nonaneurysmal SAH is a distinct new microvascular complication in type 1 diabetes.