Glycemic Control and Excess Mortality in Type 1 Diabetes

Lind, Marcus; Svensson, Ann‐Marie; Kosiborod, Mikhail; Guðbjörnsdóttir, Soffia; Pivodic, Aldina; Wedel, Hans; Dahlqvist, Sofia; Clements, Mark A.; Rosengren, Annika

doi:10.1056/nejmoa1408214

Cited by 784 publications

(681 citation statements)

References 28 publications

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“…Interestingly, all‐cause mortality, and the combined outcome (stroke and death), were only slightly increased in type 2 diabetes patients compared to patients without diabetes. Others have demonstrated an increased risk of death in type 1 diabetes patients 27, 28. In a nationwide study, based on data from the Swedish National Diabetes Register, it was found that type 1 diabetes individuals, even at optimal glycemic control, had twice as high a risk of death, predominantly from CVD, compared to matched controls from the general population 27.…”

Section: Discussionmentioning

confidence: 99%

“…Others have demonstrated an increased risk of death in type 1 diabetes patients 27, 28. In a nationwide study, based on data from the Swedish National Diabetes Register, it was found that type 1 diabetes individuals, even at optimal glycemic control, had twice as high a risk of death, predominantly from CVD, compared to matched controls from the general population 27. When myocardial infarction, stroke, and heart failure are reported as separate outcomes in individuals with diabetes, usually coronary heart disease is predominant 29.…”

Section: Discussionmentioning

confidence: 99%

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Long‐Term Risk of Stroke in Patients With Type 1 and Type 2 Diabetes Following Coronary Artery Bypass Grafting

Nyström

Holzmann

Sartipy

2015

JAHA

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BackgroundWe performed a nationwide population‐based cohort study to investigate the long‐term risk of stroke after coronary artery bypass grafting in patients with type 1 and type 2 diabetes.Methods and ResultsAll patients who underwent primary coronary artery bypass grafting in Sweden from 2000 through 2011 were included from the SWEDEHEART register. We excluded patients with prior stroke, and patients who had a stroke or died within 30 days of surgery. The National Diabetes Register was used to identify patients with type 1 and type 2 diabetes. Incident stroke (ischemic and hemorrhagic), and all‐cause mortality was obtained by record linkage with the National Patient Register and the Cause of Death register. We used multivariable Cox regression to estimate the risk of stroke in relation to type of diabetes. A total of 53 820 patients (type 1 diabetes [n=714], type 2 diabetes [n=10 054], no diabetes [n=43 052]) were included. During a mean follow‐up of 7.4 years (398 337 person‐years), in total, 8.0% (n=4296) of the patients had a stroke: 7.3% (n=52) in patients with type 1 diabetes, 9.1% (n=915) in patients with type 2 diabetes, and 7.7% (n=3329) in patients with no diabetes. The multivariable adjusted hazard ratio (95% CI) for all stroke was 1.59 (1.20–2.11) in type 1 diabetes, and 1.32 (1.23–1.43) in type 2 diabetes.ConclusionsThe long‐term risk for stroke after coronary artery bypass grafting was increased in patients with type 1 and type 2 diabetes, compared to patients with no diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐Term Risk of Stroke in Patients With Type 1 and Type 2 Diabetes Following Coronary Artery Bypass Grafting

Nyström

Holzmann

Sartipy

2015

JAHA

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“…2 More recently, data from the Swedish National Diabetes Registry found that patients with type 1 diabetes and glycated hemoglobin (A1c) levels of 6.9% (below current ADA Clinical Practice Recommendations) had twice the mortality as age-matched cohorts without diabetes. 3 In patients in the Swedish National Registry, 14.5% of all mortality was attributed to diabetic ketoacidosis or severe hypoglycemia. Among patients younger than 30 years, 31.4% of all premature mortality was attributed to diabetic ketoacidosis or severe hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

A Simple Composite Metric for the Assessment of Glycemic Status from Continuous Glucose Monitoring Data: Implications for Clinical Practice and the Artificial Pancreas

Hirsch

Balo

Sayer

et al. 2017

Diabetes Technology & Therapeutics

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Background: The potential clinical benefits of continuous glucose monitoring (CGM) have been recognized for many years, but CGM is used by a small fraction of patients with diabetes. One obstacle to greater use of the technology is the lack of simplified tools for assessing glycemic control from CGM data without complicated visual displays of data. Methods: We developed a simple new metric, the personal glycemic state (PGS), to assess glycemic control solely from continuous glucose monitoring data. PGS is a composite index that assesses four domains of glycemic control: mean glucose, glycemic variability, time in range and frequency and severity of hypoglycemia. The metric was applied to data from six clinical studies for the G4 Platinum continuous glucose monitoring system (Dexcom, San Diego, CA). The PGS was also applied to data from a study of artificial pancreas comparing results from open loop and closed loop in adolescents and in adults. Results: The new metric for glycemic control, PGS, was able to characterize the quality of glycemic control in a wide range of study subjects with various mean glucose, minimal, moderate, and excessive glycemic variability and subjects on open loop versus closed loop control. Conclusion: A new composite metric for the assessment of glycemic control based on CGM data has been defined for use in assessing glycemic control in clinical practice and research settings. The new metric may help rapidly identify problems in glycemic control and may assist with optimizing diabetes therapy during timeconstrained physician office visits.

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“…In addition to well-described chronic complications, higher HbA1c is associated with increased mortality in both the DCCT-EDIC study group and in a Swedish population-based study of persons with type 1 diabetes compared with controls. 17,18 In the DCCT-EDIC mortality study, intensive insulin therapy nearly obliterated the difference in cardiovascular outcomes at 30 years of follow-up, but in the full cohort, a 10% higher HbA1c was associated with a 56% increase in the risk of mortality. 17,19,20 Reports from Scotland, Australia, and Norway show that both acute and chronic complications of diabetes contribute to the excess mortality in persons with type 1 diabetes.…”

Section: Cgm In Type 1 Diabetes Treated With MDImentioning

confidence: 99%

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

McGill

Ahmann

2017

Diabetes Technology & Therapeutics

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Continuous glucose monitoring (CGM) is developing into an increasingly useful tool for glucose monitoring and therapeutic guidance in the treatment of diabetes. Multiple daily doses of insulin (MDI) is the most common method for intensive insulin treatment of type 1 diabetes and is also becoming more common in the treatment of type 2 diabetes as an increasing population with type 2 diabetes experiences progressive beta cell loss. The clinical evidence demonstrating the benefit of CGM in the outcomes of patients treated with MDI is becoming clearer, particularly with the recent completion of several randomized clinical trials addressing both type 1 and 2 diabetes. This evidence is reviewed.

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Glycemic Control and Excess Mortality in Type 1 Diabetes

Cited by 784 publications

References 28 publications

Long‐Term Risk of Stroke in Patients With Type 1 and Type 2 Diabetes Following Coronary Artery Bypass Grafting

Long‐Term Risk of Stroke in Patients With Type 1 and Type 2 Diabetes Following Coronary Artery Bypass Grafting

A Simple Composite Metric for the Assessment of Glycemic Status from Continuous Glucose Monitoring Data: Implications for Clinical Practice and the Artificial Pancreas

Continuous Glucose Monitoring with Multiple Daily Insulin Treatment: Outcome Studies

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