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Explaining the increased mortality in type 1 diabetes
Chiara Mameli1, Sara Mazzantini1, Moufida Ben Nasr1
1Chiara Mameli, Sara Mazzantini, Gian Vincenzo Zuccotti, Department of Pediatrics, "Ospedale dei Bambini V. Buzzi", University of Milan, 20154 Milan, Italy.
Insights
Type 1 diabetes (T1D) patients with good glycated hemoglobin levels still face elevated mortality risks. Long-term glycemic control history, especially from childhood, is crucial for understanding T1D outcomes and developing prevention strategies.
Area of Science:
- Endocrinology
- Diabetology
- Cardiovascular Medicine
Background:
- Despite advancements in glucose management and cardiovascular risk factor treatment, mortality rates in type 1 diabetes (T1D) remain high.
- Recent studies indicate that T1D individuals with glycated hemoglobin (HbA1c) below 6.9% exhibit doubled mortality risk compared to controls.
- The chronic nature of T1D, often starting in childhood, necessitates considering the entire glycemic control history for accurate mortality correlation.
Purpose of the Study:
- To discuss the implications of recent findings on T1D mortality rates.
- To emphasize the impact of early-life glycemic control on long-term outcomes in T1D.
- To explore factors associated with the chronic progression of T1D and inform preventive strategies.
Main Methods:
- Review and discussion of recent research on T1D mortality and glycemic control.
- Analysis of the long-term effects of early-onset T1D and glycemic fluctuations.
- Exploration of various factors influencing chronic T1D progression and outcomes.
Main Results:
- Individuals with T1D and HbA1c levels of 6.9% or lower have a significantly higher risk of all-cause and cardiovascular mortality.
- The transition to a hyperglycemic state in pediatric T1D patients may have lasting effects on mortality.
- A comprehensive understanding of the entire glycemic control history is essential for accurate risk assessment.
Conclusions:
- Recent mortality data in T1D highlights the complexity beyond current management strategies.
- Early-onset T1D and its historical glycemic control significantly influence long-term health outcomes.
- Further research into early T1D alterations and chronic disease factors is needed for effective preventive strategies.
Abstract:
Despite large improvements in the management of glucose levels and in the treatment of cardiovascular risk factors, the mortality rate in individuals with type 1 diabetes (T1D) is still high. Recently, Lind et al found that T1D individuals with glycated hemoglobin levels of 6.9% or lower had a risk of death from any cause or from cardiovascular causes that is twice as high as the risk for matched controls. T1D is a chronic disease with an early onset (e.g., pediatric age) and thus in order to establish a clear correlation between death rate and the glycometabolic control, the whole history of glycemic control should be considered; particularly in the early years of diabetes. The switch from a normo- to hyperglycemic milieu in an individual with T1D in the pediatric age, represents a stressful event that may impact outcomes and death rate many years later. In this paper we will discuss the aforementioned issues, and offer our view on these findings, paying a particular attention to the several alterations occurring in the earliest phases of T1D and to the many factors that may be associated with the chronic history of T1D. This may help us to better understand the recently published death rate data and to develop future innovative and effective preventive strategies.
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