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Published online March 28, 2008
Diabetes Care 31:1360-1366, 2008
DOI: 10.2337/dc08-0107
© 2008 by the American Diabetes Association
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Epidemiology/Health Services Research
Original Research

Relationship Between Risk Factors and Mortality in Type 1 Diabetic Patients in Europe

The EURODIAB Prospective Complications Study (PCS)

Sabita S. Soedamah-Muthu, PHD1,2, Nish Chaturvedi, MD3, Daniel R. Witte, PHD2, Lynda K. Stevens, MSC2, Massimo Porta, MD4, John H. Fuller, FRCP2 for the EURODIAB Prospective Complications Study Group

1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
2 Epidemiology and Public Health, Royal Free and University College London Medical School, London, U.K.
3 National Heart and Lung Institute, Imperial College, London, U.K.
4 Medicine, University of Turin, Turin, Italy

Corresponding author: S.S. Soedamah-Muthu, s.s.soedamah-muthu{at}umcutrecht.nl

OBJECTIVE—The purpose of this study was to examine risk factors for mortality in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS—Baseline risk factors were measured in the EURODIAB Prospective Cohort Study with 2,787 type 1 diabetic patients (51% men and 49% women) recruited from 16 European countries. Mortality data were collected during a 7-year follow-up.

RESULTS—There was an annual mortality rate of 5 per 1,000 person-years in patients with type 1 diabetes (mean age at baseline 33 years, range 15–61 years); of the total 2,787 subjects, 102 died. The final multivariable model contained age at baseline (standardized hazard ratio 1.78 [95% CI 1.44–2.20]), A1C (1.18 [0.95–1.46]), waist-to-hip ratio (WHR) (1.32 [1.14–1.52]), pulse pressure (1.33 [1.13–1.58]), and non-HDL cholesterol (1.33 [1.12–1.60]) as risk factors for all-cause mortality. Macroalbuminuria (2.39 [1.19–4.78]) and peripheral (1.88 [1.06–3.35]) and autonomic neuropathy (2.40 [1.32–4.36]) were the most important risk markers for mortality. Similar risk factors were found for all-cause, non-cardiovascular disease (CVD), unknown-cause, and CVD mortality.

CONCLUSIONS—Important risk factors for the increased total and non-CVD mortality in type 1 diabetic patients are age, WHR, pulse pressure, and non-HDL cholesterol. Microvascular complications from macroalbuminuria and peripheral and autonomic neuropathy are strong risk markers for future mortality exceeding the effect of the traditional risk factors.


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