The relationship between risk factors and mortality in type 1 diabetic patients in Europe, the EURODIAB Prospective Complications Study (PCS)

Abstract

Objective: 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, 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), 102 subjects died of the total 2,787. The final multivariable model contained age at baseline (sHR=1.68, 1.36-2.08), glycosylated haemoglobin (sHR=1.17, 0.94-1.44), WHR (sHR=1.32, 1.14-1.53), pulse pressure (sHR=1.27, 1.06-1.52), non-HDL cholesterol (sHR=1.25, 1.04-1.49) and antihypertensive medication (sHR=0.39, 0.25-0.62) as risk factors for all-cause mortality. Macroalbuminuria (sHR 2.22, 95%CI: 1.06-4.65), peripheral (sHR=1.92, 95%CI: 1.08-3.41) and autonomic neuropathy (sHR 2.34, 95%CI: 1.29-4.26) were the most important risk markers for mortality. Similar risk factors were found for all-cause, non-CVD, unknown cause and CVD mortality.

Conclusions: Important risk factors of the increased total and non-CVD mortality risk in type 1 patients are age, WHR, pulse pressure and non-HDL cholesterol. The use of antihypertensive medication lowers the risk of mortality in type 1 diabetes. Microvascular complications from macroalbuminuria, peripheral and autonomic neuropathy are strong risk markers for future mortality, exceeding the effect of the traditional risk factors.