Differential Association of Microvascular Attributions With Cardiovascular Disease in Patients With Long Duration of Type 1 Diabetes
Article Figures & Tables
Figures
- Figure 1
Differences in CVD prevalence across patients with and without CKD and PDR. Data are % (n per group) in Medalist patients (A) and FinnDiane patients (B). Overall P < 0.001 in both cohorts.
- Figure 2
Kidney (A) and retinal (B) photographs of a 72-year old Medalist patient with 66 years of type 1 diabetes and severe diabetic nephropathy (DN class III), but only mild DR (nonproliferative DR [NPDR]), and no CVD, showing differential protection. PAS, periodic acid-Schiff staining; Tub, tubule. *Kimmelstiel-Wilson nodule. †Mesangial expansion.
Tables
- Table 1
Clinical characteristics of Medalists stratified by the presence of CKD and PDR
+CKD/−PDR −CKD/−PDR +CKD/+PDR −CKD/+PDR N 30 327 66 339 Sex (male) 46.7 46.8 40.9 44.3 Age (years) 73 (67, 77)* 65 (61, 70) 65 (62, 71) 64 (60, 70) Age at diagnosis (years) 15 (10, 21)* 11 (6, 16) 10 (7, 14) 10 (6, 14) Duration (years) 54 (51, 63) 53 (51, 56) 54 (51, 58) 53 (51, 56) Daily insulin dose (units/kg) 0.48 (0.31, 0.62) 0.42 (0.34, 0.52) 0.44 (0.33, 0.56) 0.43 (0.35, 0.54) HbA1c (%) 7.0 (6.4, 8.0) 7.1 (6.5, 7.6) 7.2 (6.4, 7.8) 7.2 (6.7, 7.7) HbA1c (mmol/mol) 53 (46, 64) 54 (48, 60) 55 (46, 62) 55 (50, 61) Total cholesterol (mmol/L) 3.8 (3.4, 4.4) 4.1 (3.7, 4.7) 4.0 (3.4, 4.5) 4.0 (3.5, 4.7) LDL cholesterol (mmol/L) 2.0 (1.5, 2.5) 2.0 (1.7, 2.4) 2.0 (1.6, 2.5) 2.0 (1.7, 2.3) HDL cholesterol (mmol/L) 1.4 (1.1, 1.8)* 1.7 (1.4, 2.1) 1.4 (1.2, 1.7) 1.6 (1.3, 2.0) Triglycerides (mmol/L) 0.8 (0.7, 1.2)* 0.7 (0.6, 0.9) 1.0 (0.7, 1.2) 0.7 (0.6, 1.0) BMI (kg/m2) 25.5 (23.6, 28.3)* 25.2 (22.5, 28.1) 27.7 (24.1, 30.4) 25.9 (23.3, 28.7) eGFR (mL/min/1.73 m2) 40.5 (33.6, 43.7)* 77.6 (63.2, 89.9) 35.5 (28.8, 41.5) 71.8 (60.1, 85.6) Serum creatinine (µmol/L) 132.6 (114.9, 159.1)* 79.6 (69.8, 94.6) 142.8 (123.8, 176.8) 85.7 (70.7, 97.2) ACR (mg/mmol) 2.1 (0.9, 6.5)* 1.2 (0.7, 2.4) 3.6 (1.5, 14.3) 1.4 (0.8, 4.0) CRP (mg/L) 1.0 (0.6, 1.8) 0.7 (0.2, 1.7) 0.8 (0.3, 2.7) 0.7 (0.2, 1.7) Systolic blood pressure (mmHg) 130 (119, 148) 132 (120, 146) 127 (120, 148) 128 (120, 140) Diastolic blood pressure (mmHg) 60 (58, 68)* 65 (58, 70) 62 (58, 69) 62 (58, 68) Detectable C-peptide 56.7* 37.0 28.6 32.1 Responder to MMTT 22.2 5.8 5.6 5.9 CVD 34.5* 28.8 68.2 42.8 Neuropathy (MNSI ≥2) 73.3 68.8 73.9 74.3 Antihypertensive medication 72.4* 60.1 90.8 65.7 Lipid-lowering medication 75.0 66.3 80.3 72.3 Exercise 65.5* 84.3 72.3 79.8 Smoking 0 1.6 2.2 3.6 IA2 30.0 24.0 15.9 20.6 GAD65 26.7 28.5 31.8 27.0 DR3 or DR4 100.0 93.8 93.8 93.9 Data are median (IQR) or %. For C-peptide response to mixed-meal tolerance test (MMTT), n = 439. MNSI, Michigan Neuropathy Screening Instrument.
↵*P < 0.05 between all groups. Boldface text highlights the differences between groups (equals *P < 0.05 between all groups).
- Table 2
Clinical characteristics of FinnDiane patients stratified by the presence of CKD and PDR
+CKD/−PDR −CKD/−PDR +CKD/+PDR −CKD/+PDR N 21 228 170 256 Sex (male) 57.1 48.3 62.9 55.1 Age (years) 48.4 (40.2, 53.0) 45.2 (39.4, 51.1) 44.0 (39.2, 49.7) 45.6 (38.3, 50.7) Age at diagnosis (years) 12.1 (7.5, 18.3)* 12.1 (6.9, 17.5) 10.4 (6.1, 15.4) 9.5 (5.5, 14.2) Duration (years) 33.9 (27.3, 36.2) 31.5 (28.3, 36.2) 32.9 (28.9, 36.9) 33.2 (28.6, 39.3) Daily insulin dose (units/kg) 0.5 (0.43, 0.78) 0.61 (0.51, 0.73) 0.67 (0.53, 0.84) 0.63 (0.52, 0.77) HbA1c (%) 7.8 (7.3, 8.6)* 8.0 (7.4, 8.7) 8.4 (7.5, 9.2) 8.4 (7.8, 9.3) HbA1c (mmol/mol) 62 (56, 71)* 64 (57, 72) 68 (58, 77) 68 (62, 78) Total cholesterol (mmol/L) 5.2 (4.5, 5.8)* 5.0 (4.4, 5.6) 5.3 (4.7, 6.2) 5.0 (4.4, 5.7) LDL cholesterol (mmol/L) 3.3 (3.0, 4.3) 3.2 (2.6, 3.7) 3.4 (2.8, 4.1) 3.2 (2.7, 3.8) HDL cholesterol (mmol/L) 1.0 (0.9, 1.5)* 1.3 (1.1, 1.6) 1.1 (0.9, 1.4) 1.3 (1.1, 1.4) Triglycerides (mmol/L) 1.32 (1.14, 1.67)* 0.93 (0.72, 1.36) 1.59 (1.16, 2.39) 1.09 (0.85, 1.48) BMI (kg/m2) 24.2 (22.0, 25.9)* 24.6 (22.7, 27.3) 24.7 (22.3, 27.5) 25.6 (23.3, 28.2) eGFR (mL/min/1.73 m2) 40.8 (21.7, 44.1)* 86.9 (75.4, 100.2) 33.3 (16.2, 43.7) 77.6 (63.0, 94.2) Serum creatinine (µmol/L) 151.0 (123.3, 231.2)* 79.3 (70.2, 91.7) 188.2 (120.4, 332.5) 88.9 (79.3, 104.2) ACR (mg/mmol) 3.0 (0.3, 9.8)* 0.1 (0.1, 0.4) 3.3 (0.5, 13.5) 0.6 (0.1, 3.0) CRP (mg/L) 3.3 (2.2, 5.7)* 2.0 (1.2, 4.2) 2.5 (1.6, 6.2) 2.3 (1.4, 4.4) Systolic blood pressure (mmHg) 149 (137, 165)* 134 (126, 145) 151 (137, 168) 141 (128, 153) Diastolic blood pressure (mmHg) 83 (78, 88)* 80 (72, 86) 85 (78, 90) 80 (72, 88) Detectable C-peptide levels 23.5 10.0 13.9 10.6 CVD 19.1* 6.6 37.1 15.1 Antihypertensive medication 95.2* 40.8 96.5 73.4 Lipid-lowering medication 38.1* 12.7 38.2 20.3 Exercise 66.7 69.8 57.7 62.1 Smoking 14.3 27.4 19.4 22.8 Data are median (IQR) or %. Exercise data available in 50% of the patients. Boldface text highlights the differences between groups (equals *P < 0.05 between all groups).
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