Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. (Funded by the Swedish Association of Local Authorities and Regions and others.).

BACKGROUNDLong-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes. METHODSWe included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population. RESULTSAmong patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, −31.4 (95% confidence interval [CI], −56.1 to −6.7); death from cardiovascular disease, −26.0 (95% CI, −42.6 to −9.4); death from coronary heart disease, −21.7 (95% CI, −37.1 to −6.4); and hospitalization for cardiovascular disease, −45.7 (95% CI, −71.4 to −20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, −69.6 (95% CI, −95.9 to −43.2); death from cardiovascular disease, −110.0 (95% CI, −128.9 to −91.1); death from coronary heart disease, −91.9 (95% CI, −108.9 to −75.0); and hospitalization for cardiovascular disease, −203.6 (95% CI, −230.9 to −176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls. CONCLUSIONSIn Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. (Funded by the Swedish Association of Local Authorities and Regions and others.) a bs tr ac t

These results suggest that there are substantial variations in glycaemic control among people with Type 1 diabetes between the data sources and that there is room for improvement in all populations, especially in young adults.

Word count: Background: Risk of cardiovascular disease (CVD) and mortality for patients with versus without type 2 diabetes mellitus (T2DM) appears to vary by age of T2DM diagnosis, but few population studies have analyzed mortality and CVD outcomes associations across the full age range. Methods: Using the Swedish National Diabetes Registry (NDR), everyone with T2DM registered in the NDR between 1998, and, 2012 were included. Controls were randomly selected from the general population matched for age, sex, and county. The analysis cohort comprised 318,083 patients with T2DM matched with just under 1•6 million controls. Participants were followed from 1998 to 2013 for CVD outcomes and to 2014 for mortality. Outcomes of interest were total mortality, CV mortality, non-CV mortality, coronary heart disease, acute myocardial infarction, stroke, heart failure, and atrial fibrillation. We also examined life expectancy by age of diagnosis. We conducted the primary analyses using Cox proportional hazards models in those with no prior cardiovascular disease and repeated the work in the entire cohort. Results: Over a median follow-up period of 2.52 years, T2DM patients diagnosed under 40 years or less had the highest excess risk for most outcomes relative to controls with adjusted HR [95% CI] of 2•05 [1•81 to 2•83] for total mortality, 2•72 [2•13 to 3•48] for CV related mortality, 1•95 [1•68-2•25] for non-CV mortality, 4•77 [3•86-5•89] for HF and 4•33 [3•82-4•91] for CHD. All risks attenuated progressively with each increasing decade at diagnostic age; by the time T2DM was diagnosed above 80 years, the adjusted HRs for CVD and non-CVD mortality were below one, with excess risks for other CVD outcomes substantially attenuated. Moreover, survival in those diagnosed beyond 80 was the same as controls, whereas it was beyond a decade less when T2DM was diagnosed in adolescence. Finally, HRs for most outcomes were numerically greater in younger women with T2DM. 4 Conclusions: Age at diagnosis of T2DM is prognostically important for survival and cardiovascular risks, with implications for determining timing and intensity of risk factor interventions for clinical decision making and for guideline-directed care. These observations amplify support for preventing / delaying T2DM onset in younger individuals.

In the absence of a clear evidence base, the European TREAT survey confirms the wide variation in prescribing practice of systemic immunosuppression in refractory paediatric atopic eczema. The results will be used to inform the design of a randomized controlled trial relevant to patient management across Europe.