High Risk of Cardiovascular Disease in Patients With Type 1 Diabetes in the U.K.

Soedamah‐Muthu, Sabita S.; Fuller, John; Mulnier, Henrietta; Raleigh, Veena S; Lawrenson, Ross; Colhoun, Helen M.

doi:10.2337/diacare.29.04.06.dc05-1433

Cited by 334 publications

(243 citation statements)

References 28 publications

Supporting

Mentioning

215

Contrasting

Unclassified

Order By: Relevance

“…Patients with type 2 diabetes were identified using an algorithm based on age at diagnosis and type of treatment. Full details of the cohort selection have been published elsewhere [22][23][24]. For each patient with type 2 diabetes five comparison subjects of the same age and sex and with no record of or treatment for diabetes at any time before 1992 or during the follow-up period were selected at random from the database.…”

Section: Methodsmentioning

confidence: 99%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

View full text Add to dashboard Cite

Aims/hypothesis Risk estimates for stroke in patients with diabetes vary. We sought to obtain reliable risk estimates for stroke and the association with diabetes, comorbidity and lifestyle in a large cohort of type 2 diabetic patients in the UK. Materials and methods Using the General Practice Research Database, we identified all patients who had type 2 diabetes and were aged 35 to 89 years on 1 January 1992. We also identified five comparison subjects without diabetes and of the same age and sex. Hazard ratios (HRs) for stroke between January 1992 and October 1999 were calculated, and the association with age, sex, body mass index, smoking, hypertension, atrial fibrillation and duration of diabetes was investigated. Results The absolute rate of stroke was 11.91 per 1,000 person-years (95% CI 11.41-12.43) in people with diabetes (n=41,799) and 5.55 per 1,000 person-years (95% CI 5.40-5.70) in the comparison group (n=202,733). The ageadjusted HR for stroke in type 2 diabetic compared with non-diabetic subjects was 2.19 (95% CI 2.09-2.32) overall, 2.08 (95% CI 1.94-2.24) in men and 2.32 (95% CI 2.16-2.49) in women. The increase in risk attributable to diabetes was highest among young women (HR 8.18; 95% CI 4.31-15.51) and decreased with age. No investigated comorbidity or lifestyle characteristic emerged as a major contributor to risk of stroke. Conclusions/interpretation This study provides risk estimates for stroke for an unselected population from UK general practice. Patients with type 2 diabetes were at an increased risk of stroke, which decreased with age and was higher in women. Additional risk factors for stroke in type 2 diabetic patients included duration of diabetes, smoking, obesity, atrial fibrillation and hypertension.

show abstract

Section: Methodsmentioning

confidence: 99%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

View full text Add to dashboard Cite

show abstract

“…The increased cardiovascular disease (CVD) risk in individuals with diabetes mellitus cannot be fully explained by traditional cardiovascular risk factors [1,2]. Therefore, other factors and mechanisms potentially involved need to be explored.…”

Section: Introductionmentioning

confidence: 99%

Levels of soluble receptor for AGE are cross-sectionally associated with cardiovascular disease in type 1 diabetes, and this association is partially mediated by endothelial and renal dysfunction and by low-grade inflammation: the EURODIAB Prospective Complications Study

et al. 2009

View full text Add to dashboard Cite

Aims/hypothesis Plasma soluble receptor for AGE (sRAGE) may reflect the activity of the AGE-RAGE axis, which has been proposed as a potential mechanism linking hyperglycaemia to vascular complications in diabetes. We have therefore investigated: (1) whether sRAGE is associated with greater prevalence of cardiovascular disease (CVD) and microvascular complications in type 1 diabetic individuals; and (2) the extent to which any such associations are explained by markers of endothelial and renal dysfunction and inflammation.Methods The study included 477 individuals (234 women; mean age 42± 10 [SD] years) from the EURODIAB Prospective Complications Study. We used linear regression analyses to investigate the differences in sRAGE levels between individuals with and without vascular complications. All analyses were adjusted for age, sex, HbA 1c , duration of diabetes and other risk factors. Results Individuals with CVD (n=116) had higher levels of sRAGE than those without CVD or any microvascular complications (n =178): β =0.15 (95% CI 0.04-0.27).Diabetologia (2009) inflammation (β=0.12 [0.01-0.23]) attenuated these differences; altogether these variables explained about 50% of the association between sRAGE and prevalent CVD. sRAGE levels tended to be higher in the presence and across the levels of severity of albuminuria (p for trend= 0.087) and retinopathy (p for trend=0.057); adjustments for endothelial and renal dysfunction and inflammation also attenuated these differences. Conclusions/interpretation sRAGE is associated with greater prevalence of CVD in type 1 diabetic individuals, and these associations may be partly explained by endothelial and renal dysfunction and low-grade inflammation.

show abstract

“…In England many of these data are in principle available for purchase from the General Practice Research Database that offers a sample of about 7,500-8,000 type 1 diabetes patients, that is about 4.5% of the total type 1 diabetes population [63,64]. These data ought to be collected in disease registers to support evidencebased policy making.…”

Section: Discussionmentioning

confidence: 99%

“…We subject the resulting initial condition to validation. Each of these stages is also associated with increased mortality rates, mainly due to cardiovascular disease [61][62][63][64]; and these are particularly high for macroalbuminuria [65,66].…”

Section: First Five Yearsmentioning

confidence: 99%

Requisite models for strategic commissioning: the example of type 1 diabetes

Airoldi¹,

Bevan²,

Morton³

et al. 2008

Health Care Manage Sci

View full text Add to dashboard Cite

A developing emphasis of health care reforms has been creating organisations with responsibilities for strategic commissioning of services for defined populations. Such organisations must set priorities in aiming to meet their populations' needs subject to a budget constraint. This requires estimates of the health benefits and costs of different interventions for their populations. This paper outlines a framework that does this and shows how this requires modelling to produce estimates in a way that is transparent to commissioners, of requisite complexity to produce sound estimates for priority setting using routinely available data. The example illustrated in this paper is an intervention that would improve glucose control in the English population with type 1 diabetes. It takes many years for a change in glucose management to deliver maximum benefits; hence the intervention is not good value-for-money in the short run. We aim to give a more strategic view of the costs and benefits modelling costs and benefits in a steady-state model which suggests that the intervention is good value-for-money in the long run.

show abstract

High Risk of Cardiovascular Disease in Patients With Type 1 Diabetes in the U.K.

Cited by 334 publications

References 28 publications

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

Levels of soluble receptor for AGE are cross-sectionally associated with cardiovascular disease in type 1 diabetes, and this association is partially mediated by endothelial and renal dysfunction and by low-grade inflammation: the EURODIAB Prospective Complications Study

Requisite models for strategic commissioning: the example of type 1 diabetes

Contact Info

Product

Resources

About