Sudden death in type 1 diabetes

McNally, Paul; Lawrence, Ian; Panerai, R.B.; Weston, Philip J.; Thurston, H.

doi:10.1046/j.1463-1326.1999.00025.x

Cited by 35 publications

(28 citation statements)

References 84 publications

(93 reference statements)

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“…In the background population these deaths are usually classified as CAD. For diabetic patients there is reason to believe that both cardiac autonomic dysfunction and concomitant hypoglycaemia are involved, and that malignant cardiac dysrhythmias might be a common final pathway [38]. It has been recognised that patients with cardiac autonomic neuropathy secondary to diabetes sometimes die a sudden and unexpected death without an obvious cause apparent at autopsy [39].…”

Section: Discussionmentioning

confidence: 99%

Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway

et al. 2005

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Aims/hypothesis: We examined long-term total and cause-specific mortality in a nationwide, populationbased Norwegian cohort of patients with childhood-onset type 1 diabetes. Materials and methods: All Norwegian type 1 diabetic patients who were diagnosed between 1973 and 1982 and were under 15 years of age at diagnosis were included (n=1,906). Mortality was recorded from diabetes onset until 31 December 2002 and represented 46,147 person-years. The greatest age attained among deceased subjects was 40 years and the maximum diabetes duration was 30 years. Cause of death was ascertained by reviews of death certificates, autopsy protocols and medical records. The standardised mortality ratio (SMR) was based on national background statistics. Results: During follow-up 103 individuals died. The mortality rate was 2.2/1000 person-years. The overall SMR was 4.0 (95% CI 3.2-4.8) and was similar for males and females. For ischaemic heart disease the SMR was 20.2 (7.3-39.8) for men and 20.6 (1.8-54.1) for women. Acute metabolic complications of diabetes were the most common cause of death under 30 years of age (32%). Cardiovascular disease was responsible for the largest proportion of deaths from the age of 30 years onwards (30%). Violent death accounted for 28% of the deaths in the total cohort (35% among men and 11% among women). Conclusions/interpretation: Childhood-onset type 1 diabetes still carries an increased mortality risk when compared with the general population, particularly for cardiovascular disease. To reduce these deaths, attention should be directed to the prevention of acute metabolic complications, the identification of psychiatric vulnerability and the early detection and treatment of cardiovascular disease and associated risk factors.

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Section: Discussionmentioning

confidence: 99%

Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway

et al. 2005

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“…These data support a potential role for nonanatomic factors, such as autonomic neuropathy, long QT syndrome, or hypoglycemia, in the precipitation of sudden death in type I diabetic patients. 24 Clinical studies have shown that diabetes is associated with positive 25 or negative/absence of remodeling. 26 The current study supports the notion that diabetic subjects are more likely to show positive remodeling.…”

Section: Figurementioning

confidence: 99%

Morphologic Findings of Coronary Atherosclerotic Plaques in Diabetics

Burke

Kolodgie²,

Zieske³

et al. 2004

ATVB

467

338

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Objective-Coronary atherosclerotic plaque composition of diabetic subjects and localization of receptor for advanced glycation end products (RAGE) and its ligands have not been extensively studied. Method and Results-Hearts from diabetic subjects and age, race, and sex-matched nondiabetic subjects dying suddenly were examined. Coronary arteries were dissected and lesions were evaluated for plaque burden, necrotic core size, and inflammatory infiltrate. The expression of RAGE, the RAGE-binding protein (S100-A12, EN-RAGE), and cell death (apoptosis) were also determined. Lesions from type II diabetic subjects had larger mean necrotic cores (Pϭ0.01) and greater total and distal plaque load (PϽ0.001) than nondiabetic subjects. Necrotic core size correlated positively with diabetic status, independent of other risk factors. Intimal staining for macrophages, T-cells, and HLA-DR was also significantly greater in diabetic subjects (Pϭ0.03, Pϭ0.003, and PϽ0.0001), respectively. The association of increased macrophage infiltrate was independent of cholesterol levels and patient age. Expression of RAGE and EN-RAGE was significantly greater in diabetic subjects (Pϭ0.004) and was associated with apoptotic smooth muscle cells and macrophages. Conclusion-In sudden coronary death, inflammation and necrotic core size play a greater role in the progression of atherosclerosis in diabetic subjects.

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“…Hyperglycaemia activates multiple phenomena. 21 Many of these favour the development of atherosclerosis; others play a role in the development of microvascular complications, which can also be risk factors for cardiovascular disease, 22 such as cardiac autonomic neuropathy 23 and albuminuria. 24 Cardiac failure is another documented risk factor for premature death in this patient group.…”

Section: 13mentioning

confidence: 99%