The British Diabetic Association Cohort Study, II: cause‐specific mortality in patients with insulin‐treated diabetes mellitus

Laing, Susan; Swerdlow, Anthony; Slater, S. D.; Botha, J. L.; Burden, A C; Waugh, Norman; Smith, Alberto; Hill, R. D.; Bingley, Polly J.; Patterson, Chris; Qiao, Z.; Keen, H.

doi:10.1046/j.1464-5491.1999.00076.x

Cited by 302 publications

(233 citation statements)

References 22 publications

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“…The Diabetes UK Cohort and its follow-up has been described in detail elsewhere [11,12]. A total of 23,751 patients with insulin-treated diabetes diagnosed under the age of 30 years were recruited into the cohort between 1972 and 1993 from all parts of the United Kingdom.…”

Section: Methodsmentioning

confidence: 99%

“…The Diabetes UK Cohort Study (formerly BDA Cohort Study) [11,12] has Cardiovascular disease (CVD) has been recognised as a complication of diabetes in older patients for many decades [1,2], with mortality from CVD and especially from ischaemic heart disease (IHD) exceeding that followed over 23,000 patients with insulin-treated diabetes, diagnosed under the age of 30 years, and now has sufficient follow-up to examine IHD mortality in detail and compare the results with data from studies of patients with Type 2 diabetes.…”

mentioning

confidence: 99%

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Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes

Laing

Swerdlow

Slater³

et al. 2003

Diabetologia

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636

407

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Aims/hypothesis. Although ischaemic heart disease is the predominant cause of mortality in older people with diabetes, age-specific mortality rates have not been published for patients with Type 1 diabetes. The Diabetes UK cohort, essentially one of patients with Type 1 diabetes, now has sufficient follow-up to report all heart disease, and specifically ischaemic heart disease, mortality rates by age. Methods. A cohort of 23,751 patients with insulintreated diabetes, diagnosed under the age of 30 years and from throughout the United Kingdom, was identified during the period 1972 to 1993 and followed for mortality until December 2000. Age-and sex-specific heart disease mortality rates and standardised mortality ratios were calculated. Results. There were 1437 deaths during the follow-up, 536 from cardiovascular disease, and of those, 369 from ischaemic heart disease. At all ages the ischaemic heart disease mortality rates in the cohort were higher than in the general population. Mortality rates within the cohort were similar for men and women under the age of 40. The standardised mortality ratios were higher in women than men at all ages, and in women were 44.8 (95%CI 20.5-85.0) at ages 20-29 and 41.6 (26.7-61.9) at ages 30-39. Conclusions/interpretation. The risk of mortality from ischaemic heart disease is exceptionally high in young adult women with Type 1 diabetes, with rates similar to those in men with Type 1 diabetes under the age of 40. These observations emphasise the need to identify and treat coronary risk factors in these young patients. [Diabetologia (2003) 46:760-765]

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes

Laing

Swerdlow

Slater³

et al. 2003

Diabetologia

Self Cite

636

407

View full text Add to dashboard Cite

show abstract

“…Type 1 diabetes confers a twoto tenfold increased risk of death and cardiovascular disease compared with the background population [1,2]. Diabetes is associated with endothelial dysfunction and reduced neovascularisation in response to tissue ischaemia [3,4].…”

Section: Introductionmentioning

confidence: 99%

Circulating endothelial progenitor cells, endothelial function, carotid intima–media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria

et al. 2009

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Aims/hypothesis Type 1 diabetes is associated with premature arterial disease. Bone-marrow derived, circulating endothelial progenitor cells (EPCs) are believed to contribute to endothelial repair. The hypothesis tested was that circulating EPCs are reduced in young people with type 1 diabetes without vascular injury and that this is associated with impaired endothelial function and increased carotid intima-media thickness (CIMT). Methods We compared 74 people with type 1 diabetes with 80 healthy controls. CD34, CD133, vascular endothelial (VE) growth factor receptor-2 (VEGFR-2) and VE-cadherin antibodies were used to quantify EPCs and progenitor cell subtypes using flow-cytometry. Ultrasound assessment of endothelial function by brachial artery flow-mediated dilatation (FMD) and CIMT was made. Circulating endothelial markers, inflammatory markers and plasma plasminogen activator inhibitor-1 (PAI-1) levels were measured. Results CD34+VE-cadherin+, CD133+VE-cadherin+ and CD133+VEGFR-2+ EPC counts were significantly lower in people with diabetes (46-69%; p=0.004-0.043). In people with type 1 diabetes, FMD was reduced by 45% (p<0.001) and CIMT increased by 25% (p<0.001), these being correlated (r=−0.25, p=0.033). There was a significant relationship between FMD and CD34+VE-cadherin+ (r = 0.39, p = 0.001), CD133+VEGFR-2+ (r =0.25, p = 0.037) and CD34+ (r=0.34, p=0.003) counts. Circulating high-sensitivity C-reactive protein, PAI-1, interleukin-6 and E-selectin were significantly higher in the diabetes group (p < 0.001 to p = 0.049), the last two of these correlating with FMD (r=−0.27, p=0.028 and r=−0.24, p=0.048, respectively). Conclusions/interpretation These findings suggest that abnormalities of endothelial function in addition to proinflammatory and pro-thrombotic states are already common in people with type 1 diabetes before development of clinically evident arterial damage. Low EPC counts confirm risk of macrovascular complications and may account for impaired endothelial function and predict future cardiovascular events.

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“…Cardiovascular disease is the leading cause of premature death in patients with type 1 diabetes [1] and the risk of Electronic supplementary material The online version of this article (doi:10.1007/s00125-009-1541-2) includes a list of members of the FinnDiane Study Group, which is available to authorised users. cardiovascular disease in patients with diabetic nephropathy is increased tenfold [2].…”

Section: Introductionmentioning

confidence: 99%

Lipid abnormalities predict progression of renal disease in patients with type 1 diabetes

et al. 2009

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Aims/hypothesis We studied the impact of baseline lipid variables on the progression of renal disease in a large nationwide prospective cohort of patients with type 1 diabetes. Methods A total of 2,304 adult patients with type 1 diabetes and available lipid profiles participating in the Finnish Diabetic Nephropathy Study (FinnDiane) were evaluated. Data on progression of renal disease were verified from medical files and patients were followed for 5.4±2.0 (mean ± SD) years. Results High triacylglycerol, apolipoprotein (Apo) B, ApoA-II and HDL 3 -cholesterol concentrations predicted incident microalbuminuria. Progression to macroalbuminuria was predicted by high triacylglycerol and ApoB. When AER was entered into the model, triacylglycerol was no longer an independent predictor, but when patients with normal AER and microalbuminuria at baseline were pooled, triacylglycerol, HbA 1c , male sex and AER were all independent predictors of renal disease. High total cholesterol, LDLcholesterol, non-HDL-cholesterol and triacylglycerol as well as low HDL-cholesterol, HDL 2 -cholesterol, ApoA-I and ApoA-II concentrations were predictive of progression to end-stage renal disease. However, when estimated GFR was entered into the model, only total cholesterol remained an independent predictor of progression. Conclusions/interpretation Lipid abnormalities, particularly high triacylglycerol concentrations, increase the risk of progression of renal disease.

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The British Diabetic Association Cohort Study, II: cause‐specific mortality in patients with insulin‐treated diabetes mellitus

Cited by 302 publications

References 22 publications

Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes

Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes

Circulating endothelial progenitor cells, endothelial function, carotid intima–media thickness and circulating markers of endothelial dysfunction in people with type 1 diabetes without macrovascular disease or microalbuminuria

Lipid abnormalities predict progression of renal disease in patients with type 1 diabetes

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