The Pittsburgh Insulin-dependent Diabetes Mellitus (IDDM) Morbidity and Mortality Study: Mortality Results

Js, Dorman; Re, LaPorte; Lh, Kuller; Cruickshanks, K. J.; Orchard, Trevor J.; Wagener, Diane; Dj, Becker; Cavender, Druie; Drash, A L

doi:10.2337/diab.33.3.271

Cited by 273 publications

(174 citation statements)

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“…Although an increased risk of heart disease is well recognised as a chronic complication of diabetes, agespecific mortality statistics for death from IHD have not been previously reported in patients with Type 1 diabetes, perhaps because published cohorts have been too small [9,10,16]. We have shown that in patients with Type 1 diabetes IHD mortality rates are raised in comparison with the general population at all adult ages, and in both sexes.…”

Section: Discussionmentioning

confidence: 57%

“…Within the past 30 years there have been a number of studies quantifying the risk of IHD mortality but these have been mainly restricted to patients with Type 2 diabetes [3,4,5,6] or have included patients with Type 1 and Type 2 diabetes together [7,8]. Although CVD is also recognised as a complication in patients with Type 1 diabetes [9,10], mortality from IHD has been less frequently studied and IHD mortality risks by age and sex have not been reported for these patients.…”

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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

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: Discussionmentioning

confidence: 57%

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

636

407

View full text Add to dashboard Cite

show abstract

“…Since there were some differences in demographic characteristics between the two cohorts as presented in Table 1 and these characteristics have been previously found to be associated with overall mortality [13,14], they were included in multivariate models to adjust for their independent effect. The Cox proportional hazard model was employed to adjust for sex, age at onset, calendar year of onset, and duration of diabetes.…”

Section: Discussionmentioning

confidence: 99%

Markedly increased renal disease mortality and incidence of renal replacement therapy among IDDM patients in Japan in contrast to Allegheny County, Pennsylvania, USA

Matsushima

Tajima

et al. 1995

Diabetologia

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“…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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The Pittsburgh Insulin-dependent Diabetes Mellitus (IDDM) Morbidity and Mortality Study: Mortality Results

Cited by 273 publications

References 0 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

Markedly increased renal disease mortality and incidence of renal replacement therapy among IDDM patients in Japan in contrast to Allegheny County, Pennsylvania, USA

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

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