Why do some patients with type 1 diabetes live so long?

Distiller, Larry A.

doi:10.4239/wjd.v5.i3.282

Cited by 16 publications

(10 citation statements)

References 33 publications

(65 reference statements)

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“…The absence of nephropathy after 15–20 years of diabetes onset could be a marker of long-term survival of patients with diabetes. 29 In a discrete-time simulation model using published information on mortality from CVD, renal disease, and risk of lower-extremity amputation and blindness to estimate and compare mean life expectancy and quality-adjusted life-years in patients treated for T1DM, researchers showed that from 15 years of age, male and female patients had respective estimated life expectancies of 47.2 (95% CI, 35.2–59.2) and 52.7 (95% CI, 41.7–63.6) years in the intensive treatment group. 30 A higher risk of mortality from CVD and renal disease in male T1DM patients may compete with the risk of cancer incidence, leading to lower SIR in male T1DM patients than in females.…”

Section: Discussionmentioning

confidence: 99%

A Population-Based Cohort Study of All-Cause and Site-Specific Cancer Incidence Among Patients With Type 1 Diabetes Mellitus in Taiwan

Hsu

Lin

Kuo

et al. 2015

Journal of Epidemiology

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BackgroundThe relationship between type 1 diabetes mellitus (T1DM) and cancer incidence remains unclear. We sought to assess the all-cause and site-specific cancer incidence in patients with T1DM.MethodsA retrospective cohort study design was employed, in which 14 619 patients with T1DM were retrieved from Taiwan’s National Health Insurance medical claims between 2000 and 2007. The study subjects were followed to the end of 2008, and cancer incidence was assessed. We calculated age-, sex-, and calendar year-standardized incidence ratios (SIRs) of all-cause cancer incidence and site-specific neoplasm incidence, with reference to the general population.ResultsSeven hundred and sixty patients were identified for all-cause cancer over 86 610 person-years, representing an incidence rate of 87.75 cases per 10 000 person-years. The incidence rate was higher in males than in female patients (109.86 vs 69.75 cases per 10 000 person-years). T1DM was associated with a significantly increased SIR of all-cause cancer (1.13; 95% confidence interval [CI], 1.05–1.22). The sex-specific SIR was significantly elevated in female patients (1.19; 95% CI, 1.07–1.33), but the SIR for male patients was insignificantly elevated (1.09; 95% CI, 0.99–1.20). Pancreatic cancer showed the greatest increase in SIR among both male and female patients with T1DM. Male patients experienced significantly increased SIRs for kidney, rectum, liver, and colon neoplasm, and significantly increased SIRs were noted for ovarian, bladder, and colon cancer in female patients.ConclusionsT1DM was associated with a 13% increase in risk of all-cause cancer incidence. Patients with T1DM should be advised to undergo cancer screening for certain types of cancer.

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Section: Discussionmentioning

confidence: 99%

A Population-Based Cohort Study of All-Cause and Site-Specific Cancer Incidence Among Patients With Type 1 Diabetes Mellitus in Taiwan

Hsu

Lin

Kuo

et al. 2015

Journal of Epidemiology

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“…The identification of individuals with latent autoimmune diabetes of adults (LADA) is relevant for therapeutic decisions [ 7 ], since these individuals need insulin therapy much earlier than those with classical type 2 diabetes. Furthermore, since the longevity of people with childhood autoimmune diabetes has improved considerably over recent decades [ 8 ], an increasing proportion of older individuals with diabetes are those with classical type 1 diabetes.…”

Section: Pathophysiology and Types Of Diabetes In Older Peoplementioning

confidence: 99%

Diabetes in the older patient: heterogeneity requires individualisation of therapeutic strategies

Schernthaner

Schernthaner-Reiter

2018

Diabetologia

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Owing to the worldwide increase in life expectancy, the high incidence of diabetes in older individuals and the improved survival of people with diabetes, about one-third of all individuals with diabetes are now older than 65 years. Evidence is accumulating that type 2 diabetes is associated with cognitive impairment, dementia and frailty. Older people with diabetes have significantly more comorbidities, such as myocardial infarction, stroke, peripheral arterial disease and renal impairment, compared with those without diabetes. However, as a consequence of the increased use of multifactorial risk factor intervention, a considerable number of older individuals can now survive for many years without any vascular complications. Given the heterogeneity of older individuals with type 2 diabetes, an individualised approach is warranted, which must take into account the health status, presence or absence of complications, and life expectancy. In doing so, undertreatment of otherwise healthy older individuals and overtreatment of those who are frail may be avoided. Specifically, overtreatment of hyperglycaemia in older patients is potentially harmful; in particular, insulin and sulfonylureas should be avoided or, if necessary, used with caution. Instead, glucose-dependent drugs that do not induce hypoglycaemia are preferable since older patients with diabetes and impaired kidney function are especially vulnerable to this adverse event.

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“…More often, hyperglycaemia or type 1 diabetes plays a major role in increased incidence of CVD and mortality in individuals. Patients facing type 1 diabetes showed increase of premature mortality, primarily from cardiovascular disease (CVD) [ 8 ]. It also indicates that severe lipid disorders may occur in patients with type 1 diabetes, but the occurrence of elevated high-density lipoprotein cholesterol is positively associated with longevity of these patients (Figures 1 and 2 ).…”

Section: Introductionmentioning

confidence: 99%

“…It also indicates that severe lipid disorders may occur in patients with type 1 diabetes, but the occurrence of elevated high-density lipoprotein cholesterol is positively associated with longevity of these patients (Figures 1 and 2 ). Similarly, nonrenal hypertension by itself is a significant risk factor for CVD but if adequately treated does not appear to mitigate against longevity [ 8 ]. In old ages (55–60) measurement of blood pressure and anthropometric and biochemical parameters such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low density lipoprotein (LDL) assist in finding high risk of CVD, dyslipidemia, and metabolic disorders in patients [ 8 ] ( Table 1 ).…”

Section: Introductionmentioning

confidence: 99%

Emerging Risk Biomarkers in Cardiovascular Diseases and Disorders

2015

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Present review article highlights various cardiovascular risk prediction biomarkers by incorporating both traditional risk factors to be used as diagnostic markers and recent technologically generated diagnostic and therapeutic markers. This paper explains traditional biomarkers such as lipid profile, glucose, and hormone level and physiological biomarkers based on measurement of levels of important biomolecules such as serum ferritin, triglyceride to HDLp (high density lipoproteins) ratio, lipophorin-cholesterol ratio, lipid-lipophorin ratio, LDL cholesterol level, HDLp and apolipoprotein levels, lipophorins and LTPs ratio, sphingolipids, Omega-3 Index, and ST2 level. In addition, immunohistochemical, oxidative stress, inflammatory, anatomical, imaging, genetic, and therapeutic biomarkers have been explained in detail with their investigational specifications. Many of these biomarkers, alone or in combination, can play important role in prediction of risks, its types, and status of morbidity. As emerging risks are found to be affiliated with minor and microlevel factors and its diagnosis at an earlier stage could find CVD, hence, there is an urgent need of new more authentic, appropriate, and reliable diagnostic and therapeutic markers to confirm disease well in time to start the clinical aid to the patients. Present review aims to discuss new emerging biomarkers that could facilitate more authentic and fast diagnosis of CVDs, HF (heart failures), and various lipid abnormalities and disorders in the future.

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Why do some patients with type 1 diabetes live so long?

Cited by 16 publications

References 33 publications

A Population-Based Cohort Study of All-Cause and Site-Specific Cancer Incidence Among Patients With Type 1 Diabetes Mellitus in Taiwan

A Population-Based Cohort Study of All-Cause and Site-Specific Cancer Incidence Among Patients With Type 1 Diabetes Mellitus in Taiwan

Diabetes in the older patient: heterogeneity requires individualisation of therapeutic strategies

Emerging Risk Biomarkers in Cardiovascular Diseases and Disorders

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