NDR EASD 2015
10:45 - 12:15 Heding Hall. OP 02 Sledge hammers to crack nuts: cutting-edge cardiometabolic epidemiology.
Glycaemic control and incidence of dementia in 363,573 patients with type 2 diabetes: an observational study
Author Block A. Rawshani, A. Rawshani, A.-M. Svensson, S. Gudbjörnsdottir; Clinical and Molecular Medicine, Inst of Medicine, Gothenburg, Sweden.
Abstract: Background and aims: A growing body of evidence indicates that diabetes increases the risk of cognitive impairment. This has prompted interest in delineating predictors of cognitive decline and dementia in diabetes. Cohort studies relating glycated haemoglobin (HbA1c) to risk of dementia are lacking. We evaluated extensive clinical data to explore the association between HbA1c and the risk of hospitalization for dementia among persons with type 2 diabetes.
Materials and methods: We identified all patients with type 2 diabetes and no known hospitalization for dementia who were registered in the Swedish National Diabetes Registry between January, 2004, and December, 2012. These patients were followed up until hospital admission for dementia, death, or end of follow-up on Dec 31, 2012. We used Cox regression to assess the association between patients’ characteristics, including HbA1c, and dementia. All covariates were modelled as time-dependent predictors.
Results: In a cohort of 395,173 patients (contributing 2,981,247 registrations) with mean age of 64.6 years (SD 12.5) at baseline, 9,175 patients (2.3%) were admitted to hospital with a primary or secondary diagnosis of dementia during a mean (SD) follow-up of 4.6 (2.5) years. In a Cox regression analysis - with adjustment for age, sex, duration of diabetes, marital status, income, education, smoking status, systolic blood pressure, body mass index, estimated glomerular filtration rate, statins, albuminuria, type of glucose lowering treatment, atrial fibrillation, stroke and antihypertensive medications -the hazard ratio for hospitalization for dementia was 2.36 (95% CI 2.00-2.78) in patients with HbA1c of 10.5% or higher, compared with a reference group of patients with HbA1c of less than 6.5%. Statins and antihypertensive medications appeared to be protective from hospitalization for dementia. Stroke was associated with a hazard ratio of 7.69 (95% CI 7.22-8.18) for developing dementia. Albuminuria was also associated with increased risk of dementia. Refer to Figure 1.
Conclusion: The positive association between HbA1c and risk of dementia in fairly young patients with type 2 diabetes indicates a potential for prevention of dementia with improved glycaemic control.
Poster Event A, Tuesday, 12:30 - 13:30. PS 001 Cardiovascular complications in type 2 diabetes
271 Glycaemic control and excess mortality in patients with type 2 diabetes M. Tancredi, A. Rosengren, A.-M. Svensson, M. Kosiborod, A. Pivodic, S. Gudbjornsdottir, S. Dahlqvist, H. Wedel, M. Lind, Sweden, USA
Poster Event B, Tuesday, 13:45 - 14:45 PS 002 Complications in type 1 diabetes
Long-term trends in cardiovascular risk factors in type 1 diabetes: nationwide monitoring of 38,169 patients from 1996 to 2014
Author Block A. Rawshani1, A.-M. Svensson1, A. Rosengren1, S. Franzén2, B. Eliasson1, S. Gudbjörnsdottir1; 1Clinical and Molecular Medicine, Inst of Medicine, Gothenburg, Sweden, 2Västra Götalandsregionen, Centre of Registers, Gothenburg, Sweden.
Abstract:Background and aims: The last decades have witnessed remarkable advances in the management of type 1 diabetes. The risk of complications has presumably been reduced by intensive insulin therapy, improved insulin delivery and glucose monitoring, blood pressure control and lipid lowering therapy. Yet long-term trends in risk factor control has not been examined. We aimed to examine trends in six cardiovascular risk factors from 1996 to 2014, in the overall cohort and in relation to socioeconomic categories.
Materials and methods: We included all patients with type 1 diabetes entered in the Swedish National Diabetes Register from 1996 to 2014 (n=38,169 contributing 457,577 appointments). We calculated adjusted estimates of glycated haemoglobin (HbA1c), systolic blood pressure (SBP), LDL cholesterol (LDL-C), body mass index (BMI), physical activity and smoking.
Results: HbA1c declined from 68.1 mmol/mol to 64.0 mmol/mol from 1996 to 2007 and then reversed to 66.8 in 2012, declining slightly in the remaining two years. By the end of the study period there was no improvement in HbA1c since the turn of the millennium (Figure 1). Individuals with a college/university degree had 4 mmol/mol lower HbA1c than individuals with 9 years or less education and there was no trend towards reduced differences. Overall LDL-C declined from 2.85 in 2002 to 2.59 in 2014, which was, however, not significantly lower than LDL-C in 2006. Higher education, but not higher income, was associated with lower LDL-C. BMI increased linearly, from 24.7 kg/m2 to 26.1 kg/m2 from 1996 to 2014. SBP decreased from 131.2 mmHg in 1996 to 125.9 mmHg in 2014. Odds ratio for being a smoker in 2014, compared with 1999, was 0.75 (95% CI 0.69 to 0.82); there were staggering differences in relation socioeconomic status, with no tendencies towards reduced gaps. Smoking rates declined more in the background population than among persons with type 1 diabetes. Physical activity doubled between 2004 and 2007 and then remained unchanged for the remaining seven years. Odds ratio for being physically active in 2014, compared with 2001, was 5.25 (95% CI 5.05 to 5.45).
Conclusion: Blood pressure control has been successful. Smoking rates have declined but smoking cessation has been less less successful among persons with type 1 diabetes, as compared with persons without diabetes. Promotion of physical activity has been successful. Less stable improvements are noted for HbA1c and LDL-C. BMI is increasing steadily. Socioeconomic differences are pronounced.
276 Gender aspects in type 1 diabetes patients undergoing angiography: a registry report C. Hero, V. Ritsinger, A.-M. Svensson, N. Saleh, B. Lagerqvist, A. Norhammar, K. Eeg-Olofsson, Sweden
277 What makes a survivor? Description of patients with very long duration of type 1 diabetes with and without a history of micro- or macrovascular complications B. Eliasson, S. Adamsson Eryd, A.-M. Svensson, S. Franzén, P.M. Nilsson, S. Gudbjörnsdottir, Sweden
278 Determinants of HbA1c in patients with type 1 diabetes in seven Swedish county councils
M. Lilja, B. Julin, G. Andersson, I.-L. Andersson, M. Axelsen, M. Ek,
R. Kristiansson, J. Lekell, A. Lindberg, P. Lindgren, F. Löndahl, K. Looström Muth, A.-M. Svensson, T. Dahlström, Sweden
279 HbA1c and incidence of micro- and macrovascular disease in patients with very long duration of type 1 diabetes S. Adamsson Eryd, A. Rawshani, A.-M. Svensson, S. Franzén, B. Eliasson, P.M. Nilsson, S. Gudbjörnsdottir, Sweden
Poster Event B, Tuesday, 13:45 - 14:45
PS 122 Cardiovascular complications in type 1 diabetes
1201 Mortality by affected coronary artery vessels in 2776 patients with type 1 diabetes undergoing coronary angiography
K. Eeg-Olofsson, V. Ritsinger, C. Hero, N. Saleh, B. Lagerqvist,
A.-M. Svensson, A. Norhammar, Sweden
Poster Event B, Tuesday, 13:45 - 14:45. PS 116 Getting to the heart of the matter: cardiovascular complications in diabetes
1156 HbA1c and risk of stroke in 33,414 type 1 diabetes patients compared to 166,097 controls from the general population. A. Rosengren, C.H. Stahl, S. Gudbjornsdottir, A.-M. Svensson, M. Kosiborod, M. Clements, M. Lind, Sweden, USA
Poster Event B, Tuesday, 13:45 - 14:45. PS 116 Getting to the heart of the matter: cardiovascular complications in diabetes
1157 Blood pressure and stroke risk in 408,076 type 2 diabetes patients compared to 1,913,507 controls from the general population. C.H. Stahl, M. Lind, S. Gudbjornsdottir, A.-M. Svensson, M. Kosiborod, M. Clements, A. Rosengren, Sweden, USA
Poster Event B, Tuesday, 13:45 - 14:45 PS 122 Cardiovascular complications in type 1 diabetes Chair: G. Jermendy, Hungary
1195 Type 1 diabetes as a coronary disease equivalent: an analysis of 33,886 individuals with type 1 diabetes and 169,223 controls from the Swedish National Diabetes Registry . V. Matuleviciene, A. Rosengren, S. Gudbjörnsdottir, A.-M. Svensson, A. Mårtensson, H. Wedel, S. Dahlqvist, M. Kosiborod, M. Lind, Sweden, USA
1196 Decreased eGFR as a risk factor for heart failure in 13,781 patients with type 1 diabetes. D. Vestberg, A. Rosengren, M. Olsson, S. Gudbjörnsdottir, B. Haraldsson, A.-M. Svensson, M. Lind, Sweden
1197 Incidence of atrial fibrillation in 33442 individuals with type 1 diabetes from the National Diabetes Registry compared to 167930 matched controls in Sweden from 2001-2011
S. Dahlqvist, A. Rosengren, S. Gudbjörnsdottir, A.-M. Svensson, A. Mårtensson, H. Wedel, M. Kosiborod, M. Lind, Sweden, USA
1198 Features of coronary artery disease in 2776 type 1 diabetes patients undergoing coronary angiography
B. Lagerqvist, V. Ritsinger, C. Hero, N. Saleh, K. Eeg-Olofsson, A.-M. Svensson, A. Norhammar, Sweden
Use of statins and risk of cardiovascular disease and death in type 1 diabetes: a report from Swedish NDR S. Gudbjörnsdottir, C. Hero, A. Rawshani, A.-M. Svensson, S. Franzén, B. Eliasson, K. Eeg-Olofsson, Sweden
Background and aims: The effect of statins in primary prevention among persons with type 1 diabetes (T1D) without previous cardiovascular disease (CVD) is unknown. We examined the effect of statins on major cardiovascular events and death in T1D.
Materials and methods: We used the Swedish National Diabetes Register to perform a propensity score based study. A total of 24,230 individuals (included during 2006-2008) with T1D without history of CVD were followed until 31/12/2012; 18,843 were un-treated and 5387 treated with statins. Mean follow-up was 6.0 years. A propensity score (PS) for treatment with statins was estimated using 32 baseline variables. The PS was used to estimate the effect of statins in the overall cohort (by stratification on PS) and in a matched cohort.
Results: The PS allowed for balancing of all 32 covariates; there were no differences between treated and untreated after accounting for the PS. Hazard ratios (HR) and 95% confidence intervals for statin treated vs. un-treated in the overall cohort was as follows: for cardiovascular death, 0.60 (0.50–0.72), for all-cause death, 0.56 (0.48–0.64), for fatal/nonfatal stroke 0.56 (0.46–0.70), for fatal/nonfatal acute myocardial infarction 0.78 (0.66–0.92), for fatal/nonfatal coronary heart disease 0.85 (0.74–0.97). In the matched cohort statin users had a significantly reduced risk of all-cause mortality whereas remaining outcomes did not differ between the groups.
Conclusion: Primary prevention with statins halves the risk of cardiovascular disease and death among persons with T1D without history of cardiovascular disease.
1201 Mortality by affected coronary artery vessels in 2776 patients with type 1 diabetes undergoing coronary angiography K. Eeg-Olofsson, V. Ritsinger, C. Hero, N. Saleh, B. Lagerqvist, A.-M. Svensson, A. Norhammar, Sweden
Onsdag: Poster Event D, Wednesday, 13:45 - 14:45 PS 076 Insulin therapy: determinants of response
846 Identification of key success factors in type 2 diabetes care in Sweden. S. Ekeblad Lien, L. Odevall, T. Holm, M. Bojestig, S. Gudbjörnsdottir, C.-G. Östenson, Sweden
Poster Event E, Thursday, 13:00 - 14:00. PS 083 Health care delivery in diabetes
Impact of socioeconomic status and ethnicity on risk of stroke, hospitalisation for heart failure and death in 371,092 individuals with type 2 diabetes
Author Block B. Zethelius 1, A. Rawshani2, A.-M. Svensson3, B. Eliasson4, A. Rosengren4, S. Gudbjörnsdottir4; 1Dept of Public Health and Caring Sciences/Geriatrics, Institute of Clinical Sciences, Uppsala, Sweden, 2Inst of Medicine, Gothenburg, Sweden, 3Dept of Molecular and Clinical Medicine, Inst of Medicine, Gothenburg, Sweden, 4Clinical and Molecular Medicine, Inst of Medicine, Gothenburg, Sweden.
Abstract:Background and aims: Socioeconomic status (SES) and ethnicity are powerful predictors of coronary heart disease in diabetes, but whether this association extends to heart failure and stroke is unknown. We examined the impact of SES and ethnicity on the risk of stroke, hospitalization for heart failure (HF) and overall mortality in type 2 diabetes.
Materials and methods: We included 371,092 patients (contributing 2,766,349 appointments) with type 2 diabetes in the Swedish National Diabetes Register (NDR) during 2004-2012. Clinical data from the NDR was linked to national registers, whereby information on income, education, marital status, country of birth, comorbidities and events was obtained. Swedish natives were used as the reference group for ethnicity. Patients were followed until a first incident event (hospitalization for heart failure and fatal/nonfatal stroke), death or end of follow-up. The association between socioeconomic variables and the outcomes was modeled using Cox regression. Two models were computed for each outcome. The first model was adjusted for demographic and diabetes-related covariates. The second model was additionally adjusted for outcome specific covariates.
Results: Mean (SD) follow-up was 4.7 (2.5) years. HF occurred in 26,448 (7.1%) persons. Fatal/nonfatal stroke occurred in 38,480 (10.1%) persons and 49,829 died (13.4%). Immigrants from Nordic countries had 9% and 14% elevated risk of HF (Figure 1). Immigrants from the Middle East and North Africa had 22% to 50% lower risk of all outcomes. Immigrants from the Mediterranean Basin had 23% lower risk of stroke. Latin Americans had 50% lower risk of HF and 40% lower risk of overall mortality. East Asians had 60% lower risk of HF and 50% lower risk of overall death. As compared with having 9 years or less education, having a college/university degree was associated with 20% lower risk of both HF and overall mortality. Those with 10 to 12 years of education had 10% lower risk of both death and HF, compared with having 9 years or less education. Income was inversely associated with the outcomes. As compared with the highest income quintile, those in the two lowest quintiles had 50% higher risk of all outcomes. As compared with being single, being married was associated with 12% lower risk of HF. Individuals who were widowed had 10% higher risk of HF.
Conclusion: There are marked socioeconomic disparities in the risk of HF, stroke and overall mortality despite equitable access to universal health care. We find indications of a healthy immigrant phenomenon, as non-Western immigrants frequently had lower risk than native Swedes. Socioeconomic status and ethnicity are independent predictors of stroke, HF and death in type 2 diabetes.
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