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Predictors of mortality and end‐stage diabetic complications in patients with Type 1 diabetes mellitus on intensified insulin therapy
Author(s) -
Mühlhauser I.,
Overmann H.,
Bender R.,
Jörgens V.,
Berger M.
Publication year - 2000
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2000.00372.x
Subject(s) - medicine , hazard ratio , diabetes mellitus , diabetic retinopathy , blood pressure , diabetic nephropathy , renal replacement therapy , type 2 diabetes , proportional hazards model , insulin , surgery , type 2 diabetes mellitus , cohort , confidence interval , endocrinology
SUMMARYAims To assess predictors of mortality and end‐stage diabetic complications in patients with Type 1 diabetes mellitus on intensified insulin therapy. Methods A cohort of 3674 patients (insulin treatment before age 31) who had participated in a 5‐day in‐patient group treatment and teaching programme for intensification of insulin therapy between 9/1978 and 12/1994 were re‐assessed after 10 ± 3 (mean ± sd ) years. Results Vital status and data on blindness, amputations, and renal replacement therapy were documented for 97% patients; 7% patients had died, 1.3% had become blind, 2% had amputations and 4.6% started renal replacement therapy. Using the Cox proportional hazards model, the following risk factors of mortality as assessed at baseline were identified: nephropathy (at least macroproteinuria), hazard ratio 3.8 (95% confidence interval 2.6–5.6); smoking, 1.9 (1.4–2.6); diabetes duration, 1.5 (1.2–1.8) for a difference of 10 years; serum cholesterol, 1.1 (1.0–1.2) for a difference of 1 mmol/l; lower social status, 1.4 (1.1–1.8) for a difference of 1 out of 3 levels; age, 1.3 (1.1–1.6) for a difference of 10 years; male sex, 1.4 (1.1–1.9); systolic blood pressure, 1.1 (1–1.2) for a difference of 10 mmHg. For the combined endpoint – blindness or amputations or renal replacement therapy – predictors were: nephropathy, foot complications, HbA 1c , smoking, cholesterol, systolic blood pressure, retinopathy, hypertension, and social status. Conclusion In Type 1 diabetic patients who start intensified insulin therapy, nephropathy remains the strongest predictor of mortality and end‐stage complications. Glycosylated haemoglobin is a risk factor of end‐stage complications but not of mortality. Conventional risk factors comparable to the general population, particularly smoking become operative as predictors of both mortality and end‐stage complications.