New thesis on type 1 and type 2 diabetes: several world news and key findings
In a new dissertation from the University of Gothenburg, several exceptionally important studies have been published. Dr. Aidin Rawshani has written the thesis together with colleagues from the National Diabetes Register, University of Gothenburg, University of Glasgow, University of Southwestern etc. diabetes care, as well as the life of those living with diabetes. We have already discussed two of the articles from the thesis (Life expectancy and survival in type 1 diabetes and the importance of risk factor control in type 2 diabetes).
What were they investigated?
- Long-term trends (1998 to 2014) in complications and mortality among people with diabetes compared to the general population were examined. The aim was to investigate whether there was an improvement in survival and reduced the risk of complications among people with diabetes.
- The possibility of using modern treatment to eliminate the increased risk of cardiovascular disease and premature death associated with diabetes has also been studied. Today, most people with diabetes receive treatment for blood pressure, blood lipids, blood sugar, etc., but we do not know if the combined effect of these treatments can actually eliminate all risks associated with diabetes.
- Finally, the relative importance of cardiovascular diseases has also been studied. risk factors and the levels with the lowest risk of cardiovascular disease. This means studying which risk factors are most important, how important they are, and what level (e.g. blood sugar) is the best.
The following picture shows how the risk of dying is affected by the number of risk factors. We see that the fewer risk factors you have, the lower the risks. You can even get rid of the risk, or at least reduce it very sharply, if you control your risk factors.
What was shown in the thesis?
- In the period 1998-2014, patients with type 1 diabetes experienced an approximately 30% reduction in the risk of cardiovascular disease and, in addition, a greater improvement was achieved than the rest of the population. This means that the risk of cardiovascular disease decreased dramatically during this period for people with type 1 diabetes. These results are very pleasing! Patients with type 2 diabetes experienced a dramatic decrease in the risk of cardiovascular disease between 1998 and 2014. Compared to the rest of the population, people with diabetes actually experienced a 20% greater improvement in the risk of cardiovascular disease, which is very pleasing for people with type 2 diabetes.
- Thus, over the past 16 years, morbidity and mortality from cardiovascular diseases have decreased Significantly in individuals with diabetes.
- For individuals with type 2 diabetes, the increased risk of complications gradually decreased for each risk factor managed to control. For patients with type 2 diabetes who had all risk factors in control, there was no significantly increased risk of death or stroke but 16% lower risk of acute myocardial infarction. This is extremely pleasing and sensational results! However, patients with diabetes had a high risk of heart failure, despite optimal risk factor control. The main risk factors for cardiovascular morbidity and death were HbA1c (blood sugar), LDL cholesterol, hypodynamia and hypertension.
- Having blood sugar and blood pressure lower than the levels recommended today proved to be favorable. This means that lower blood sugar (HbA1c) and blood pressure, i.e. lower levels than the levels we are aiming for today, can be good for people with diabetes.
- For people with type 1 diabetes, HbA1c, followed by diabetes duration and kidney function, were the main risk factors for complications. with type 1 diabetes exhibits an increased risk of cardiovascular disease and death even if they control all “common” risk factors. Those with type 1 diabetes who managed to control all the risk factors had an 82% increased risk of acute myocardial infarction and 97% increased risk of heart failure.
- Results of the study on longevity and survival in type 1 diabetes are discussed here.
Link to the thesis: Aidin Rawshanis thesis at GUPEA (University of Gothenburg)
Dissertation: Epidemiological aspects of cardiovascular morbidity and mortality among individuals with diabetes: the relative importance of cardiovascular risk factors