Cardiovascular and Renal Disease Burden in Type 1 Compared With Type 2 Diabetes: A Two-Country Nationwide Observational Study

Abstract

<b>Objective: </b>Type 1 (T1D) and type 2 diabetes (T2D) increase risks of cardiovascular and renal disease (CVRD) compared to diabetes-free populations. Direct comparisons between T1D and T2D are scarce. We examined this by pooling full-population cohorts in Sweden and Norway. <p><b>Research Design and Methods: </b>59,331 T1D and 484,241 T2D patients, aged 18-84 years, were followed over a mean period of 2.6 years from December 31, 2013. Patients were identified in nationwide prescribed drug and hospital registries in Norway and Sweden<b>. </b>Prevalence and event rates of myocardial infarction (MI), heart failure (HF), stroke, chronic kidney disease (CKD), all-cause death and cardiovascular death were assessed following age stratification in 5-year intervals. Cox regression analyses were used to estimate risk.</p> <p><b>Results: </b>The prevalence of cardiovascular disease was similar in T1D and T2D across age strata, whereas CKD was more common in T1D. Age-adjusted event-rates comparing T1D versus T2D showed that HF risk was increased between the ages 65-79 years, MI between 55-79 years and stroke between 40-54 years, 1.3-1.4-fold, 1.3-1.8-fold and 1.4-1.7 fold respectively. CKD risk was 1.4-3.0-fold higher in T1D at all ages. The all-cause death risk was 1.2-1.5-fold higher in T1D above 50 years, with a similar trend for CV death.</p> <p><b>Conclusions: </b>Adult T1D compared to T2D patients had an overall greater risk of cardiorenal disease (heart failure and CKD) across ages, of MI and all-cause death at middle-older ages and of stroke at younger ages. The total age-adjusted CVRD burden and risks were greater among T1D patients compared to T2D, highlighting their need for improved prevention strategies.</p>