IDF21-0476 Macrovascular complications in type 1 diabetes mellitus patients with over 25 years of disease

Abstract

Background: Macrovascular complications (MvC) are the most common cause of death in people with diabetes. Intensive glycemic control has proven to reduce its incidence in diabetes mellitus type 1 (T1DM). However, as for the general population, there are other factors influencing the development of cardiovascular disease. Aim: In a sample of T1DM patients with 25 years of disease: to evaluate the prevalence of MvC; to analyze the relationship between the development of MvC and several factors; to analyze the relationship between macrovascular and microvascular complications. Method: We performed a retrospective study based on the clinical files of T1DM patients with over 25 years of disease. Information was gathered regarding years of disease, average A1C per patient for each five year time period (A-A1C), types of treatment and complications. Statistical analysis was performed with SPSSv23, using: qui-square test for categorical variables, t-test (if normal distribution) or Mann-Whitney (if non-normal distribution) for continuous variables and Kaplan-Meier curves. The results were considered statistically significant if p<0,05. Results: The sample was constituted by 43 patients, 60,5% female, average age 52,6±1,5 years and average duration of T1DM 35,1±1,0 years. Arterial hypertension was present in 60,5% and dyslipidemia in 83,7%. The prevalence of MvC was 39,5% (average time for first MvC 29,4±2 years after diagnosis): 23,3% coronary heart disease; 20,9% heart failure; 20,9% peripheral artery disease and 9,3% cerebrovascular disease. All the patients were treated with intensive insulin therapy (median beginning time 1±7,5 years after diagnosis); 88,4% used functional insulin therapy (average start 19,5±2,0 years after diagnosis); 46,5% used subcutaneous continuous insulin perfusion (average start 21,7±1,5 years after diagnosis). A-A1C analysis was difficulted by several missing values, specially from the initial years of disease. However we observed that patients with MvC tended to have greater A-A1C values in most time periods, without statistical significance. The group with MvC had a longer course of disease (p=0,036) and predominance of the male gender (p=0,036). The patients with arterial hypertension had more (p=0,003) and more precocious (p=0,022) MvC. There were also more MvC in the patients with dyslipidemia (p=0,019). There was a tendency towards more prevalence of nephropathy, retinopathy and neuropathy in the group with MvC (p=0,068, 0,056 e 0,084, respectively). The group with MvC had more time of evolution of microvascular complications in average (p=0,019). Discussion: This work stands out the importance of dyslipidemia and arterial hypertension as contributors to MvC. There was a longer time of evolution of microvascular complications in the MvC group and a tendency towards a higher prevalence of each type of microvascular complications in this group. This data is likely explained by the importance of glycemic control in both types of complications. Although higher A-A1C values in the group with McV did not attain statistical significance, this is probably due to low sample size and several missing data.