scholarly journals A patient-level model to estimate lifetime health outcomes of patients with type 1 diabetes

2020 ◽  
Author(s):  
An Tran-Duy ◽  
Josh Knight ◽  
Andrew J Palmer ◽  
Dennis Petrie ◽  
Tom WC Lung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Risk Factor ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Economic Evaluations ◽  
Internal Validation ◽  
Patient Level ◽  
The Impact

<b>OBJECTIVE </b> <p>To develop a patient-level simulation model for predicting lifetime health outcomes of patients with type 1 diabetes and as a tool for economic evaluation of type 1 diabetes treatment based on data from a large, longitudinal cohort.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>Data for model development were obtained from the <a>Swedish National Diabetes Register</a>. We derived parametric proportional hazards models predicting absolute risk of diabetes complications and death based on a wide range of clinical variables and history of complications. We used linear regression models to predict risk factor progression. Internal validation was performed, estimates of life expectancies for different age-sex strata were computed, and the impact of key risk factors on life expectancy was assessed.</p> <p><b>RESULTS </b></p> <p>The study population consisted of 27,841 patients with type 1 diabetes with a mean duration of follow-up of 7 years. Internal validation showed good agreement between predicted and observed cumulative incidence of death and 10 complications. Simulated life expectancy was approximately 13 years lower than that of the sex- and age-matched general population, and patients with type 1 diabetes could expect to live with one or more complications for approximately 40% of their remaining life. Sensitivity analysis showed the importance of preventing renal dysfunction, hypoglycaemia and hyperglycaemia, and lowering HbA1c in reducing the risk of complications and death.</p> <p><b>CONCLUSIONS </b></p> Our model was able to simulate risk factor progression and event histories that closely match the observed outcomes, and project events occurring over patients’ lifetimes. The model can serve as a tool to estimate the impact of changing clinical risk factors on health outcomes to inform economic evaluations of interventions in type 1 diabetes.

scholarly journals A patient-level model to estimate lifetime health outcomes of patients with type 1 diabetes

2020 ◽  
Author(s):  
An Tran-Duy ◽  
Josh Knight ◽  
Andrew J Palmer ◽  
Dennis Petrie ◽  
Tom WC Lung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Risk Factor ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Economic Evaluations ◽  
Internal Validation ◽  
Patient Level ◽  
The Impact

<b>OBJECTIVE </b> <p>To develop a patient-level simulation model for predicting lifetime health outcomes of patients with type 1 diabetes and as a tool for economic evaluation of type 1 diabetes treatment based on data from a large, longitudinal cohort.</p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>Data for model development were obtained from the <a>Swedish National Diabetes Register</a>. We derived parametric proportional hazards models predicting absolute risk of diabetes complications and death based on a wide range of clinical variables and history of complications. We used linear regression models to predict risk factor progression. Internal validation was performed, estimates of life expectancies for different age-sex strata were computed, and the impact of key risk factors on life expectancy was assessed.</p> <p><b>RESULTS </b></p> <p>The study population consisted of 27,841 patients with type 1 diabetes with a mean duration of follow-up of 7 years. Internal validation showed good agreement between predicted and observed cumulative incidence of death and 10 complications. Simulated life expectancy was approximately 13 years lower than that of the sex- and age-matched general population, and patients with type 1 diabetes could expect to live with one or more complications for approximately 40% of their remaining life. Sensitivity analysis showed the importance of preventing renal dysfunction, hypoglycaemia and hyperglycaemia, and lowering HbA1c in reducing the risk of complications and death.</p> <p><b>CONCLUSIONS </b></p> Our model was able to simulate risk factor progression and event histories that closely match the observed outcomes, and project events occurring over patients’ lifetimes. The model can serve as a tool to estimate the impact of changing clinical risk factors on health outcomes to inform economic evaluations of interventions in type 1 diabetes.

scholarly journals Development of a life expectancy table for individuals with type 1 diabetes

Diabetologia ◽  
2021 ◽  
Author(s):  
An Tran-Duy ◽  
Josh Knight ◽  
Philip M. Clarke ◽  
Ann-Marie Svensson ◽  
Björn Eliasson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Risk Factor ◽  
Life Expectancy ◽  
Simulation Model ◽  
Real World ◽  
Smoking Status ◽  
World Population ◽  
Substantial Variation

Abstract Aims/hypothesis Tables reporting life expectancies by common risk factors are available for individuals with type 2 diabetes; however, there is currently no published equivalent for individuals with type 1 diabetes. We aimed to develop a life expectancy table using a recently published simulation model for individuals with type 1 diabetes. Methods The simulation model was developed using data from a real-world population of patients with type 1 diabetes selected from the Swedish National Diabetes Register. The following six important risk factors were included in the life table: sex; age; current smoking status; BMI; eGFR; and HbA1c. For each of 1024 cells in the life expectancy table, a synthetic cohort containing 1000 individuals was created, with other risk factors assigned values representative of the real-world population. The simulations were executed for all synthetic cohorts and life expectancy for each cell was calculated as mean survival time of the individuals in the respective cohort. Results There was a substantial variation in life expectancy across patients with different risk factor levels. Life expectancy of 20-year-old men varied from 29.3 years to 50.6 years, constituting a gap of 21.3 years between those with worst and best risk factor levels. In 20-year-old women, this gap was 18.9 years (life expectancy range 35.0–53.9 years). The variation in life expectancy was a function of the combination of risk factor values, with HbA1c and eGFR consistently showing a negative and positive correlation, respectively, with life expectancy at any level combination of other risk factors. Individuals with the lowest level (20 kg/m2) and highest level of BMI (35 kg/m2) had a lower life expectancy compared with those with a BMI of 25 kg/m2. Non-smokers and women had a higher life expectancy than smokers and men, respectively, with the difference in life expectancy ranging from 0.4 years to 2.7 years between non-smokers and smokers, and from 1.9 years to 5.9 years between women and men, depending on levels of other risk factors. Conclusions/interpretation The life expectancy table generated in this study shows a substantial variation in life expectancy across individuals with different modifiable risk factors. The table allows for rapid communications of risk in an easily understood format between healthcare professionals, health economists, researchers, policy makers and patients. Particularly, it supports clinicians in their discussion with patients about the benefits of improving risk factors. Graphical abstract

scholarly journals Risk Factors for Cardiovascular Disease (CVD) in Adults with Type 1 Diabetes: Findings from Prospective Real-life T1D Exchange Registry

2020 ◽  
Vol 105 (5) ◽  
pp. e2032-e2038 ◽  
Author(s):  
Viral N Shah ◽  
Ryan Bailey ◽  
Mengdi Wu ◽  
Nicole C Foster ◽  
Rodica Pop-Busui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
The United States ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Impact

Abstract Context Cardiovascular disease (CVD) is a major cause of mortality in adults with type 1 diabetes. Objective We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Design Observational study of CVD and CVD risk factors over a median of 5.3 years. Setting The T1D Exchange clinic network. Patients Adults (age ≥ 18 years) with type 1 diabetes and without known CVD diagnosed before or at enrollment. Main Outcome Measure Associations between CVD risk factors and incident CVD were assessed by multivariable logistic regression. Results The study included 8,727 participants (53% female, 88% non-Hispanic white, median age 33 years [interquartile ratio {IQR} = 21, 48], type 1 diabetes duration 16 years [IQR = 9, 26]). At enrollment, median HbA1c was 7.6% (66 mmol/mol) (IQR = 6.9 [52], 8.6 [70]), 33% used a statin, and 37% used blood pressure medication. Over a mean follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD. Ischemic heart disease was the most common CVD event. Increasing age, body mass index, HbA1c, presence of hypertension and dyslipidemia, increasing duration of diabetes, and diabetic nephropathy were associated with increased risk for CVD. There were no significant gender differences in CVD risk. Conclusion HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important risk factors for CVD in adults with type 1 diabetes. A longer follow-up is likely required to assess the impact of other traditional CVD risk factors on incident CVD in the current era.

scholarly journals Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry

Diabetologia ◽  
2021 ◽  
Author(s):  
Sara Hallström ◽  
Ann-Marie Svensson ◽  
Aldina Pivodic ◽  
Arndís F. Ólafsdóttir ◽  
Magnus Löndahl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Lower Extremity ◽  
Renal Dysfunction ◽  
Diabetes Registry ◽  
Male Sex ◽  
The Impact ◽  
Over Time ◽  
Age And Sex

Abstract Aims/hypothesis The aim of this work was to study the incidence over time of lower extremity amputations and determine variables associated with increased risk of amputations in people with type 1 diabetes. Methods Individuals with type 1 diabetes registered in the Swedish National Diabetes Registry with no previous amputation from 1 January 1998 and followed to 2 October 2019 were included. Time-updated Cox regression and gradient of risk per SD were used to evaluate the impact of risk factors on the incidence of amputation. Age- and sex-adjusted incidences were estimated over time. Results Of 46,088 people with type 1 diabetes with no previous amputation (mean age 32.5 years [SD 14.5], 25,354 [55%] male sex), 1519 (3.3%) underwent amputation. Median follow-up was 12.4 years. The standardised incidence for any amputation in 1998–2001 was 2.84 (95% CI 2.32, 3.36) per 1000 person-years and decreased to 1.64 (95% CI 1.38, 1.90) per 1000 person-years in 2017–2019. The incidence for minor and major amputations showed a similar pattern. Hyperglycaemia and renal dysfunction were the strongest risk factors for amputation, followed by older age, male sex, cardiovascular comorbidities, smoking and hypertension. Glycaemic control and age- and sex-adjusted renal function improved during the corresponding time period as amputations decreased. Conclusions/interpretation The incidence of amputation and of the most prominent risk factors for amputation, including renal dysfunction and hyperglycaemia, has improved considerably during recent years for people with type 1 diabetes. This finding has important implications for quality of life, health economics and prognosis regarding CVD, indicating a trend shift in the treatment of type 1 diabetes. Graphical abstract

scholarly journals A Patient-Level Model to Estimate Lifetime Health Outcomes of Patients With Type 1 Diabetes

Diabetes Care ◽  
2020 ◽  
Vol 43 (8) ◽  
pp. 1741-1749
Author(s):  
An Tran-Duy ◽  
Josh Knight ◽  
Andrew J. Palmer ◽  
Dennis Petrie ◽  
Tom W.C. Lung ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Health Outcomes ◽  
Patient Level ◽  
Level Model

The Impact of Obesity and Lifestyle Status on Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes (T1D)

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1606-P
Author(s):  
ANNA-MARIA LAMPOUSI ◽  
DIMITRIOS E. DELIS ◽  
MARIA XATZIPSALTI ◽  
ANDRIANI VAZEOU
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Cardiovascular Risk ◽  
Children And Adolescents ◽  
Cardiovascular Risk Factors ◽  
The Impact

scholarly journals The impact of parental risk factors on the risk of stroke in type 1 diabetes

2021 ◽  
Author(s):  
Anni Ylinen ◽  
◽  
Stefanie Hägg-Holmberg ◽  
Marika I. Eriksson ◽  
Carol Forsblom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Hemorrhagic Stroke ◽  
Cox Regression Analysis ◽  
Parental Risk Factors ◽  
Increased Risk ◽  
History Of ◽  
The Impact

Abstract Background Individuals with type 1 diabetes have a markedly increased risk of stroke. In the general population, genetic predisposition has been linked to increased risk of stroke, but this has not been assessed in type 1 diabetes. Our aim was, therefore, to study how parental risk factors affect the risk of stroke in individuals with type 1 diabetes. Methods This study represents an observational follow-up of 4011 individuals from the Finnish Diabetic Nephropathy Study, mean age at baseline 37.6 ± 11.9 years. All strokes during follow-up were verified from medical records or death certificates. The strokes were classified as either ischemic or hemorrhagic. All individuals filled out questionnaires concerning their parents’ medical history of hypertension, diabetes, stroke, and/or myocardial infarction. Results During a median follow-up of 12.4 (10.9–14.2) years, 188 individuals (4.6%) were diagnosed with their first ever stroke; 134 were ischemic and 54 hemorrhagic. In Cox regression analysis, a history of maternal stroke increased the risk of hemorrhagic stroke, hazard ratio 2.86 (95% confidence interval 1.27–6.44, p = 0.011) after adjustment for sex, age, BMI, retinal photocoagulation, and diabetic kidney disease. There was, however, no association between maternal stroke and ischemic stroke. No other associations between parental risk factors and ischemic or hemorrhagic stroke were observed. Conclusion A history of maternal stroke increases the risk of hemorrhagic stroke in individuals with type 1 diabetes. Other parental risk factors seem to have limited impact on the risk of stroke.

Periphere arterielle Verschlusskrankheit bei Diabetes mellitus Typ 1 und Typ 2: Unterscheiden sich die Risikofaktoren?

VASA ◽  
2002 ◽  
Vol 31 (4) ◽  
pp. 249-254 ◽  
Author(s):  
Zander ◽  
Heinke ◽  
Reindel ◽  
Kohnert ◽  
Kairies ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Multivariate Logistic Regression Analysis ◽  
Diabetes Duration ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
The Impact

Background : Diabetic patients have increased prevalence of peripheral arterial disease (PAD). It is not clearly shown whether the prognostic factors are identical in relation to the type of diabetes. This study was done to compare the associations of PAD with risk factors and with micro-and macrovascular complications of inpatients with type 1 and type 2 diabetes. Methods: In a retrospective cross-sectional study 1087 patients with type 1 diabetes and 1060 patients with type 2 diabetes were examined. PAD was diagnosed when ankle-brachial-pressure-index (ABI) was < 1.0. In cases with incompressible arteries (mediasclerosis) pulse wave formes were analyzed. Multivariate logistic regression analysis was applied to evaluate the impact of different variables on PAD risk , after adjusting for different variables separately. Results: In both types of diabetes (type 1 vs. type 2) PAD risk (odds ratio; OR) was increased in the presence of coronary heart disease (OR 9.3 vs. 3.5), diabetic nephropathy (OR 3.0 vs.2.8), neuropathy (OR 7.9 vs. 1.8), foot ulceration (OR 8.9 vs. 5.5), increased daily insulin requirement > 0.6 m/kg b.w. (OR 5.2 vs. 2.9), diabetes duration of 20–29 years (OR 28.9) and > 30 years (OR 51.1) in type 1 diabetes, and diabetes duration of 10–19 years (OR 3.8) and > 20 years (OR 4.3) in type 2 diabetes. In type 2 diabetes, PAD risk was associated with microalbuminuria (OR 2.1), macroalbuminuria (OR 3.3), background retinopathy (OR 1.9), proliferative retinopathy (OR 2.8), increased triglycerides (TG) (OR 1.7) and decreased HDL-cholesterol (HDL-C > 0.90 mmol/l: OR 0.49). Conclusions: PAD risk factors and micro- and macrovascular comorbidity are very similar in type 1 and type 2 diabetes.

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