Almost 1 in 30 patients with Type 1 diabetes develops heart failure
MedWire News: Glycemia increases the risk for heart failure in patients with Type 1 diabetes, a large study has revealed.
The finding raises the possibility that adequate diabetes management could reduce the risk for heart failure.
It is well established that Type 1 diabetes is associated with increased mortality due to cardiovascular disease, increasing the risk by up to 40-fold. Furthermore, intensive glycemic control has been shown to reduce the risk for cardiovascular disease in patients with Type 1 diabetes.
Type 2 diabetes is also associated with an increased risk for cardiovascular disease, although a meta-analysis suggested that intensive glycemic control did not reduce the risk for heart failure.
The effect of glycemic control on incident heart failure in patients with Type 1 diabetes remain unclear, so Marcus Lind (Uddevalla Hospital, Sweden) and colleagues undertook a large observational study to investigate further.
Specifically, Lind and team collated data from 20,985 patients with Type 1 diabetes aged 38.6 years on average. Patients were included on a national diabetes register between 1998 and 2003 and were followed-up until they developed heart failure, died, or reached the end of the follow-up period in 2009.
Over an average follow-up period of 9 years, 3% of patients were admitted to hospital with a diagnosis of heart failure, equivalent to 3.38 events per 1000 patient-years. The incidence of heart failure was directly related to the degree of glycemia at baseline, with 1.42 events per 1000 patient-years for patients with HbA1c below 6.5%, rising to 5.20 events per 1000 patient-years in patients with HbA1c at or above 10.5%.
"During 9 years of follow-up, we recorded hospital admission for heart failure in almost one in 30 of fairly young patients with Type 1 diabetes, implying that heart failure is a major diabetic complication in such patients," summarize the investigators.
"Because treatment for heart failure improves survival and quality of life, clinicians should be observant of signs of heart failure in management of patients with Type 1 diabetes, starting at an early stage," the authors recommend, adding that "echocardiography might be warranted, especially in the presence of poor glycemic control, long duration of diabetes, or an adverse risk factor profile."
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By Philip Ford