MORNING BLOOD PRESSURE SURGE & TARGET ORGAN DAMAGE IN NEWLY DIAGNOSED TYPE 2 DIABETES PATIENTS : A CROSS SECTIONAL STUDY

Andre Tritansa Faizal

RS Bhayangkara Tingkat 1 R. Said SukantoGlycemic Control and Excess Mortalityin Type 1 DiabetesCitation : N Engl J Med 2014;371:1972-82.

Background Type 1 Diabetes is associated wit a substantially increased risk of premature death as compared with that in the general populationThe excess risk of death from any cause and of death from cardiovascular causes is unknown among patients with type 1 diabetes and various levels of glycemic control

Methods patients with type 1 diabetes registered in the Swedish National Diabetes Register after January 1, 1998For each patient, five controls were randomly selected from the general population and matched according to age and sex,Patients and controls were followed until December 31, 2011Information on coexisting conditions and causes of death was retrieved by linking personal identification numbers from patients and controls to the Swedish Inpatient Register and the Cause of Death Register

Results

Results

Hazard ratios for death from any cause and for death from cardiovascular causes among patients with type 1 diabetes versus controls were 3.52 (95% confidence interval [CI], 3.06 to 4.04) and 4.60 (95% CI, 3.47 to 6.10),

There was a significant excess risk of death from any cause and from cardiovascular causes among patients with type 1 diabetes who had an updated mean glycated hemoglobin level of 6.9% or lower (52 mmol per mole), as compared with controls, with the risk gradually increasing at higher levels6Results

There were 912 patients in whom the cause of death was related to diabetes. The primary cause was reported as diabetic ketoacidosis or hypoglycaemia for 132 patients (14.5%), renal complications for 84 patients (9.2%), vascular complications for 82 patients (9.0%), and eye complications for 1 patient (0.1%)

Cardiovascular disease is the main cause of death later in life

According to the Prescribed Drug Register, 43.1% of patients with type 1 diabetes received a prescription for a statin medication at any time after 2005, as compared with 9.0% of controls. Reninangiotensinaldosterone system inhibitors were prescribed for 39.7% of patients with type 1 diabetes as compared with 10.7% of controls.7Discussion for patients with type 1 diabetes who had on-target glycemic control, the risk of death from any cause and the risk of death from cardiovascular causes were still more than twice the risks in the general populationFor patients with diabetes who had very poor glycemic control, the risks of death were 8 and 10 times as high as those in the general populationSome previous studies have evaluated the relationship between glycemic control and all-cause mortality among persons with type 1 diabetes, have shown an association between the level of glycemic control and all-cause mortality

Unlike patients with type 2 diabetes, those with type 1 diabetes generally do not have excess rates of obesity, hypertension, or hypercholesterolemia, thus, the increased risks of death from any cause and of death from cardiovascular causes among patients with type 1 diabetes who have good glycemic control is unexplained.8Discussion the risk of death for patients with type 1 diabetes and stage 5 chronic kidney disease was 30 timesThe excess risk of death from any cause or from cardiovascular disease did not decrease over time in the present studyIn a recent large study from Canada and the United Kingdom that did not distinguish types of diabetes, the excess risk of death declined substantially over time, albeit not among patients younger than 40 years of age.9Study limitations :could not conclude that patients who have consistently good glycemic control from the time of diagnosis onward still have an excess risk of deathobservational nature of the study does not allow to definitively exclude the possibility of residual confounding of deathcould have underestimated diabetic coma as a cause of death, since the majority of unspecified diabetes-related deaths occurred outside the hospitalalthough the associations between glycated haemoglobin level and risk of death are robust, the observational nature of the study does not allow us to definitively exclude the possibility of residual confounding

Hypoglycemia is difficult to document in real-life studies, since patients with hypoglycemic symptoms do not always measure glucose levels10Conclusions patients with type 1 diabetes who have a glycated hemoglobin level of 6.9% or lower, the risks of death from any cause and from cardiovascular causes are twice as high as those in the general population and that the risks are several times as high among patients with poor glycemic control.THANK YOU