Predictors of mortality and end-stage diabetic complications in patients with Type 1 diabetes mellitus on intensified insulin therapy

Authors

  • I. Mühlhauser,

    1. Department of Nutrition and Metabolic Diseases (WHO Collaborating Centre for Diabetes), University of Düsseldorf, Germany
    2. Department of Health Science and Education, University of Hamburg, Germany
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  • H. Overmann,

    1. Department of Nutrition and Metabolic Diseases (WHO Collaborating Centre for Diabetes), University of Düsseldorf, Germany
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  • R. Bender,

    1. Department of Nutrition and Metabolic Diseases (WHO Collaborating Centre for Diabetes), University of Düsseldorf, Germany
    2. Institute of Epidemiology and Medical Statistics, School of Public Health, University of Bielefeld, Germany
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  • V. Jörgens,

    1. Department of Nutrition and Metabolic Diseases (WHO Collaborating Centre for Diabetes), University of Düsseldorf, Germany
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  • M. Berger

    1. Department of Nutrition and Metabolic Diseases (WHO Collaborating Centre for Diabetes), University of Düsseldorf, Germany
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Univ-Prof. Dr med. Ingrid Mühlhauser, Medizinische Klinik der Universität Düsseldorf, Klinik für Stoffwechselkrankheiten und Ernährung, Moorenstraße 5, D-40225 Düsseldorf, Germany.
E-mail: Ingrid_Muehlhauser@uni-hamburg.de

Abstract

SUMMARY

Aims  To assess predictors of mortality and end-stage diabetic complications in patients with Type 1 diabetes mellitus on intensified insulin therapy.

Methods  A cohort of 3674 patients (insulin treatment before age 31) who had participated in a 5-day in-patient group treatment and teaching programme for intensification of insulin therapy between 9/1978 and 12/1994 were re-assessed after 10 ± 3 (mean ± sd) years.

Results  Vital status and data on blindness, amputations, and renal replacement therapy were documented for 97% patients; 7% patients had died, 1.3% had become blind, 2% had amputations and 4.6% started renal replacement therapy. Using the Cox proportional hazards model, the following risk factors of mortality as assessed at baseline were identified: nephropathy (at least macroproteinuria), hazard ratio 3.8 (95% confidence interval 2.6–5.6); smoking, 1.9 (1.4–2.6); diabetes duration, 1.5 (1.2–1.8) for a difference of 10 years; serum cholesterol, 1.1 (1.0–1.2) for a difference of 1 mmol/l; lower social status, 1.4 (1.1–1.8) for a difference of 1 out of 3 levels; age, 1.3 (1.1–1.6) for a difference of 10 years; male sex, 1.4 (1.1–1.9); systolic blood pressure, 1.1 (1–1.2) for a difference of 10 mmHg. For the combined endpoint – blindness or amputations or renal replacement therapy – predictors were: nephropathy, foot complications, HbA1c, smoking, cholesterol, systolic blood pressure, retinopathy, hypertension, and social status.

Conclusion  In Type 1 diabetic patients who start intensified insulin therapy, nephropathy remains the strongest predictor of mortality and end-stage complications. Glycosylated haemoglobin is a risk factor of end-stage complications but not of mortality. Conventional risk factors comparable to the general population, particularly smoking become operative as predictors of both mortality and end-stage complications.

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