[ Diabetes Type 1 ]

Relationship Between Risk Factors and Mortality in Type 1 Diabetic Patients in Europe

In this prospective, non-interventional, cross-sectional case control study, seven hundred and twenty-nine subjects from Los Angeles County University of Southern California Medical Center (LAC + USC), Los Angeles, CA, were enrolled. The incidence of retinopathy was determined in 233 individuals, aged 50 to 74 years, by ophthalmoscopy and fundus photography at baseline and after an average follow-up of 9.4 years. The incidence of retinopathy was 157/502 (31.3%). The American Diabetes Association (ADA) criterion was used to identify cases with microalbuminuria, macroalbuminuria and end stage renal disease (ESRD) for prevalence estimation and risk factor assessment. Physical examination, biochemical tests and assessment of complications were done on both occasions. In lower SES urban areas, 73% were sedentary, 37% were obese, and 13.5% had diabetes. This cross-sectional observational study done at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka & National Institute of Ophthalmology & Hospital (NIO & H), Sher-e-Bangla Nagar, Dhaka, Bangladesh from January 2006 to June 2006.

Non-diabetic individuals underwent an oral glucose tolerance test to detect whether their glucose metabolism was impaired. It is concluded that in these Type 1 diabetic children the insulin dose for a given level of metabolic control (our surrogate measure of insulin resistance) was related to a single cardiovascular risk factor: triglyceride concentrations. It is still not clear what risk factors explain this excess mortality risk. Diabetic women were more likely to be obese and dyslipidemic. Although CVD is the major cause of death in patients with type 1 diabetes, it only accounts for approximately half of all deaths, and it is therefore important to study the totality of risk and non-CVD causes of mortality in this young population that is particularly vulnerable to premature death. Previous studies have often had too few deaths (4) or have not collected key risk factors at baseline (1,2). The few large cohort studies that have studied this question have produced inconsistent findings (4–6), in part because key common risk factors were not always included.

Therefore, the aim of this study was to examine risk factors for all-cause mortality in a large, 7-year prospective cohort study of patients with type 1 diabetes.

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