Key result
The presence of three concomitant microvascular complications increased the risk of all-cause mortality by 692% (HR 7.92) compared with patients free from complications.
Why the study?
The impact of different combinations of diabetic microvascular complications on long-term mortality had not been adequately assessed.
Does the presence of single or combined diabetic microvascular complications increase all-cause mortality in patients with type 1 and type 2 diabetes?
Cohort (n=303)
No
Does the presence of single or combined diabetic microvascular complications increase all-cause mortality in patients with type 1 and type 2 diabetes?
The presence of multiple concomitant diabetic microvascular complications, particularly chronic kidney disease and cardiac autonomic neuropathy, synergistically increases the long-term risk of all-cause mortality in patients with diabetes.
Multiple microvascular complications were associated with higher mortality; extends prior data on synergistic risks but leaves causal effects open.
BACKGROUND: The prognostic value of common and frequently associated diabetic microvascular complications (MVC), namely chronic kidney disease (CKD), cardiac autonomic neuropathy (CAN), peripheral neuropathy (DPN), and retinopathy (DR), is well established. However, the impact of their different combinations on long-term mortality has not been adequately assessed. METHODS: Tc-DTPA dynamic renal scintigraphy, overnight urine collection, cardiovascular autonomic tests, monofilament testing, and dilated fundus oculi examination. RESULTS: After a 5,244 person-years follow-up, a total of 133 (43.9%) deaths occurred. The presence of CKD and CAN, regardless of other MVC, increased the adjusted all-cause mortality risk by 117% (HR 2.17 [1.45-3.26]) and 54% (HR 1.54 [1.01-2.36]), respectively. Concomitant CKD&CAN at baseline were associated with the highest mortality risk (HR 5.08 [2.52-10.26]), followed by CKD&DR (HR 2.95 [1.63-5.32]), and CAN&DR (HR 2.07 [1.11-3.85]). Compared with patients free from MVC, the mortality risk was only numerically higher in those with any isolated MVC (HR 1.52 [0.87-2.67]), while increased by 203% (HR 3.03 [1.62-5.68]) and 692% (HR 7.92 [2.93-21.37]) in patients with two and three concomitant MVC, respectively. CONCLUSIONS: Our study demonstrates the long-term, synergistic, negative effects of single and concomitant diabetic MVC on all-cause mortality, which should encourage comprehensive screenings for MCV in both T1D and T2D to improve risk stratification and treatment.
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Sacchetta et al. (2022) conducted a cohort in Type 1 and Type 2 diabetes (n=303). Three concomitant microvascular complications vs. No microvascular complications was evaluated on All-cause mortality (HR 7.92, 95% CI 2.93-21.37). The presence of three concomitant microvascular complications increased the risk of all-cause mortality by 692% (HR 7.92) compared with patients free from complications.
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