A recent article published in the New England Journal of Medicine  reviewed data collected from 1998-2012 from adults in the Swedish National Diabetes Register with type 1 diabetes (T1D) and type 2 diabetes (T2D).  Information was analyzed for various end points including overall mortality rate and incidence of cardiovascular disease (CVD) and coronary heart disease (CHD).

Results from the study showed that during the observed time period the incidence rates of CVD and overall mortality rates decreased in both the T1D and T2D groups.

This is good news for those previously diagnosed with these conditions and most likely the improvements are related to a variety of factors including a reduction of predisposing risk factors for diabetes and CVD such as hypertension, hyperlipidemia and elevated glycated hemoglobin levels.  These reductions were most likely a result of a combination of improved targeted pharmaceutical recommendations from healthcare providers as well as increased education and implementation of modifiable lifestyle behaviors and nutrition in patients.

However, although rates of complications in those with T1D and T2D are declining according to data from this analysis, the incidence of these complications in patients with diabetes is still much greater than those without diabetes. What is even more troubling is these effects are now being seen in younger patients as well.

Another recent study found that after adjusting for age, sex and race or ethnic group, the relative annual incidence of T1D in children between the ages of 0-19 increased 1.8% between 2002 to 2012.  In the same time period, T2D rates also rose 4.8% in children aged 10-19 years old.

When patients are being diagnosed with diabetes at younger ages their long term outcomes may be bleak. To counter that possibility and to reduce the incidence of associated complications, lifestyle management including education on appropriate nutrition and physical activity in younger patients should become a critical part of patient management plans from healthcare practitioners. Improving nutritional quality and increasing exercise are cornerstones of diabetes management recommendations as per updated 2015 guidelines published by the American Diabetes Association and may support a reduction in the incidence of diabetes both in childhood and adulthood as well as limiting long term complications.[1]

Why Is This Clinically Important?

  • Diagnosis of T1D and T2D is increasing– particularly in children
  • Rates of mortality and CV complications association with T1D and T2D have decreased but they are still significantly higher than in the general population
  • Recommending lifestyle management including nutrition and exercise in youth and adults may reduce risk of T1D and T2D diagnosis and long-term complications in these populations

References

Mayer-Davis E, et al.  Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012.  N Engl J Med 2017; 376:1419-1429.   http://www.nejm.org/doi/full/10.1056/NEJMoa1610187

Rawshani A, et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes.  N Engl J Med 2017; 376:1407-1418.  http://www.nejm.org/doi/pdf/10.1056/NEJMoa1608664#iid=f02

[1] Fox C, et al.  Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association.  Diabetes Care. 2015 Sep; 38(9): 1777-1803. https://doi.org/10.2337/dci15-0012

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