Risk of Cardiovascular Disease and Total Mortality in Adults with Type 1 Diabetes: Scottish Registry Linkage Study
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{"title"=>"Risk of Cardiovascular Disease and Total Mortality in Adults with Type 1 Diabetes: Scottish Registry Linkage Study", "type"=>"journal", "authors"=>[{"first_name"=>"Shona J.", "last_name"=>"Livingstone", "scopus_author_id"=>"7004658349"}, {"first_name"=>"Helen C.", "last_name"=>"Looker", "scopus_author_id"=>"6603290887"}, {"first_name"=>"Eleanor J.", "last_name"=>"Hothersall", "scopus_author_id"=>"14063196700"}, {"first_name"=>"Sarah H.", "last_name"=>"Wild", "scopus_author_id"=>"7103086309"}, {"first_name"=>"Robert S.", "last_name"=>"Lindsay", "scopus_author_id"=>"7402182925"}, {"first_name"=>"John", "last_name"=>"Chalmers", "scopus_author_id"=>"54912078200"}, {"first_name"=>"Stephen", "last_name"=>"Cleland", "scopus_author_id"=>"7003968203"}, {"first_name"=>"Graham P.", "last_name"=>"Leese", "scopus_author_id"=>"25628497900"}, {"first_name"=>"John", "last_name"=>"McKnight", "scopus_author_id"=>"7101765378"}, {"first_name"=>"Andrew D.", "last_name"=>"Morris", "scopus_author_id"=>"7403404521"}, {"first_name"=>"Donald W.M.", "last_name"=>"Pearson", "scopus_author_id"=>"7402462968"}, {"first_name"=>"Norman R.", "last_name"=>"Peden", "scopus_author_id"=>"7004457916"}, {"first_name"=>"John R.", "last_name"=>"Petrie", "scopus_author_id"=>"7103382892"}, {"first_name"=>"Sam", "last_name"=>"Philip", "scopus_author_id"=>"12797452800"}, {"first_name"=>"Naveed", "last_name"=>"Sattar", "scopus_author_id"=>"7007043802"}, {"first_name"=>"Frank", "last_name"=>"Sullivan", "scopus_author_id"=>"7101762078"}, {"first_name"=>"Helen M.", "last_name"=>"Colhoun", "scopus_author_id"=>"7003466904"}], "year"=>2012, "source"=>"PLoS Medicine", "identifiers"=>{"scopus"=>"2-s2.0-84868116559", "sgr"=>"84868116559", "issn"=>"15491277", "doi"=>"10.1371/journal.pmed.1001321", "pmid"=>"23055834", "isbn"=>"1549-1277", "pui"=>"365953476"}, "id"=>"a5b7bfae-7483-3d8a-a4c4-71659c809f73", "abstract"=>"BACKGROUND Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM. METHODS AND FINDINGS The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥20 years in 2005-2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4-3.8, p<0.001) than men (2.3: 2.0-2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2-3.0, p<0.001) in men and 2.7 (2.2-3.4, p<0.001) in women. Between 2005-2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ≥40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60-69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA(1c) of <7% and 37% had very poor (≥9%) glycaemic control. Among those aged ≥40, 37% had blood pressures above even conservative targets (≥140/90 mmHg) and 39% of those ≥40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used. CONCLUSIONS Although the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/risk-cardiovascular-disease-total-mortality-adults-type-1-diabetes-scottish-registry-linkage-study", "reader_count"=>58, "reader_count_by_academic_status"=>{"Librarian"=>1, "Student > Doctoral Student"=>4, "Researcher"=>6, "Student > Ph. D. 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Student"=>11, "Student > Postgraduate"=>8, "Other"=>8, "Student > Master"=>7, "Student > Bachelor"=>6, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>1, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>1, "Agricultural and Biological Sciences"=>4, "Business, Management and Accounting"=>1, "Chemistry"=>1, "Computer Science"=>1, "Economics, Econometrics and Finance"=>1, "Biochemistry, Genetics and Molecular Biology"=>2, "Nursing and Health Professions"=>3, "Medicine and Dentistry"=>36, "Sports and Recreations"=>3, "Physics and Astronomy"=>1, "Psychology"=>1, "Social Sciences"=>2, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>36}, "Social Sciences"=>{"Social Sciences"=>2}, "Sports and Recreations"=>{"Sports and Recreations"=>3}, "Physics and Astronomy"=>{"Physics and Astronomy"=>1}, "Psychology"=>{"Psychology"=>1}, "Unspecified"=>{"Unspecified"=>1}, "Chemistry"=>{"Chemistry"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}}, "reader_count_by_country"=>{"Canada"=>1, "United Kingdom"=>2, "Italy"=>1, "Portugal"=>1}, "group_count"=>1}

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  • {"files"=>["https://ndownloader.figshare.com/files/565745"], "description"=>"<p>Risk factor prevalence in type 1 diabetes, May 2008.</p>", "links"=>[], "tags"=>["prevalence"], "article_id"=>236228, "categories"=>["Chemistry", "Biotechnology"], "users"=>["Shona J. Livingstone", "Helen C. Looker", "Eleanor J. Hothersall", "Sarah H. Wild", "Robert S. Lindsay", "John Chalmers", "Stephen Cleland", "Graham P. Leese", "John McKnight", "Andrew D. Morris", "Donald W. M. Pearson", "Norman R. Peden", "John R. Petrie", "Sam Philip", "Naveed Sattar", "Frank Sullivan", "Helen M. Colhoun"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001321.g003", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_factor_prevalence_in_type_1_diabetes_May_2008_/236228", "title"=>"Risk factor prevalence in type 1 diabetes, May 2008.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-10-02 01:43:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/565871"], "description"=>"a<p>All those aged ≥20 and observed in the period 2005–2007.</p><p>SE, standard error.</p>", "links"=>[], "tags"=>["rates", "irrs", "compared", "non-diabetic"], "article_id"=>236343, "categories"=>["Chemistry", "Biotechnology"], "users"=>["Shona J. Livingstone", "Helen C. Looker", "Eleanor J. Hothersall", "Sarah H. Wild", "Robert S. Lindsay", "John Chalmers", "Stephen Cleland", "Graham P. Leese", "John McKnight", "Andrew D. Morris", "Donald W. M. Pearson", "Norman R. Peden", "John R. Petrie", "Sam Philip", "Naveed Sattar", "Frank Sullivan", "Helen M. Colhoun"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001321.t002", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Incidence_rates_and_IRRs_for_total_mortality_in_those_with_type_1_diabetes_compared_with_the_non_diabetic_population_/236343", "title"=>"Incidence rates and IRRs for total mortality in those with type 1 diabetes compared with the non-diabetic population.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-10-02 01:45:43"}
  • {"files"=>["https://ndownloader.figshare.com/files/299706", "https://ndownloader.figshare.com/files/299774"], "description"=>"<div><h3>Background</h3><p>Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.</p> <h3>Methods and Findings</h3><p>The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥20 years in 2005–2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (<em>n</em> = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4–3.8, <em>p</em><0.001) than men (2.3: 2.0–2.7, <em>p</em><0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2–3.0, <em>p</em><0.001) in men and 2.7 (2.2–3.4, <em>p</em><0.001) in women. Between 2005–2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ≥40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60–69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA<sub>1c</sub> of <7% and 37% had very poor (≥9%) glycaemic control. Among those aged ≥40, 37% had blood pressures above even conservative targets (≥140/90 mmHg) and 39% of those ≥40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.</p> <h3>Conclusions</h3><p>Although the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.</p> <p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["cardiovascular", "adults", "scottish", "registry", "linkage"], "article_id"=>119080, "categories"=>["Chemistry", "Biotechnology"], "users"=>["Shona J. Livingstone", "Helen C. Looker", "Eleanor J. Hothersall", "Sarah H. Wild", "Robert S. Lindsay", "John Chalmers", "Stephen Cleland", "Graham P. Leese", "John McKnight", "Andrew D. Morris", "Donald W. M. Pearson", "Norman R. Peden", "John R. Petrie", "Sam Philip", "Naveed Sattar", "Frank Sullivan", "Helen M. Colhoun"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001321.s001", "https://dx.doi.org/10.1371/journal.pmed.1001321.s002"], "stats"=>{"downloads"=>16, "page_views"=>21, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Risk_of_Cardiovascular_Disease_and_Total_Mortality_in_Adults_with_Type_1_Diabetes_Scottish_Registry_Linkage_Study/119080", "title"=>"Risk of Cardiovascular Disease and Total Mortality in Adults with Type 1 Diabetes: Scottish Registry Linkage Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-10-02 02:31:20"}
  • {"files"=>["https://ndownloader.figshare.com/files/565582"], "description"=>"<p>All lines are interpolations. <i>y</i> axis for mortality panel has a different range to the other panels for purposes of display.</p>", "links"=>[], "tags"=>["rates", "cerebrovascular", "all-cause", "non-diabetic", "scotland"], "article_id"=>236057, "categories"=>["Chemistry", "Biotechnology"], "users"=>["Shona J. Livingstone", "Helen C. Looker", "Eleanor J. Hothersall", "Sarah H. Wild", "Robert S. Lindsay", "John Chalmers", "Stephen Cleland", "Graham P. Leese", "John McKnight", "Andrew D. Morris", "Donald W. M. Pearson", "Norman R. Peden", "John R. Petrie", "Sam Philip", "Naveed Sattar", "Frank Sullivan", "Helen M. Colhoun"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001321.g001", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Age_standardised_rates_for_primary_CVD_primary_CHD_primary_cerebrovascular_disease_and_all_cause_mortality_by_sex_and_age_band_for_people_with_type_1_diabetes_or_non_diabetic_in_Scotland_2005_8211_2007_/236057", "title"=>"Age-standardised rates for primary CVD, primary CHD, primary cerebrovascular disease, and all-cause mortality by sex and age band for people with type 1 diabetes or non-diabetic in Scotland 2005–2007.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-10-02 01:40:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/565678"], "description"=>"<p>Most common underlying causes of death in type 1 diabetes, 2005–2007.</p>", "links"=>[], "tags"=>["causes"], "article_id"=>236155, "categories"=>["Chemistry", "Biotechnology"], "users"=>["Shona J. Livingstone", "Helen C. Looker", "Eleanor J. Hothersall", "Sarah H. Wild", "Robert S. Lindsay", "John Chalmers", "Stephen Cleland", "Graham P. Leese", "John McKnight", "Andrew D. Morris", "Donald W. M. Pearson", "Norman R. Peden", "John R. Petrie", "Sam Philip", "Naveed Sattar", "Frank Sullivan", "Helen M. Colhoun"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001321.g002", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Most_common_underlying_causes_of_death_in_type_1_diabetes_2005_8211_2007_/236155", "title"=>"Most common underlying causes of death in type 1 diabetes, 2005–2007.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-10-02 01:42:35"}
  • {"files"=>["https://ndownloader.figshare.com/files/565922"], "description"=>"<p>Values are median (25th–75th percentile) for continuous variables, % (standard error) for categorical variables.</p>a<p>Numbers varied slightly for available data for different risk factors.</p>", "links"=>[], "tags"=>["levels", "aged"], "article_id"=>236397, "categories"=>["Chemistry", "Biotechnology"], "users"=>["Shona J. Livingstone", "Helen C. Looker", "Eleanor J. Hothersall", "Sarah H. Wild", "Robert S. Lindsay", "John Chalmers", "Stephen Cleland", "Graham P. Leese", "John McKnight", "Andrew D. Morris", "Donald W. M. Pearson", "Norman R. Peden", "John R. Petrie", "Sam Philip", "Naveed Sattar", "Frank Sullivan", "Helen M. Colhoun"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001321.t003", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_factor_levels_in_all_those_with_type_1_diabetes_aged_8805_20_by_age_and_sex_at_most_recent_assessment_/236397", "title"=>"Risk factor levels in all those with type 1 diabetes aged ≥20 by age and sex at most recent assessment.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-10-02 01:46:37"}

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Relative Metric

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