Risk factors

Diabetes complication trends differ for T1D and T2D

Contrasting trends in hospitalisations for major diabetes-related complications for people with type 1 and type 2 diabetes between 2010 and 2019 are largely unexplained, experts say.

An analysis of data from NDSS registrants in Victoria, NSW, Queensland and the ACT comprised 70,885 people with type 1 diabetes and 1,089,270 with type 2 diabetes.

Linkage with hospital data sets found the age-adjusted incidence of hospitalisation for MI, heart failure (HF), lower extremity amputations (LEA), and hypoglycaemia were stable over time in people with type 1 diabetes.

The age-adjusted incidence of stroke increased from 2010–2011 to 2018–2019 and the incidence of hyperglycaemia increased from 2010–2011 to 2016–2017.

Different patterns were seen in people with type 2 diabetes, with the age-adjusted incidence of hospitalisation for MI decreasing from 2012–2013 to 2018–2019 as did the incidence of HF and hypoglycaemia from 2010–2011 to 2018–2019.

There was however an increase in the incidence of mainly minor (below ankle) LEAs which “suggests an ongoing need to improve early detection and treatment of diabetic foot ulcers.”

“It is also worth noting that while frequently overlooked as a public health problem in Australia, LEAs were one of the most common major diabetes-related complications, especially among young and middle-aged people, and are responsible for a large proportion of the disability burden of diabetes,” the study authors said.

Trends in hospitalisation rates for complications were largely consistent in males and females although strokes increased more in females with type 1 diabetes and decreased more in females than males

In both type 1 and type 2 diabetes, the incidence of hospitalisations for MI, stroke, HF, and LEA increased with age.

The study, published in Diabetes Care, showed the incidence of hypoglycaemia and hyperglycaemia was highest in people with type 1 diabetes aged 0–19 years.

“Conversely, in type 2 diabetes, hypoglycaemia incidence increased with increasing age, while incidence of hyperglycaemia was highest in people aged 20–39 years,” it said.

The investigators, including Professor Jonathon Shaw and Professor Dianna Magliano, said their findings were largely consistent with those from other comparable, high-income countries.

They suggested use of GLP-1 receptor antagonists and SGLT2 inhibitors may have partly contributed to reductions in MI and HF in the type 2 diabetes cohort.

“However, given  that declines in the incidence of MI and HF predate widespread use of these drugs, it is unlikely that these drugs played a major role in these declines,” they observed.

“Importantly, the causes of these trends remain almost completely unknown, highlighting critical deficiencies in diabetes surveillance. Future research to identify the causes of these trends will be critical to mount an effective response,” they concluded.

Further reductions

Professor Magliano, from the Baker Institute and Monash University, said diabetes complications are expected to fall further as uptake of newer medications increases.

“We can be cautiously optimistic that our diabetes management strategies do in fact work but we can’t take our foot off the pedal and we have to continue managing people with diabetes really well for them to further increase their lifespans.”

She believed the real reason driving the observed trends to date was likely to be control of risk factors such as smoking, lipids, hypertension, and better management of diabetes overall.

“And we know that in places like Asia where they have had a really good push on aggressive management of diabetes in multidisciplinary teams that they have had a bigger drop in mortality.”

She said countries such as Singapore, Taiwan, Korea and Hong Kong had worked hard on a more coordinated approach to diabetes with better collection of data, a wider array of medicines on the free list, better screening, better use of dietitians and allied health, and more.

“We can’t really say … because it is ecological data but it wasn’t surprising that those countries had the large decline [in mortality]. We are making this link … but it was certainly interesting that if you put a lot of effort in you can get some rewards.”

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