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E-pub ahead of print

Relationship between Peripheral Neuropathy, Diastolic Function, and Adverse Cardiovascular Outcome in Individuals with Type 1 Diabetes Mellitus without Known Cardiovascular Disease: Results from The Thousand & 1 Study

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AIM: This study investigated the association between measures of peripheral neuropathy (PN) and impaired left ventricular diastolic function, and the prognosis in patients with type 1 diabetes (T1DM) and no known cardiovascular disease (CVD). Furthermore, we tested the incremental prognostic value of including measures of PN and diastolic function to the established Steno T1 Risk Engine.

METHODS: Echocardiography and quantitative biothesiometry was performed to evaluate diastolic function and PN. The participants were categorized according severity of diastolic function and PN. Endpoint was combined CV-events and all-cause death. Association was analysed using multivariable regression models. The prognostic capability was assessed with Harrell's C-statistics and tested against the Steno T1 Risk Engine.

RESULTS: A total of 946 individuals (51.5% males) were included. Mean follow-up was 6 (SD 1.3) years. The total number of CV-events and all-cause death were 100. In the multi-adjusted analysis, both PN and impaired diastolic function were associated with increased risk of CV-events and all-cause death: Severe PN vs. no PN: Hazard Ratio (HR) 2.23 (95% confidence interval [CI]: 1.06:4.68, p = 0.035). Severe diastolic impairment vs. normal function: HR 2.27 (95% CI: 1.16:4.44), p = 0.016). Measures of diastolic function improved the prognostic capability when added to the Steno T1 Risk Engine: C-statistic 0.797, (95% CI: 0.793-0.817) vs. 0.785 (0.744-0.825) p =0.006.

CONCLUSION: PN and impaired diastolic function are associated with an increased risk of CV-events and all-cause death in patients with T1DM. Measures of diastolic function improved prediction of prognosis by the Steno T1 Risk Engine. This article is protected by copyright. All rights reserved.

OriginalsprogEngelsk
TidsskriftDiabetes, Obesity and Metabolism
ISSN1462-8902
DOI
StatusE-pub ahead of print - 29 sep. 2020

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This article is protected by copyright. All rights reserved.

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