J Korean Diabetes.  2024 Jun;25(2):62-68. 10.4093/jkd.2024.25.2.62.

Do Type 1 and Type 2 Diabetes Have the Same Vascular Complications?

• Cho YK

• KMID: 2556755
• DOI: http://doi.org/10.4093/jkd.2024.25.2.62

Abstract

Both type 1 and type 2 diabetes can lead to cardiovascular disease (CVD) and high mortality rates. The differing risks and vascular outcomes associated with these two types of diabetes are subjects of ongoing debate, necessitating further research. The recent increase in type 2 diabetes prevalence presents a significant challenge to global health due to its strong link with CVD. The elevated CVD risk in individuals with diabetes compared to those without is influenced by various factors. These include common cardiovascular risk factors such as high low-density lipoprotein cholesterol, hypertension, and smoking, as well as diabetes-specific factors like HbA1c level and micro- or macroalbuminuria. Some of these risk factors are modifiable, while others, such as age, sex, and type of diabetes, are not. Notably, older individuals with well-managed type 2 diabetes can often achieve CVD risk levels similar to that of the general population. Conversely, younger individuals with type 1 diabetes generally struggle to reach similar risk levels, likely due to the prolonged and cumulative effects of hyperglycemia. The comparison of CVD risks between type 1 and type 2 diabetes is complex and influenced by a variety of factors. This statement aims to provide a thorough overview of the current knowledge regarding diabetes-related cardiovascular risks, with a special focus on the differences between type 1 and type 2 diabetes.

Keyword

Cardiovascular diseases; Diabetes mellitus, type 1; Diabetes mellitus, type 2

Reference

1.Sun H., Saeedi P., Karuranga S., Pinkepank M., Ogurtsova K., Duncan BB, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022. 183:109119.

2.Rosenwaike I. Mortality differentials among persons born in Cuba, Mexico, and Puerto Rico residing in the United States, 1979-81. Am J Public Health. 1987. 77:603–6.

3.Ahlqvist E., Storm P., Käräjämäki A., Martinell M., Dorkhan M., Carlsson A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol. 2018. 6:361–9.

4.Al-Majdoub M., Ali A., Storm P., Rosengren AH., Groop L., Spégel P. Metabolite profiling of LADA challenges the view of a metabolically distinct subtype. Diabetes. 2017. 66:806–14.

5.Hjort R., Ahlqvist E., Carlsson PO., Grill V., Groop L., Martinell M, et al. Overweight, obesity and the risk of LADA: results from a Swedish case-control study and the Norwe-gian HUNT Study. Diabetologia. 2018. 61:1333–43.

6.Skyler JS., Bakris GL., Bonifacio E., Darsow T., Eckel RH., Groop L, et al. Differentiation of diabetes by pathophys-iology, natural history, and prognosis. Diabetes. 2017. 66:241–55.

7.Zimmet P., Alberti KG., Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001. 414:782–7.

8.Chen L., Magliano DJ., Zimmet PZ. The worldwide epi-demiology of type 2 diabetes mellitus present and future perspectives. Nat Rev Endocrinol. 2011. 8:228–36.

9.Katsarou A., Gudbjörnsdottir S., Rawshani A., Dabelea D., Bonifacio E., Anderson BJ, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017. 3:17016.

10.Green A., Hede SM., Patterson CC., Wild SH., Imperatore G., Roglic G, et al. Type 1 diabetes in 2017: global estimates of incident and prevalent cases in children and adults. Diabetologia. 2021. 64:2741–50.

11.Chae HW., Seo GH., Song K., Choi HS., Suh J., Kwon A, et al. Incidence and prevalence of type 1 diabetes mellitus among Korean children and adolescents between 2007 and 2017: an epidemiologic study based on a national da-tabase. Diabetes Metab J. 2020. 44:866–74.

12.Thomas NJ., Lynam AL., Hill AV., Weedon MN., Shields BM., Oram RA, et al. Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age and is com-monly treated as type 2 diabetes. Diabetologia. 2019. 62:1167–72.

13.Sarwar N., Gao P., Seshasai SR., Gobin R., Kaptoge S., Di An-gelantonio E., Emerging Risk Factors Collaboration, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010. 375:2215–22.

14.Rawshani A., Rawshani A., Franzén S., Eliasson B., Svensson AM., Miftaraj M, et al. Range of risk factor levels: control, mortality, and cardiovascular outcomes in type 1 diabetes mellitus. Circulation. 2017. 135:1522–31.

15.Rawshani A., Sattar N., Franzén S., Rawshani A., Hattersley AT., Svensson AM, et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet. 2018. 392:477–86.

16.Rawshani A., Rawshani A., Franzén S., Eliasson B., Svensson AM., Miftaraj M, et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med. 2017. 376:1407–18.

17.Morton JI., Lazzarini PA., Shaw JE., Magliano DJ. Trends in the incidence of hospitalization for major diabetes-related complications in people with type 1 and type 2 diabetes in Australia, 2010-2019. Diabetes Care. 2022. 45:789–97.

18.Sattar N., Rawshani A., Franzén S., Rawshani A., Svensson AM., Rosengren A, et al. Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks. Circulation. 2019. 139:2228–37.

19.Constantino MI., Molyneaux L., Limacher-Gisler F., Al-Saeed A., Luo C., Wu T, et al. Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care. 2013. 36:3863–9.

20.Dabelea D., Stafford JM., Mayer-Davis EJ., D'Agostino R Jr., Dolan L., Imperatore G., SEARCH for Diabetes in Youth Research Group, et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adoles-cence with complications during teenage years and young adulthood. JAMA. 2017. 317:825–35.

21.Luk AO., Lau ES., So WY., Ma RC., Kong AP., Ozaki R, et al. Prospective study on the incidences of cardiovascular-renal complications in Chinese patients with young-onset type 1 and type 2 diabetes. Diabetes Care. 2014. 37:149–57.

22.Kiss Z., Rokszin G., Abonyi-Tóth Z., Jermendy G., Kempler P., Barkai L, et al. Young adult patients with type 1 diabetes have a higher risk of mortality than those of similar age with type 2 diabetes: a nationwide analysis in Hungary. Diabetes Metab Res Rev. 2019. 35:e3190.

23.Shao SC., Chang KC., Hung MJ., Yang NI., Chan YY., Chen HY, et al. Comparative risk evaluation for cardiovascular events associated with dapagliflozin vs. empagliflozin in real-world type 2 diabetes patients: a multi-institutional cohort study. Cardiovasc Diabetol. 2019. 18:120.

24.Orchard TJ., Nathan DM., Zinman B., Cleary P., Brillon D., Backlund JY., Writing Group for the DCCT/EDIC Research Group, et al. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. JAMA. 2015. 313:45–53.

25.Zgibor JC., Piatt GA., Ruppert K., Orchard TJ., Roberts MS. Deficiencies of cardiovascular risk prediction models for type 1 diabetes. Diabetes Care. 2006. 29:1860–5.

26.Hong YH., Chung IH., Han K., Chung S. Taskforce Team of the Obesity Fact Sheet of the Korean Society for the Study of Obesity. Prevalence of type 2 diabetes mellitus among Korean children, adolescents, and adults younger than 30 years: changes from 2002 to 2016. Diabetes Metab J. 2022. 46:297–306.

27.Choi HH., Choi G., Yoon H., Ha KH., Kim DJ. Rising incidence of diabetes in young adults in South Korea: a national cohort study. Diabetes Metab J. 2022. 46:803–7.