Heart failure mortality remains 20% at end of year 1 and 50% by 5 years and accounts for 2% of US hospital admissions. However with modern management mortality is improved.
Diabetes is linked to heart failure through CVD and is increasing rapidly leading to the question: is there a risk that heart failure mortality will increase over the next few years.
Meta-analysis of trials (Turnbull Diabetologia) have shown no link between glycaemic control and HF in DM2. There are similar no studies of note in DM1.
The present study was designed to relate glycaemic control to hospitalization with HF in DM1. 20,985 adult DM1 patients in the NDR 1998-2003. Followed until end of 2009. MI and other CVD morbidities were included. Poisson regression was used.
Mean age 38.6 years, HbA1c 8.2% and median follow up was 9 years. 3% of the patients were hospitalized with HF. General population admission rate with HF for this age group was 0.1% There was a clear correlation between HbA1c and risk of hospitalization in the study group.
Hazard Ratio for HF admission per percentage rise in HbA1c was 1.3 when corrected for other factors. Other key risks identified were age HR 1.64, diabetes duration HR 1.34, and smoking HR 1.9.
This was a non randomized study thus cannot say whether reduced HbA1c reduces HF risk, but it is representative of a long term DM1 population in real life practice.
In conclusion HF is a major complication in DM1 that may be worth screening for. Good glycaemic control may reduce admission with HF but there are other risk factors (eg. Age, BMI, smoking, diabetes duration).
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