Retrospective analysis of patients with decompensated type 1 diabetes mellitus: identifying predictors of adverse outcome

Aim. To study clinicopathological and echocardiographic da ta and long-term outcomes of patients hospitalized with decom pensated type 1 diabetes mellitus (T1DM), and to analyze pos sible associations of these factors with adverse outcomes during follow-up. Material and Methods. Here we analyzed case his tories of 502 patients with decompensated T1DM admitted to Vinogradov City Clinical Hospital (Moscow) between Febru ary 2022 and January 2024. Vital status during the long-term follow-up was determined through phone contact with patients or their close relatives. Associations between clinical data and long-term outcomes were assessed using univariate regression analysis. Follow-up outcomes were determined at 18.5 [12.4; 24.0] months after discharge. Patients were divided into two groups: survivors (n = 476) and patients with fatal outcomes (n = 26). Results. Survivors were characterized by younger age, low er glycated hemoglobin levels, and shorter T1DM duration (p < 0.05). Older age (Hazard Ratio (HR) 1.085; 95 % Confidence Interval (CI) [1.058–1.113]), arterial hypertension (HR 3.180; 95 % CI [1.457–6.939]), higher glycated hemoglobin level (HR 14.0; 95 % CI [6.6–29.5]), and longer duration of T1DM (HR 1.063; 95 % CI [1.020–1.107]) were significantly associated with mortality in the long-term period (p < 0.05). Percutaneous coronary intervention (HR 5.183; 95 % CI [1.223–21.956]) and chronic heart failure (HR 9.172; 95 % CI [3.830–21.963]) had a negative prognostic impact on long-term outcomes (p < 0.05). Conclusion. Older age, longer disease duration, higher glycated hemoglobin levels, and arterial hypertension are significant pre dictors of long-term mortality in patients with T1DM. A history of percutaneous coronary intervention and chronic heart failure further worsen the long-term prognosis in this patient popula tion.

1. Dedov II, Shestakova MV, editors. Saharnyj diabet tipa 1: realii i pers pektivy. Moscow: Medical informational agency; 2016. (In Russ). DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. Lan cet. 2018;391(10138):2449–2462. https://doi.org/10.1016/S0140-6736(18)31320-5

2. Kobalava ZhD, Stavtseva YuV, Troitskaya EA, Safarova AF, Petrosyan AE. Blood pressure phenotypes in young patients with type 1 diabetes. Russian Journal of Cardiology. 2020;25(3):3729. (In Russ). https://doi.org/10.15829/1560-4071-2020-3-3729

3. Dedov II, Shestakova MV, Vikulova OK, Zheleznyakova AV, Isakov MA, Sazonova DV, et al. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Reg ister of Diabetes Mellitus for the period 2010 - 2022. Diabetes mellitus. 2023;26(2):104–123. (In Russ). https://doi.org/10.14341/DM13035

4. Suntsov II, Maslova OV, Dedov II. Screening for diabetic complica tions as a tool for the evaluation of medical and preventive aid to pa tients. Problems of Endocrinology. 2010;56(1):3–8. (In Russ).

5. Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikono va TV, Sukhareva OY, et al. Diabetes mellitus type 1 in adults. Dia betes mellitus. 2020;23(1S):42–114. (Russ). https://doi.org/10.14341/DM12505

6. Preis SR, Hwang SJ, Coady S, Pencina MJ, D'Agostino RB, Savage PJ, et al. Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation. 2009;119(13):1728–1735. https://doi.org/10.1161/CIRCULATIONAHA.108.829176

7. Soedamah-Muthu SS, Chaturvedi N, Witte DR, Stevens LK, Porta M, Fuller JH. Relationship between risk factors and mortality in type 1 diabetic patients in Europe: the EURODIAB Prospective Complica tions Study (PCS). Diabetes care. 2008;31(7):1360–1366. https://doi.org/10.2337/dc08-0107

8. Lung TWC, Hayes AJ, Herman WH, Si L, Palmer AJ, Clarke PM. A Meta-Analysis of the Relative Risk of Mortality for Type 1 Diabe tes Patients Compared to the General Population: Exploring Tempo ral Changes in Relative Mortality. PLoS ONE. 2014;9(11):e113635. https://doi.org/10.1371/journal.pone.0113635

9. Chalakova T, Yotov Y, Tzotchev K, Galcheva S, Balev B, Bocheva Y et al. Type 1 Diabetes Mellitus – Risk Factor for Cardiovascular Disease Morbidity and Mortality. Current diabetes reviews. 2021;17(1):37–54. https://doi.org/10.2174/1573399816666200511004205

10. Collier A, Connelly PJ, Hair M, Cameron L, Ghosh S, Waugh N. Mor tality risk remains higher in individuals with type 1 diabetes: A pop ulation-based cohort study (the Ayrshire diabetes follow-up cohort [ADOC]). Diabetes, Obesity and Metabolism. 2018;20:1965–1971. https://doi.org/10.1111/dom.13334

11. Sandahl K, Nielsen LB, Svensson J, Johannesen J, Pociot F, Mortensen HB, et al. Increased mortality in a Danish cohort of young people with Type 1 diabetes mellitus followed for 24 years. Diabetic Medicine. 2017;34(3):380–386. https://doi.org/10.1111/dme.13124

12. Astrup AS. Cardiovascular morbidity and mortality in diabetes melli tus: prediction and prognosis. Dan Med Bull. 2011;58(8):B4152

13. Rossing P, Hougaard P, Borch-Johnsen K, Parving HH. Predictors of mortality in insulin dependent diabetes: 10 year observational fol low up study. BMJ. 1996;313(7060):779–784. https://doi.org/10.1136/bmj.313.7060.779

14. Al-Rubeaan K, Youssef AM, Ibrahim HM, Al-Sharqawi AH, AlQu maidi H, AlNaqeb D, et al. All-cause mortality and its risk factors among type 1 and type 2 diabetes mellitus in a country facing diabe tes epidemic. Diabetes Res Clin Pract 2016:118:130–139. https://doi.org/10.1016/j.diabres.2016.06.012

15. McEwen LN, Kim C, Karter AJ, Haan MN, Ghosh D, Lantz PM, et al. Risk factors for mortality among patients with diabetes: the Translat ing Research Into Action for Diabetes (TRIAD) Study. Diabetes care. 2007;30(7):1736–1741. https://doi.org/10.2337/dc07-0305

16. Dedov II, Mel`nichenko GA, editors. Endocrinology: National guide lines. Moscow: GEOTAR-Media; 2024. (Russ). 18. Moss SE, Klein R, Klein BE, Meuer SM. The association of gly cemia and cause-specific mortality in a diabetic population. Arch Intern Med. 1994;154(21):2473–2479. https://doi.org/10.1001/archinte.1994.00420210113013

17. Rawshani A, Rawshani A, Sattar N, Franzén S, McGuire DK, Eliasson B, et al. Relative prognostic importance and optimal levels of risk fac tors for mortality and cardiovascular outcomes in type 1 diabetes mel litus. Circulation. 2019;139(16):1900–1912. https://doi.org/10.1161/CIRCULATIONAHA.118.037454

18. Inoue K, Nianogo R, Telesca D, Goto A, Khachadourian V, Tsugawa Y, et al. Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999-2015. Int J Epidemiol. 2021;50(4):1373 1383. https://doi.org/10.1093/ije/dyaa263

19. Cleary PA, Orchard TJ, Genuth S, Wong ND, Detrano R, Backlund J-YC, et al. The effect of intensive glycemic treatment on coronary ar tery calcification in type 1 diabetic participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. Diabetes. 2006;55(12):3556 3565. https://doi.org/10.2337/db06-0653

20. Soedamah-Muthu SS, Colhoun HM, Abrahamian H, Chan NN, Man gili R, Reboldi GP, et al. Trends in hypertension management in type I diabetes across Europe, 1989/1990–1997/1999. Diabetologia. 2002;45:1362–1371. https://doi.org/10.1007/s00125-002-0914-6.

21. Tchernyshova TE. Lethal predictors of the first type di abetes. Medical examination problem. 2001;1(4):26–29. (In Russ).

22. Long H, Li J, Li R, Zhang H, Ge H, Zeng H, et al. Plas ma glucose levels and diabetes are independent predic tors for mortality in patients with COVID-19. Epidemi ol Infect. 2022;16(150):e106. https://doi.org/10.1017/S095026882200022X

23. Wargny M, Potier L, Gourdy P, Pichelin M, Amadou C, Benhamou PY, et al. Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updat ed results from the nationwide CORONADO study. Di abetologia. 2021;64(4):778–794. https://doi.org/10.1007/s00125-020-05351-w.