Microvascular complications have synergistic negative effect on all cause mortality among diabetics

The CHAMP1ON study, CHronic diabetes complications and All-cause Mortality in Pisa from 1999 ONwards, is an observational, single-centre study involving 497 consecutive outpatients referred for dysglycemia in the University Hospital of Pisa between 1999 and 2000.

The study demonstrated the following findings:

· A total of 133 (43.9%) deaths occurred after a 5,244 person-years follow-up.

· The presence of CAN and CKD, irrespective of other MVC, raised the risk of adjusted all-cause mortality by 117% (HR 2.17) and 54% (HR 1.54), respectively.

· Concomitant CKD&CAN at baseline was associated with the highest mortality risk (HR 5.08), followed by CKD&DR (HR 2.95) and CAN&DR (HR 2.07).

· The mortality risk was numerically more significant in patients with any isolated MVC (HR 1.52) than in patients free from MVC. In contrast, in patients with two and three concomitant MVC, it increased by 203% (HR 3.03) and 692% (HR 7.92), respectively.

"Over a significantly long follow-up period of 21 years, CKD, DR, and CAN, but DPN, lowered life expectancy by 1.3 to 2.6 years, and CAN and CKD raised the adjusted all-cause mortality by 117% and 54%," the researchers concluded.

"The findings should encourage comprehensive screenings for microvascular complications in both T1D and T2D to improve treatment and risk stratification," they wrote.

Reference:

Sacchetta, L., Chiriacò, M., Nesti, L. et al. Synergistic effect of chronic kidney disease, neuropathy, and retinopathy on all-cause mortality in type 1 and type 2 diabetes: a 21-year longitudinal study. Cardiovasc Diabetol 21, 233 (2022). https://doi.org/10.1186/s12933-022-01675-6