| Popis: |
Introduction: The association between body mass index (BMI) and mortality in diabetes is complex and sparsely investigated for cardiovascular (CVD) outcomes. We aimed to investigate these relationships among patients with type 1 and type 2 diabetes using data from the Swedish national diabetes registry (NDR), with focus on potential reverse causality. Considering recent fi ndings of marked excess risks among patients with early onset of type 1 diabetes we aimed to investigate risk factor trajectories based on age at onset. Methods: The thesis is based on data from the Swedish national diabetes registry (Study I-IV) and matched controls taken from the general population (Study I and III), using statistical methods such as Cox regression, linear regression, mixed models and machine learning. Results: Study I, the short-term risk of death (1 year) was linked to age, educational level and CVD risk factors. Conclusions: Among patients with type 1 and type 2 diabetes our analyses provided no support for an obesity paradox for the outcomes of death (type 1 diabetes) and CVD complications including HF after considering the infl uence of reverse causality. The strong relationship between obesity and HF which was worsened by poor glycemic control, was absent for AMI, indicating different pathophysiological mechanisms behind these two outcomes. The age at onset of type 1 diabetes seems to be an important predictor of glycemic control during the fi rst years of adulthood, as well as for the prevalence of albuminuria leading to a more rapid decline in eGFR from an early age. Our study also stresses the importance of early optimization of CVD risk factors, in particular glycemic control, in patients with type 1 diabetes. |
