Published online Jun 15, 2014. doi: 10.4239/wjd.v5.i3.282
Revised: March 5, 2014
Accepted: April 9, 2014
Published online: June 15, 2014
While the lifespan of people with type 1 diabetes has increased progressively since the advent of insulin therapy, these patients still experience premature mortality, primarily from cardiovascular disease (CVD). However, a subgroup of those with type 1 diabetes survives well into old age without significant morbidity. It is the purpose of this review to explore the factors which may help in identifying these patients. It might be expected that hyperglycaemia plays a major role in explaining the increased incidence of CVD and mortality of these individuals. However, while a number of publications have associated poor long term glycaemic control with an increase in both all-cause mortality and CVD in those with type 1 diabetes, it is apparent that good glycaemic control alone cannot explain why some patients with type 1 diabetes avoid fatal CVD events. Lipid disorders may occur in those with type 1 diabetes, but the occurrence of elevated high-density lipoprotein-cholesterol is positively associated with longevity in this population. Non-renal hypertension, by itself is a significant risk factor for CVD but if adequately treated does not appear to mitigate against longevity. However, the presence of nephropathy is a major risk factor and its absence after 15-20 years of diabetes appears to be a marker of long-term survival. One of the major factors linked with long-term survival is the absence of features of the metabolic syndrome and more specifically the presence of insulin sensitivity. Genetic factors also play a role, with a family history of longevity and an absence of type 2 diabetes and hypertension in the family being important considerations. There is thus a complex interaction between multiple risk factors in determining which patients with type 1 diabetes are likely to live into older age. However, these patients can often be identified clinically based on a combination of factors as outlined above.
Core tip: People with type 1 diabetes are generally assumed to have a shortened lifespan. This contention is supported by a number of epidemiological studies confirming a trend towards premature death, primarily due to cardiovascular disease. However, a subset of type 1 individuals survives for many years, living for over 50 years or more with type 1 diabetes. This review explores the clinical features that are linked to long-term survival in people with type 1 diabetes, allowing identification of these individuals. Recognising these individuals will aid in assessing prognosis, and treating the identified risk factors could improve survival.