Non-Invasive Cardiac Monitoring in Type 1 Diabetes Marian Rewers, MD, PhD Professor & Clinical...
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Non-Invasive Cardiac Monitoring in Type 1 Diabetes Marian Rewers, MD, PhD Professor & Clinical Director Barbara Davis Center for Childhood Diabetes University of Colorado Denver
Non-Invasive Cardiac Monitoring in Type 1 Diabetes Marian Rewers, MD, PhD Professor & Clinical Director Barbara Davis Center for Childhood Diabetes University
Non-Invasive Cardiac Monitoring in Type 1 Diabetes Marian
Rewers, MD, PhD Professor & Clinical Director Barbara Davis
Center for Childhood Diabetes University of Colorado Denver
Slide 2
Type 1 diabetes affects mostly adults The U.S., 2003 estimates
Number of patients
Slide 3
Improving survival among T1 DM patients Allegheny County IDDM
Registry 1965-1999
Slide 4
Declining cumulative incidence of microvascular complications
Steno Clinic, Denmark, 600 Patients with T1 DM onset 1965-84 Hovind
P, et al. Diabetes Care 2003 1961-65 1966-70 1971-75 1976-80
Diabetic nephropathyProliferative diabetic retinopathy 1965-69
1970-74 1975-79 1980-84 30 20 10 40
Slide 5
Increasing cumulative incidence of Coronary Artery Disease
Epidemiology of Diabetic Complications Study, Pittsburgh, U.S. 684
Patients with T1 DM diagnosed 1950-1980, followed up to 2000 %
Orchard T, 2003 Diabetes duration
Slide 6
The prevalence of T1 DM peaks ~50 yrs of age in the U.S. The
survival has improved, largely due to better control of
hyperglycemia, hypertension and prevention of acute complications
and ESRD. Coronary artery disease became the leading cause of death
in people with T1 DM. Diabetic women have 10-30 times higher risk
of CAD, and diabetic men have 4-10 times higher risk, compared to
the general population. Summary
Slide 7
Pilot Study Led to NIH Funding N=135 Baseline examination
N=1,416 Pilot Study Participants N=109 CAC Progression Nested
Case-Control Study Progressors: n=98, Non-Progressors: n=173 Pilot
Study Participants N=98 Coronary Artery Calcification in Type 1
3-yr follow-up examination in progress N=1,211
Slide 8
MenWomen T1DM 300 Controls 382 T1DM 352 Controls 382 HbA1c (%)
LDL-c (mg/dl) HDL-c (mg/dl) Age (yr) BMI (kg/m) Ever smoker 7.8*
105* 51* 37 26.7 28% 5.5 122 43 40 27.1 30% 7.9* 98* 60 36 26.0 31%
5.3 105 58 37 25.0 30% Coronary Artery Calcification in Type 1
Diabetes (CACTI) 1,416 participants, CAD-free, aged 20-55 years
Including 652 with T1 DM of at least 10 yrs duration
Slide 9
Coronary artery lumen (angiography), plaque (IVUS) and
calcification (EBT) in a young woman with T1 DM and premature CAD
Coronary Artery Calcification CACTI 1448, female DM diagnosis age 8
Angioplasty age 26 Deceased age 28
Slide 10
Agatston units
Slide 11
Prevalence of Coronary Artery Calcification CACTI Study,
n=1,416 Age women men age-adjusted OR=4.2 (2.4-7.5) OR=2.3
(1.5-3.7) Dabelea D, et al. Diabetes 2003
Slide 12
Snell-Bergeon et al. Diabetes Care 2003
Slide 13
Predictors of 3-year Progression of CAC in T1DM Patients
(N=500) Significant predictors OR 95% CI p-value HbA1c > 8.6%
vs. 8.6% A Hypertension Y/N B HDL-ch per 10 mg/dl C 1.88 1.05-3.35
0.03 1.83 1.07-3.16 0.03 0.69 0.45-0.89 0.04 Adjusting for age
(p=0.007), gender (p=0.16), diabetes duration (p=0.0004), baseline
CAC (p
