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Recent studies conducted at the University of Gothenburg shed light on a significant shift in the risk profile of arterial disease among individuals with type 1 and type 2 diabetes. While the risks of heart attack and stroke have seen a notable decline over the past two decades, complications affecting more peripheral vessels have gained relative importance.
The research, published in The Lancet Regional Health — Europe, draws from extensive data spanning 20 years and involving over 34,000 individuals with type 1 diabetes, 655,000 individuals with type 2 diabetes, and over 2.6 million individuals without diabetes from the Swedish National Diabetes Register.
Analyses of various complications in peripheral blood vessels reveal a downward trend in complications over time, with exceptions. Notably, there has been a gradual transition in risk from arterial diseases in central organs to complications in peripheral vessels among individuals with diabetes.
The findings underscore the potential of optimal control of modifiable risk factors in type 1 diabetes to reduce the risk of peripheral arterial complications by 30-50%. These include long-term blood sugar and blood pressure management. Conversely, patients with type 1 diabetes may not benefit significantly from lowering current guideline values for other cardiometabolic risk factors.
In type 2 diabetes, lower levels of bad cholesterol and triglycerides have been associated with reduced risks of certain complications, emphasizing the importance of managing these factors. However, being above the current guideline value for triglycerides does not necessarily increase the risk.
Long-term blood sugar emerges as a critical marker for peripheral arterial disease in both type 1 and type 2 diabetes, showcasing its significance compared to other risk factors. Notably, elevated long-term blood sugar appears to reinforce the aorta and reduce the risk of specific complications.
Dr. Aidin Rawshani, the lead researcher, underscores the importance of maintaining lower levels of cardiometabolic risk factors, particularly early and intensive control of long-term blood sugar. He emphasizes the nuanced differences in the effects of these risk factors on different parts of the arterial tree, highlighting the significant role of long-term blood sugar in peripheral arterial disease development.
These insights offer valuable guidance for healthcare professionals in managing arterial disease risk among individuals with diabetes. By focusing on optimal control of modifiable risk factors, clinicians can potentially mitigate the risk of peripheral arterial complications and improve long-term health outcomes for patients.
The comprehensive study provides a nuanced understanding of disease trends and risk factors, paving the way for more targeted and effective interventions in diabetes management.
