Studies at the University of Gothenburg have shown a redistribution in the risks of arterial disease in individuals with type 1 and type 2 diabetes. While the risks of heart attack and stroke have decreased significantly, complications in more peripheral vessels have increased in relative importance. Previous research has identified cardiometabolic risk factors such as obesity, lipid disorders, and high blood pressure as major contributors to the increased risk of heart attack and stroke in individuals with diabetes. However, the impact of these risk factors on blood vessels outside central organs like the heart and brain had not been extensively studied until now.
Two articles published in The Lancet Regional Health – Europe have shed light on the trends of peripheral arterial diseases over two decades in individuals with type 1 and type 2 diabetes. The studies included data from the Swedish National Diabetes Register on over 34,000 individuals with type 1 diabetes, 655,000 individuals with type 2 diabetes, and over 2.6 million individuals without diabetes. The researchers investigated complications such as carotid artery calcification, abdominal aorta calcification, peripheral blood vessel calcification, and small vessel disease in the feet, and found that these complications have decreased over time in individuals with diabetes.
The results of the studies suggest that closer monitoring of long-term blood sugar and blood pressure could reduce the risk of several peripheral arterial complications by 30-50% in individuals with type 1 diabetes. For type 2 diabetes, lower levels of triglycerides were associated with a reduced risk of peripheral arterial disease. However, lowering other cardiometabolic risk factors such as BMI, cholesterol levels, and renal function did not have a significant impact on reducing the risk of peripheral arterial complications in individuals with type 1 diabetes.
Long-term blood sugar was found to be the most important marker for peripheral arterial disease in both type 1 and type 2 diabetes. Elevated long-term blood sugar appeared to reinforce the aorta and reduce the risk of hernia and rupture of the inner wall of the artery. These findings highlight the differences in the effects of long-term blood sugar and other cardiometabolic risk factors on central versus peripheral arteries, emphasizing the importance of early and intensive control of long-term blood sugar in reducing the risk of future arterial events in individuals with diabetes.
The studies also provided insights into disease trends from 2001 to 2020, showing significant reductions in calcification of carotid arteries and abdominal aorta as well as peripheral blood vessels in individuals with type 1 and type 2 diabetes. Optimal control of risk factors was shown to virtually eliminate the risk of arterial disease in the carotid arteries and lower extremities in individuals with type 1 diabetes. However, the risk of small vessel disease in the feet could not be eliminated even with optimal control of risk factors. The findings underscore the importance of managing blood lipids, blood sugar, blood pressure, renal function, and lifestyle in reducing the risk of peripheral arterial complications in individuals with diabetes.
