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Sudden Cardiac Death in Patients With Type 1 Versus Type 2 Diabetes

Published:October 20, 2022DOI:https://doi.org/10.1016/j.mayocp.2022.05.021

      Abstract

      Objective

      To investigate the association between type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D) with risk of sudden cardiac arrest (SCA).

      Methods

      In a prospective community-based study of SCA from February 1, 2002, through November 30, 2019, we ascertained 2771 cases age 18 years of age or older and matched them to 8313 controls based on geography, age, sex, and race/ethnicity. We used logistic regression to evaluate the independent association between diabetes, T1D, T2D, and SCA.

      Results

      Patients had a mean age of 64.5±15.9 years, were 33.3% female and 23.9% non-White race. Overall, 36.7% (n=1016) of cases and 23.8% (n=1981) of controls had diabetes. Among individuals with diabetes, the proportion of T1D was 6.5% (n=66) among cases and 2.0% among controls (n=40). Diabetes was associated with 1.5-times higher odds of SCA. Compared with those without diabetes, the odds ratio and 95% CI for SCA was 4.36 (95% CI, 2.81 to 6.75; P<.001) in T1D and 1.45 (95% CI, 1.30 to 1.63; P<.001) in T2D after multivariable adjustment. Among those with diabetes, the odds of having SCA were 2.41 times higher in T1D than in T2D (95% CI, 1.53 to 3.80; P<.001). Cases of SCA with T1D were more likely to have an unwitnessed arrest, less likely to receive resuscitation, and less likely to survive compared with those with T2D.

      Conclusion

      Type 1 diabetes was more strongly associated with SCA compared with T2D and had less favorable outcomes following resuscitation. Diabetes type could influence the approach to risk stratification and prevention of SCA.

      Abbreviations and Acronyms:

      BMI (body mass index), CAD (coronary artery disease), CKD (chronic kidney disease), OR (odds ratio), SCA (sudden cardiac arrest), SCD (sudden cardiac death), T1D (type 1 diabetes), T2D (type 2 diabetes)
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      References

        • Curb J.D.
        • Rodriguez B.L.
        • Burchfiel C.M.
        • Abbott R.D.
        • Chiu D.
        • Yano K.
        Sudden death, impaired glucose tolerance, and diabetes in Japanese American men.
        Circulation. 1995; 91: 2591-2595
        • Balkau B.
        • Jouven X.
        • Ducimetiere P.
        • Eschwege E.
        Diabetes as a risk factor for sudden death.
        Lancet. 1999; 354: 1968-1969
        • Burke A.P.
        • Farb A.
        • Pestaner J.
        • et al.
        Traditional risk factors and the incidence of sudden coronary death with and without coronary thrombosis in blacks.
        Circulation. 2002; 105: 419-424
        • Albert C.M.
        • Chae C.U.
        • Grodstein F.
        • et al.
        Prospective study of sudden cardiac death among women in the United States.
        Circulation. 2003; 107: 2096-2101
        • Jouven X.
        • Lemaitre R.N.
        • Rea T.D.
        • Sotoodehnia N.
        • Empana J.P.
        • Siscovick D.S.
        Diabetes, glucose level, and risk of sudden cardiac death.
        Eur Heart J. 2005; 26: 2142-2147
        • Chugh S.S.
        Sudden cardiac death in 2017: spotlight on prediction and prevention.
        Int J Cardiol. 2017; 237: 2-5
        • Cho N.H.
        • Shaw J.E.
        • Karuranga S.
        • et al.
        IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045.
        Diabetes Res Clin Pract. 2018; 138: 271-281
        • CDC
        National Diabetes Statistics Report, 2020.
        Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA2020 (Accessed June 4, 2021. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf)
        • Lee Y.B.
        • Han K.
        • Kim B.
        • et al.
        Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study.
        Cardiovasc Diabetol. 2019; 18: 157
        • Lind M.
        • Svensson A.M.
        • Kosiborod M.
        • et al.
        Glycemic control and excess mortality in type 1 diabetes.
        N Engl J Med. 2014; 371: 1972-1982
        • Gagnum V.
        • Stene L.C.
        • Leivestad T.
        • Joner G.
        • Skrivarhaug T.
        Long-term mortality and end-stage renal disease in a type 1 diabetes population diagnosed at age 15-29 years in Norway.
        Diabetes Care. 2017; 40: 38-45
        • Svane J.
        • Lynge T.H.
        • Pedersen-Bjergaard U.
        • et al.
        Cause-specific mortality in children and young adults with diabetes mellitus: a Danish nationwide cohort study.
        Eur J Prev Cardiol. 2019; 28: 159-165
        • Svane J.
        • Pedersen-Bjergaard U.
        • Tfelt-Hansen J.
        Diabetes and the risk of sudden cardiac death.
        Curr Cardiol Rep. 2020; 22: 112
        • American Diabetes Association
        2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes — 2020.
        Diabetes Care. 2020; 43: S14-S31
        • Lynge T.H.
        • Svane J.
        • Pedersen-Bjergaard U.
        • et al.
        Sudden cardiac death among persons with diabetes aged 1-49 years: a 10-year nationwide study of 14,294 deaths in Denmark.
        Eur Heart J. 2020; 41: 2699-2706
        • Tu E.
        • Twigg S.M.
        • Duflou J.
        • Semsarian C.
        Causes of death in young Australians with type 1 diabetes: a review of coronial postmortem examinations.
        Med J Aust. 2008; 188: 699-702
        • Tu E.
        • Twigg S.M.
        • Semsarian C.
        Sudden death in type 1 diabetes: the mystery of the 'dead in bed' syndrome.
        Int J Cardiol. 2010; 138: 91-93
        • Tattersall R.B.
        • Gill G.V.
        Unexplained deaths of type 1 diabetic patients.
        Diabet Med. 1991; 8: 49-58
        • Chugh S.S.
        • Jui J.
        • Gunson K.
        • et al.
        Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community.
        J Am Coll Cardiol. 2004; 44: 1268-1275
        • Reinier K.
        • Nichols G.A.
        • Huertas-Vazquez A.
        • et al.
        Distinctive clinical profile of blacks versus whites presenting with sudden cardiac arrest.
        Circulation. 2015; 132: 380-387
        • American Diabetes Association
        2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes — 2019.
        Diabetes Care. 2019; 42: S13-S28
        • Xu G.
        • Liu B.
        • Sun Y.
        • et al.
        Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study.
        BMJ. 2018; 362: k1497
        • Narayanan K.
        • Reinier K.
        • Uy-Evanado A.
        • et al.
        Frequency and determinants of implantable cardioverter defibrillator deployment among primary prevention candidates with subsequent sudden cardiac arrest in the community.
        Circulation. 2013; 128: 1733-1738
        • Teodorescu C.
        • Reinier K.
        • Dervan C.
        • et al.
        Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study.
        Circulation. 2010; 122: 2116-2122
        • Parry M.
        • Danielson K.
        • Brennenstuhl S.
        • Drennan I.R.
        • Morrison L.J.
        The association between diabetes status and survival following an out-of-hospital cardiac arrest: A retrospective cohort study.
        Resuscitation. 2017; 113: 21-26
        • Adabag S.
        • Huxley R.R.
        • Lopez F.L.
        • et al.
        Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study.
        Heart. 2015; 101: 215-221
        • Chugh S.S.
        Early identification of risk factors for sudden cardiac death.
        Nat Rev Cardiol. 2010; 7: 318-326
        • Suzuki T.
        • Agarwal S.K.
        • Deo R.
        • et al.
        Kidney function and sudden cardiac death in the community: the Atherosclerosis Risk in Communities (ARIC) study.
        Am Heart J. 2016; 180: 46-53
        • Aro A.L.
        • Rusinaru C.
        • Uy-Evanado A.
        • et al.
        Syncope and risk of sudden cardiac arrest in coronary artery disease.
        Int J Cardiol. 2017; 231: 26-30
        • Bergner D.W.
        • Goldberger J.J.
        Diabetes mellitus and sudden cardiac death: what are the data?.
        Cardiol J. 2010; 17: 117-129
        • Chugh S.S.
        • Reinier K.
        • Singh T.
        • et al.
        Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study.
        Circulation. 2009; 119: 663-670
        • Yang Y.
        • Aro A.L.
        • Nair S.G.
        • et al.
        Novel measure of autonomic remodeling associated with sudden cardiac arrest in diabetes.
        Heart Rhythm. 2017; 14: 1449-1455
        • Hsieh A.
        • Twigg S.M.
        The enigma of the dead-in-bed syndrome: challenges in predicting and preventing this devastating complication of type 1 diabetes.
        J Diabetes Complications. 2014; 28: 585-587
        • Tsujimoto T.
        • Yamamoto-Honda R.
        • Kajio H.
        • et al.
        High risk of abnormal QT prolongation in the early morning in diabetic and non-diabetic patients with severe hypoglycemia.
        Ann Med. 2015; 47: 238-244
        • Ramireddy A.
        • Chugh H.S.
        • Reinier K.
        • et al.
        Sudden cardiac death during nighttime hours.
        Heart Rhythm. 2021; 18: 778-784