Cardio-cerebrovascular Outcomes in MODY, Type 1 Diabetes, and Type 2 Diabetes: A Prospective Cohort Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 108; no. 11; pp. 2970 - 2980
• Main Authors: Wu, Hui-Xuan, Chu, Tian-Yao, Iqbal, Junaid, Jiang, Hong-Li, Li, Long, Wu, Yan-Xuan, Zhou, Hou-De
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01-11-2023
• Subjects: Analysis; Angina; Angina pectoris; Biobanks; Cerebral infarction; China; Congestive heart failure; Diabetes; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Genetic analysis; Health aspects; Heart attack; Mortality; Myocardial infarction; Type 1 diabetes; Type 2 diabetes; Unstable angina; China; United Kingdom > UK; mortality; type 1 diabetes; MODY; type 2 diabetes; MACE; Type 2 diabetes; Type 1 diabetes; Mortality
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/clinem/dgad233

Abstract
Context
Cardio-cerebrovascular events are severe complications of diabetes.
Objective
We aim to compare the incident risk of cardio-cerebrovascular events in maturity onset diabetes of the young (MODY), type 1 diabetes, and type 2 diabetes.
Methods
Type 1 diabetes, type 2 diabetes, and MODY were diagnosed by whole exome sequencing. The primary endpoint was the occurrence of the first major adverse cardiovascular event (MACE), including acute myocardial infarction, heart failure, stroke, unstable angina pectoris, and cardio-cerebrovascular-related mortality. Cox proportional hazards models were applied and adjusted to calculate hazard ratios (HRs) and 95% CIs for the incident risk of MACE in type 1 diabetes, type 2 diabetes, MODY, and MODY subgroups compared with people without diabetes (control group).
Results
Type 1 diabetes, type 2 diabetes, and MODY accounted for 2.7%, 68.1%, and 11.4% of 26 198 participants with diabetes from UK Biobank. During a median follow-up of 13 years, 1028 MACEs occurred in the control group, contrasting with 70 events in patients with type 1 diabetes (HR 2.15, 95% CI 1.69-2.74, P < .05), 5020 events in patients with type 2 diabetes (HR 7.02, 95% CI 6.56-7.51, P < .05), and 717 events in MODY (HR 5.79, 95% CI 5.26-6.37, P < .05). The hazard of MACE in HNF1B-MODY was highest among MODY subgroups (HR 11.00, 95% CI 5.47-22.00, P = 1.5 × 10–11).
Conclusion
MODY diagnosed by genetic analysis represents higher prevalence than the clinical diagnosis in UK Biobank. The risk of incident cardio-cerebrovascular events in MODY ranks between type 1 diabetes and type 2 diabetes.