The Impact on Life Expectancy of Delaying or Avoiding Type 1 Diabetes Using the Metabo-Reno-Cardiovascular Disease Model
Author(s)
Mafalda Ramos, MSc1, Luís de Souto Martins, PhD1, Mark Lamotte, MD2.
1Th(is)²Modeling, Asse, Belgium, 2Cardiologist - Health economic specialist, Th(is)²Modeling, Asse, Belgium.
1Th(is)²Modeling, Asse, Belgium, 2Cardiologist - Health economic specialist, Th(is)²Modeling, Asse, Belgium.
OBJECTIVES: Delaying the onset or avoiding the occurrence of diabetes leads to a longer life expectancy and fewer co-morbidities. The Metabo-Reno-Cardiovascular-Disease-Model (MRCDM) allows to follow an individual pathway from normal glucose tolerance (NGT) to type-1 (T1D) or 2 (T2D) diabetes. To use the MRCDM to predict the life expectancy (LE) in adolescents with NGT and that will develop T1D after 1 and 10 years, or that do not develop T1D but are at risk to develop T2D later in life.
METHODS: Individuals had a starting age of 15 years and BMI 25kg/m². Lipid levels, blood pressure, uACR and eGFR were within the normal range and 15% were smokers. Lipids and blood pressure were kept constant over time. Natural progressions of BMI (increase of 0.1kg/m² per year), eGFR and uACR were employed. HbA1c of 7.5% was assumed at T1D onset. After T2D onset, HbA1c progressed over time following the UKPDS90 equation. Analyses were run using different CVD risk equations depending on the glycemic status: NGT: Framingham and QRisk3; T1D: Framingham, QRisk3, EDIC, Pittsburgh, Scottish Registry Linkage (SRL) and SweNDR; T2D: Framingham, QRisk3, UKPDS and SweNDR. CVD, microvascular disease, end-stage kidney disease, and other weight-related complications were predicted. Case fatality approach was applied using UK non-specific mortality data.
RESULTS: Predicted LE in the cohort developing T1D after 1 year varied between 63.96 (Pittsburgh) and 69.33 (Framingham) years. Delaying onset of T1D to 10 years extended LE by 0.46 (SRL) to 2.38 (EDIC) years. Avoiding T1D resulted in a life expectancy ranging from 76.35 (Framingham) to 77.24 (SweNDR) years; hence 7-12 years more than those that develop T1D.
CONCLUSIONS: The set of risk equations tested predict similar LEs except Pittsburgh that predicts lower. However, the choice of the equation will drive the health economic outcomes between interventions because incremental life-years will differ.
METHODS: Individuals had a starting age of 15 years and BMI 25kg/m². Lipid levels, blood pressure, uACR and eGFR were within the normal range and 15% were smokers. Lipids and blood pressure were kept constant over time. Natural progressions of BMI (increase of 0.1kg/m² per year), eGFR and uACR were employed. HbA1c of 7.5% was assumed at T1D onset. After T2D onset, HbA1c progressed over time following the UKPDS90 equation. Analyses were run using different CVD risk equations depending on the glycemic status: NGT: Framingham and QRisk3; T1D: Framingham, QRisk3, EDIC, Pittsburgh, Scottish Registry Linkage (SRL) and SweNDR; T2D: Framingham, QRisk3, UKPDS and SweNDR. CVD, microvascular disease, end-stage kidney disease, and other weight-related complications were predicted. Case fatality approach was applied using UK non-specific mortality data.
RESULTS: Predicted LE in the cohort developing T1D after 1 year varied between 63.96 (Pittsburgh) and 69.33 (Framingham) years. Delaying onset of T1D to 10 years extended LE by 0.46 (SRL) to 2.38 (EDIC) years. Avoiding T1D resulted in a life expectancy ranging from 76.35 (Framingham) to 77.24 (SweNDR) years; hence 7-12 years more than those that develop T1D.
CONCLUSIONS: The set of risk equations tested predict similar LEs except Pittsburgh that predicts lower. However, the choice of the equation will drive the health economic outcomes between interventions because incremental life-years will differ.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO243
Topic
Clinical Outcomes, Economic Evaluation, Methodological & Statistical Research
Topic Subcategory
Clinical Outcomes Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Urinary/Kidney Disorders