Comorbidities and mortality in subgroups of adults with diabetes with up to 14 years follow-up: a prospective cohort study in Sweden
Authors' conclusion
Diabetes subgroups could inform on outcomes, as well as guide treatment and follow-up needed for newly diagnosed individuals with diabetes. SIRD stands out as a high-risk subgroup that is not identified by conventional glycaemia-based risk factors, but bears risk of early onset end-organ damage and would benefit from identification and treatment before the diagnosis of diabetes.
Study context
- Population
- Adults ≥18 years diagnosed with diabetes at regional care centres, enrolled within 1 year of diagnosis, without pancreatitis, All New Diabetics in Scania (ANDIS) cohort, Sweden25,590 screened
- Participants
- 19,076 adults
- Exposure
- Diabetes subgroups vs mild age-related (MARD)
- Severe insulin-resistant diabetes (SIRD)n = 3,348
- Outcome
- Long-term outcomes (prevalent and incident comorbidities) and mortality
Methodological detailsANDIS1 and ANDIS2 subsets, Fine-Gray proportional hazards regression, Enrolment Jan 1, 2008–Nov 3, 2016 (ANDIS1) and Nov 4, 2016–April 6, 2022 (ANDIS2)
- ANDIS1 and ANDIS2 subsets
- Fine-Gray proportional hazards regression
- Enrolment Jan 1, 2008–Nov 3, 2016 (ANDIS1) and Nov 4, 2016–April 6, 2022 (ANDIS2)
Main finding
As reported in the abstract
median follow-up 9.63 years (ANDIS1), 2.83 years (ANDIS2)
Each group vs MARDEstimate (95% CI)
SAIDage- and sex-adjusted
aHR, retinopathy 1.35(1.08–1.70)
SIDDage- and sex-adjusted
aHR, retinopathy 2.11(1.82–2.44)
SAID
aHR, neuropathy 2.58(1.87–3.56)
SIDD
aHR, neuropathy 2.13(1.69–2.70)
SIDD
aHR, kidney failure 2.94(1.69–5.09)
SIRD
aHR, kidney failure 3.41(2.06–5.64)
SIDD
aHR, MI 1.44(1.13–1.82)
SIRD
aHR, MI 1.51(1.22–1.87)
SIRD
aHR, AF 1.32(1.13–1.54)
MOD
aHR, AF 1.58(1.26–1.98)
SIDDonly increased in SIDD
aHR, stroke 1.32(1.07–1.62)
SIRD
aHR, steatotic liver disease 3.29(2.32–4.66)
SIRD
aHR, HF 1.55(1.34–1.79)
- Total mortality highest in severe insulin-deficient diabetes (SIDD), SIRD and MOD (aHRs), even after adjustment for established risk factors, largely driven by cardiovascular mortality
- 1.44-1.52
Observational data: associations, not effects.
Further findings
Prevalence at diagnosis in SIRD (highest)
- Hypertension
- 2336 [69.8%] of 3348
- Dyslipidaemia
- 1484 [44.4%]
- Kidney disease
- 366 [10.9%]
- Cardiovascular disease
- 1026 [30.6%]
- Steatotic liver disease
- 38 [1.1%]
Original publication
Comorbidities and mortality in subgroups of adults with diabetes with up to 14 years follow-up: a prospective cohort study in Sweden. Lancet Diabetes Endocrinol. Published 14 November 2025. doi:10.
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