1664-P: Does “Healthy Diabetes” Exist? Long-Term Survival in Diabetes Heart Study Participants

The Diabetes Heart Study, initiated in 1997, includes examination and follow-up of 1221 European Americans, 85% with type 2 diabetes (T2D). Baseline examination included extensive medical history, laboratory measures, and CT-imaging for coronary artery calcium (CAC). Through 2016, 451 participants had died. CVD-attributable deaths occurred over an age range of 39-93 years. In high-risk participants with T2D and CAC>1000, 52% died after mean 14.9 year follow-up; however, many are still alive. 64% of surviving T2D participants lived with diabetes for >20 years and 16.4% (31 male, 46 female) >30 years. Among deceased individuals, the average duration of diabetes was 20.8 years. Comparing long-term T2D-survivors to deceased, difference in CAC, a powerful predictor of mortality, was not significant (P=0.85) with mean CAC in survivors (male=4730, female=1147) and deceased (male=4085, female=1220). Conventional clinical measures did not differ significantly (glucose, HbA1c, BP; P>0.05) or were modestly different (cholesterol P=0.033; LDL P=0.035). There was a difference in the use of statins at baseline: 53% in survivors, 41% in deceased (P=0.05) and C-reactive protein (P=0.04). The strongest individual trait difference was in duration of T2D at baseline (P<0.0001) but mean T2D-duration at baseline in survivors was 20 vs. 12.5 years in deceased). Thus, a significant number of individuals with T2D have long-term survival even in the presence of a significant burden of subclinical CVD, but conventional clinical measures provide little Insight. Research into the characteristics of long-term survivors with T2D may prove beneficial to all T2D patients.