{rfName}

Indexed in

License and use

Citations

44

Altmetrics

Grant support

A.J.A received a research grant from Associacio Catalana de Diabetis, Ajut per a la recerca en diabetis modalitat clinica 2018.

Analysis of institutional authors

Giménez MAuthorBoswell LAuthorViñals CAuthorBlanco JAuthorVinagre IAuthorEsmatjes EAuthorConget IAuthorAmor AjCorresponding Author

Share

Publications
>
Article

Use of the Steno T1 Risk Engine Identifies Preclinical Atherosclerosis Better Than Use of ESC/EASD-2019 in Adult Subjects With Type 1 Diabetes at High Risk

Publicated to:Diabetes Care. 45 (10): 2412-2421 - 2022-10-01 45(10), DOI: 10.2337/dc22-0118

Authors: Seres-Noriega, Tonet; Gimenez, Marga; Perea, Veronica; Boswell, Laura; Vinals, Clara; Blanco, Jesus; Vinagre, Irene; Pane, Adriana; Esmatjes, Enric; Conget, Ignacio; Amor, Antonio J

Affiliations

Althaia Univ Hlth Network, Endocrinol & Nutr Dept, Manresa, Spain - Author
Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. - Author
Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain. - Author
Endocrinology and Nutrition Department, Althaia University Health Network, Manresa, Spain. - Author
Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain. - Author
Hosp Clin Barcelona, Endocrinol & Nutr Dept, Diabet Unit, Barcelona, Spain - Author
Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Endocrinol & Nutr Dept, Diabet Unit, Barcelona, Spain - Author
Hosp Univ Mutua Terrassa, Endocrinol & Nutr Dept, Terrassa, Spain - Author
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Diabet Enfermedades, Madrid, Spain - Author
See more

Abstract

To evaluate the concordance between the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD (ESC/EASD-2019) and the Steno T1 Risk Engine (Steno-Risk) cardiovascular risk scales for individuals with type 1 diabetes (T1D) without cardiovascular disease (CVD) and to analyze the relationships of their use with identification of preclinical atherosclerosis.We consecutively selected patients with T1D, without CVD, age ?40 years, with nephropathy, and/or with ?10 years of T1D evolution with another risk factor. The presence of plaque at different carotid segments was determined by ultrasonography. Cardiovascular risk was estimated in accord with ESC/EASD-2019 risk groups (moderate/high/very high) and the Steno-Risk (<10%, low; 10-20%, moderate; ?20%, high), as T1D-specific scores. In an exploratory analysis, we also evaluated the non-T1D-specific 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk (ACC/AHA-2013) pooled cohort equation for individuals between 40 and 79 years of age.We included 501 patients (53% men, mean age 48.8 years, median T1D duration 26.5 years, 41.3% harboring plaques). Concordance between T1D-specific scales was poor (? = 0.19). A stepped increase in the presence of plaques according to Steno-Risk category was seen (18.4%, 38.2%, and 64.1%, for low, moderate, and high risk, respectively; P for trend <0.001), with no differences according to ESC/EASD-2019 (P = 0.130). Steno-Risk identified individuals with plaques, unlike ESC/EASD-2019 (area under the curve [AUC] 0.691, P < 0.001, vs. AUC 0.538, P = 0.149). Finally, in polynomial regression models (with adjustment for lipid parameters and cardioprotective treatment), irrespective of the ESC/EASD-2019 category, high risk by Steno-Risk was directly associated with atherosclerosis (in moderate/high-risk by ESC/EASD-2019 odds ratio 2.91 [95% CI 1.27-6.72] and 4.94 [2.35-10.40] for the presence of plaque and two or more plaques). Similar results were obtained with discordant higher Steno-Risk versus ACC/AHA-2013 (P < 0.001).Among T1D patients undergoing primary prevention, use of Steno-Risk seems to result in better recognition of individuals with atherosclerosis in comparison with ESC/EASD-2019. Notwithstanding, carotid ultrasound could improve the categorization of cardiovascular risk.© 2022 by the American Diabetes Association.

Keywords

associationepidemiologymortalitynationwidepredictionAdultAgedArticleAtherosclerosisCardiovascular diseaseCardiovascular diseasesCardiovascular riskCardiovascular-diseaseClinical evaluationClinical featureCohort analysisComplicationControlled studyCross-sectional studyDiabetes mellitus, type 1Disease durationEchographyFemaleHigh risk patientHumanHumansHydroxymethylglutaryl coenzyme a reductase inhibitorHydroxymethylglutaryl-coa reductase inhibitorsInsulin dependent diabetes mellitusLipidLipidsMajor clinical studyMaleMiddle agedPractice guidelineRisk assessmentRisk factorRisk factors

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Diabetes Care due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 6/145, thus managing to position itself as a Q1 (Primer Cuartil), in the category Endocrinology & Metabolism. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.73. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.54 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 8.24 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-01, the following number of citations:

  • WoS: 17
  • Scopus: 16
  • Europe PMC: 6

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-01:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 36.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 36 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 15.7.
  • The number of mentions on the social network X (formerly Twitter): 23 (Altmetric).

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Amor Fernández, Antonio Jesús).

the author responsible for correspondence tasks has been Amor Fernández, Antonio Jesús.