Analysis of the Effect of Nine Consecutive Years’ Intensive Management and Number of Times Achieving the Target Control on Endpoint Events in T2DM Patients in Sanlitun Community Health Service Center in Beijing

Abstract

Objective. To investigate the effect of intensive management and achieving the target control more than 3 times on endpoint events during 9 consecutive years’ annual assessment in type 2 diabetes (T2DM) patients in the Sanlitun Community Health Service Center in Beijing, including blood glucose, blood pressure, lipids profiles, and the joint target control. Methods. In Beijing Community Diabetes Study (BCDS), 224 patients with T2DM from the Sanlitun Community Health Service Center were enrolled in 2008. All patients were randomly assigned to the intensive management group (n = 113) and the standard management group (n = 111). All patients were followed up for nine consecutive years from January 2009 to December 2017. Systolic blood pressure (SBP), diastolic blood pressure (DBP), glycosylated hemoglobin (HbA1c), and low-density lipoprotein cholesterol (LDL-C) were detected as the main indexes, and the endpoint events were also carried out at the same time. The endpoint events were analyzed by using survival analysis (Kaplan–Meier method) based on management grouping and whether achieving the target control more than 3 times or not. Results. During the nine-year follow-up, the abscission number was 35 (14.29%), among which 14 (12.39%) was in the intensive management group and 21 (18.92%) was in the standard management group. The incidence of diabetic retinopathy (6 cases, 5.41%) and diabetic nephropathy (13 cases, 11.71%) in the standard management group was significantly higher than that in the intensive management group (1 case, 0.88%; 5 cases, 4.42%), respectively (P<0.05). However, there were no significant differences on the other endpoint events between the two groups (P>0.05). All-cause death was 23 cases, in which patients who achieved the target control (HbA1c and LDL-C) and the joint target control more than 3 times were significantly lower than that of less than 3 times (P<0.05). As far as death caused by cardiovascular events, cerebrovascular events, and newly onset coronary heart disease are concerned, there were no significant differences on the aforementioned endpoint events between the two groups based on target control more than 3 times or not (P>0.05). There were less incidence of new onset cerebrovascular events, stenosis or occlusion of large arteries, and diabetic microvascular complications in patients who achieved target control (HbA1c and LDL-C) and the joint target control more than 3 times than those with target control less than 3 times (P<0.05). Conclusions. The intensive management can effectively reduce the occurrence of microvascular complications. The incidence of all-cause death and the other endpoint events decreased in T2DM patients who achieved the joint target control more than 3 times during the nine-year management, which improved survival time and life quality. This trial is registered with ChiCTR-TRC-13003978 and ChiCTR-OOC-15006090.

The effects of acarbose therapy on reductions of myocardial infarction and all-cause death in T2DM during 10-year multifactorial interventions (The Beijing Community Diabetes Study 24)

“…There is growing evidence that joint target control plays an important role in the development of diabetes complications 27 , 28 . What's important is this article differs from other research is the 10 years’ observation, which explained the relationship between acarbose therapy and myocardial infarction.…”