Glycemic control and the risk of microvascular complications in people with diabetes mellitus

Abstract

Dear Editor-in-Chief, Anjana et al. reported in a recent study that, over a 9-year follow-up period, diabetic subjects with irregular or infrequent doctor visits had almost double the risk of glycemic burden, retinopathy and nephropathy compared to those with regular follow-up. However, the authors observed a nonsignificant effect of a better diabetes management on the occurrence of coronary heart disease (CAD) and peripheral arterial diseases (PAD) [1]. This result was interesting, opposite to what we know, and the authors were not able to discuss this outcome successfully in their paper. However, upon reading the paper in detail, we needed to take attention of the readers to several methodological issues regarding the study.Several studies were previously published from the cohort which served as the patient source for the present work, and CAD and PAD data had already been reported separately (Article references 19 and 20). In the original trial for CAD frequency, presence of CAD was assessed in 84 % of subjects totally, by a resting 12-lead electrocardiogram using Minnesota coding by a single observer, or with a past self-report history of documented myocardial infarction [2]. Data related to PAD prevalence was also obtained from another study on the same cohort, in which Doppler ankle-brachial index measurement (ABI) was restricted to 50 % of the participants due to logistical reasons (authors' statement), reaching a total of 631 participants with a definite testing for PAD through ABI measurement [3]. Thus, because the definition of CAD patients was not robust in the first trial, and because only one half of the participants had evidence-based PAD workup in the second report, the present study with a so-called extended follow-up was most probably subject to incorrect classifications. Therefore, in such case, follow-up and outcome analyses may easily become inconclusive. Particular attention was also required for ABI testing in people with diabetes [4] when using to screen for PAD which is indeed more common in these patients [5].Moreover, Table 2 of the study reported CAD and PAD data as if all participants had both initial and outcome detections for CAD or PAD; however, missing data of 16 % for CAD and 50 % for PAD at initial assessment should not have been ignored at the final analyses.

Retinal Microcirculation in Predicting Diabetic Nephropathy in Type 2 Diabetic Patients without Retinopathy

“…According to recent clinical findings, despite the continuous advancement of clinical protocols, the risk of developing end-stage renal disease as a result of DN has not changed significantly over the past 20 years [7,8]. Further, these findings suggest that the pathophysiological mechanisms leading to DN are probably not yet fully understood, and there remains a need to identify patients predisposed to developing this complication (at stages preceding the appearance of microalbuminuria).…”

Association between multimorbidity and mean platelet volume in diabetic patients with acute myocardial infarction

“…MPV is a marker of platelet size and activity and has been linked to poor prognosis following St elevation myocardial infarction (STEMI) [ 20 , 21 ]. In this sense, regular glycemic control could result in lowering disease burden, especially when DM itself and glycemia have a great impact on platelet function [ 22 – 24 ].…”

Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study : Reply to Dr. Tasci et al.

“…We wish to thank Tasci and colleagues for their interest in our paper published in Acta Diabetologica [1,2]. We would like to emphasize that this was not a prospective cohort study but a retrospective study based on electronic medical records.…”