Incidence of complications and mortality in a type 2 diabetes patient cohort study followed up from diagnosis in a primary healthcare centre

Abstract

Summary Aims: To determine the microvascular and macrovascular complications and mortality incidence rates and to identify the related factors in patients recently diagnosed with type 2 diabetes between 1991 and 2000 and followed until 2006. Methods: Retrospective longitudinal study in a primary healthcare center. Patients without any measure of glycaemia in the 3 years previous to diabetes diagnosis were excluded. Annual incidence rates for microvascular and macrovascular complications and mortality were estimated. Analysis of KaplanMeier survival curves and Cox proportional risk models by gender were done. Results: Of 469 patients [mean age: 60.4 (SD 10.7) years, 53.9% women], 80 died principally of tumoral (38.7%) and cardiovascular (30%) causes. The mean follow‐up period was 8.81 years. (SD 3.21). The complication rates per 1000 patients/year (95% CI) were: microvascular complications 29.11 (22.97–36.38), macrovascular complications 24.10 (19.05–30.08) and mortality 19.23 (15.25–23.93), all of those being significantly greater in males except for cerebrovascular disease. Complications and mortality were associated with age, HbA1c, HDL‐cholesterol, blood pressure and smoking with a different significance for each gender. HbA1c was related to microvascular complications in both sexes and to macrovascular complications only in women. Conclusion: The annual rates for death and complications in a Mediterranean type 2 diabetic patient cohort followed from diagnosis were lower than those published in Anglo‐Saxon countries. Males showed higher death and complication rates except in terms of cerebrovascular disease. Predictors of complication and death were different depending on gender. In terms of mortality, unlike in other studies, only one‐third of the deaths were for cardiovascular causes.

An alternative approach to modelling HbA1c trajectories in patients with type 2 diabetes mellitus

“…Despite the heterogeneous nature of HbA1c progression in T2DM, trajectories tended to vary according to baseline HbA1c, treatment group and patient age. The systematic literature review additionally identified a small number of studies that examined ethnic differences and gender differences in HbA1c progression in T2DM patients.…”

Cardiovascular event rates and healthcare resource utilisation among high-risk adults with type 2 diabetes mellitus in a large population-based study

“…Although most previous studies have not examined high‐risk subgroups of patients with type 2 diabetes, the present study findings confirm the higher incidence of CV events among individuals with type 2 diabetes that have been reported in previous studies . A 10‐year (1994–2004) analysis of a 5% sample of Medicare claims data found that patients with type 2 diabetes mellitus had higher incidence rates of congestive heart failure (CHF), MI and stroke than persons with no diagnosis of type 2 diabetes .…”

Clinical characteristics of type 2 diabetic patients on basal insulin therapy with adequate fasting glucose control who do not achieve HbA1c targets

“…With regard to the cardiovascular risk factor profile, mean BP and LDL‐C values were better than those published in previous Spanish studies, but smoking habits were similar . Controlling these cardiovascular risk factors, especially smoking habits, should be prioritized in diabetic individuals because of their effects on micro‐ and macrovascular complications and mortality . Another important finding of the present study is the high number of patients with a BMI ≥30 kg/m 2 in the subgroup of T2DM patients treated with basal insulin and normal FPG, particularly in the 56–65 year age group (52.9%), a figure that is higher than those found in previous studies and that can also contribute to inadequate control of HbA1c in these patients.…”