Inpatient screening for albuminuria and retinopathy to predict long-term mortality in type 2 diabetic patients: a retrospective cohort study

Abstract

BackgroundThere is a high hospitalization rate for diabetic patients. Since retinopathy and albuminuria are both important manifestations of microvascular disease in diabetes, our aim was to investigate the effect of retinopathy and albuminuria on long-term mortality in type 2 diabetic inpatients through this observational cohort study.MethodsType 2 diabetic inpatients given a primary diagnosis of poor glucose control were consecutively enrolled during their hospitalization periods. Clinical information was collected through review of each patient’s medical records, and mortality data were obtained from the national registry in Taiwan.ResultsA total of 761 type 2 diabetic inpatients were enrolled in the study with a median follow-up period of 6.6 years (interquartile range, 4.0–9.6 years). Patients in the Albuminuria(−)/Retinopathy(+), Albuminuria(+)/Retinopathy(−) and Albuminuria(+)/Retinopathy(+) groups had significantly higher risks of all-cause mortality and cardiovascular mortality than those in the Albuminuria(−)/Retinopathy(−) group. However, among patients with albuminuria, there was no significant difference in cumulative mortality between those with and without retinopathy (P = 0.821). A decrease in the estimated glomerular filtration rate (eGFR), but not retinopathy, was an independent predictor of all-cause mortality (95% CI 0.647‒0.893; P < 0.001) and cardiovascular mortality (95% CI 0.564‒0.921; P = 0.009) in type 2 diabetic inpatients with albuminuria.ConclusionsAlbuminuria in type 2 diabetic inpatients is a strong predictor of long-term mortality after discharge from the hospital. Retinopathy is an independent predictor of mortality in type 2 diabetic inpatients without albuminuria but not in those with albuminuria. A low eGFR is a better predictor of mortality than retinopathy in type 2 diabetic inpatients with albuminuria.

<p>Influence of Diabetic Retinopathy on the Relationship Between Body Mass Index and Mortality in Patients with Poorly Controlled Type 2 Diabetes</p>

“…In Asians with type 2 diabetes, Sabanayagam et al 35 reported that DR was associated with 1.54-fold increased risk of mortality, and this result is consistent with our own previous study in which we found that DR was associated with 1.58-fold increased risk of mortality in patients without albuminuria. 36 The role of adiposity is ambiguous in patients with DR. 37 DR has been shown to be associated with obesity. 38,39 On the contrary, several studies have shown that obesity has the potential to diminish the severity of DR in Asians with type 2 diabetes.…”

Use of sodium‐glucose co‐transporter‐2 inhibitors in Asian patients with type 2 diabetes and kidney disease: An Asian perspective and expert recommendations

“…The corresponding figures for neuropathy were 20.1% versus 8.7% ( P < .001) 45 . Furthermore, an analysis of predictors of long‐term outcomes showed that low eGFR, but not retinopathy, was an independent predictor of all‐cause mortality and CV mortality in patients with T2D and albuminuria 46 …”

Effects of retinopathy and chronic kidney disease on long-term mortality in type 2 diabetic inpatients with normal urinary albumin or protein: a retrospective cohort study

“…Although there is a high prevalence of DR in type 2 diabetic patients with albuminuria, 19 the concordance between DR and CKD was lower in patients with normoalbuminuria than in those with albuminuria. 44 45 In the present study, we found that the prevalence of retinopathy was not significantly different between patients with and without CKD.…”