Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes

Abstract

IntroductionType 2 diabetes (T2D) is a common condition that, if left untreated or poorly managed, can lead to adverse microvascular and macrovascular complications. We estimated the prevalence and incidence of microvascular and macrovascular complications among patients newly diagnosed with T2D within a US integrated healthcare system.Research design and methodsWe conducted a retrospective cohort study among patients newly diagnosed with T2D between 2003 and 2014. We evaluated 13 complications, including chronic kidney disease (CKD), cardiovascular disease (CVD), and all-cause mortality through 2018. Multivariable Cox proportional hazards models were used to study factors associated with complications.ResultsWe identified 135 199 patients with incident T2D. The mean age was 58 years, and 48% were women. The prevalence of CKD was the highest of the complications at the time of T2D diagnosis (prevalence=12.3%, 95% CI 12.2% to 12.5%), while the prevalence of CVD was among the lowest at 3.3% (95% CI 3.2% to 3.3%). The median time to incidence of a T2D complication ranged from 3.0 to 5.2 years. High incidence rates (95% CI) of T2D complications included peripheral neuropathy (26.9, 95% CI 26.5 to 27.3 per 1000 person-years (PY)), CKD (21.2, 95% CI 20.9 to 21.6 per 1000 PY), and CVD (11.9, 95% CI 11.7 to 12.2 per 1000 PY). The trend of 5-year incidence rates of T2D complications by diagnosis year decreased over time (p value<0.001). Older age, non-Hispanic white race/ethnicity, sex, higher A1C, smoking, and hypertension were associated with increased CKD and CVD incidence.ConclusionThough incidence rates of T2D complications were lower in more recent years (2010–2014), a significant proportion of patients had complications at T2D diagnosis. Earlier preventive therapies as well as managing modifiable factors may help delay the development and progression of T2D complications.

Manifestation of Heart Failure and Chronic Kidney Disease are Associated with Increased Mortality Risk in Early Stages of Type 2 Diabetes Mellitus: Analysis of a Japanese Real-World Hospital Claims Database

“…It is widely accepted that CKD is a common complication of T2DM, and diabetes is the most common cause of CKD and end-stage renal disease [9]. Furthermore, CKD often develops in the early stages of T2DM [10][11][12][13]. Our data provide further evidence that CKD is a common, early comorbidity in patients with T2DM, and was more frequent in this An epidemiological link between diabetes and development of HF is evident even in the absence of ASCVD.…”

Educational Differences in Diabetes Mortality among Hispanics in the United States: An Epidemiological Analysis of Vital Statistics Data (1989–2018)

“…There is evidence to suggest that various cardiovascular complications may already be present at the initial diagnosis of type 2 diabetes [ 45 ]. In such cases, these individuals would likely benefit from early preventive therapies, including lifestyle therapies, that may not be available to those with low education, such as minority groups in the USA.…”

Diabetes and restenosis

“…Macrovascular complications mediated by atherosclerosis prove to be the leading cause of premature death in this population [22][23][24]. Nonetheless, microvascular complications can often present clinically in the form of diabetic nephropathy, neuropathy, and retinopathy [25][26][27][28][29][30][31][32]. A major contributor to both types of vasculopathy is endothelial damage, mediated in part by the actual glycemic control of each patient [33].…”