Joint and distinct risk factors associated with micro- and macrovascular complications in a cohort of type 2 diabetic patients cared through disease management.
We analysed the risk factors associated with diabetic complications in the cohort of patients assisted by a type 2 diabetes mellitus (T2DM) shared-care program. We analysed registry data from 16,136 T2DM patients. Of them, 4,781 had microangiopathy, 3,469 CV events. They were 70.5 ± 17.1 years old, 50% were male, disease duration 13.3 ± 7.8 years, BMI 28.7 ± 4.9 kg/m², HbA1c 7.08 ± 1.23%, FBG 134.7 ± 35.7 mg/dl, 2hPPBG 163.9 ± 47.8 mg/dl, 12.5% smokers. Cholesterol 202.5 ± 37.6 mg/dl, HDL 51.4 ± 20.4 mg/dl, LDL 126.5 ± 36.0 mg/dl, triglyceride 146.2 ± 72.4 mg/dl, SBP 137.8 ± 14.2 mmHg, DBP 80.7 ± 10.8 mmHg, 10-year CV risk score 13.7 ± 9.1; 70.4% had no microangiopathy-i.e. renal, retinal, peripheral nerve disease-and 78.5% of patients had no CV events. Age-adjusted risk factors associated with diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. FBG and SBP were associated with microangiopathy, whereas smoking with cardiovascular events. Optimal targets were reached in: FBG 17%, 2hPPBG 8%, HbA1c 21%, cholesterol 17%, HDL 8%, LDL 5%, triglyceride 20%, SBP 13%, DBP 30%. Drug profiles showed 13% using metformin, 28% sulphonilureas, 26% bitherapy, 4% insulin; 12% statins, 16% anti-platelets, 27% anti-hypertensives, 2% anti-coagulants. T2DM patients showed an acceptable CV risk profile. Joint risk factors for diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. Distinct risk factors were FBG and SBP for micro- and smoking for macrovascular disease. A targeted-to-treat approach needs more attention in the care of T2DM patients.
Ciardullo
Anna V
AV
Modena shared-care Diabetes Program, Local Health Unit, Azienda USL, Modena, Italy. a.ciardullo@ausl.mo.it
Daghio
M Monica
MM
Bevini
Massimo
M
Feltri
Gaetano
G
Novi
Doriano
D
Fattori
Giuseppe
G
Borsari
Silvana
S
Donato
Carlo Di
CD
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods / Q000706:statistics & numerical data