title: Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes.
abstract: OBJECTIVE
  Data are inconsistent regarding the associations between age, age at diagnosis of diabetes, diabetes duration and subsequent vascular complications.
  
  
  METHODS
  The associations between age (or age at diagnosis), diabetes duration and major macrovascular events, all-cause death and major microvascular events were examined in 11,140 patients with type 2 diabetes randomly allocated to intensive or standard glucose control in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Rates were calculated by 5 year baseline age (or age at diagnosis) and diabetes duration strata. Risks were estimated using Cox models adjusted for treatment assignment and HbA1c.
  
  
  RESULTS
  The mean age (±SD) was 65.8 ± 6.4 years, age at diagnosis was 57.8 ± 8.7 years and diabetes duration was 7.9 ± 6.4 years. Diabetes duration was associated with the risk of macrovascular events (HR 1.13 [95% CI 1.08, 1.17]), microvascular events (1.28 [1.23, 1.33]) and death (1.15 [1.10, 1.20]) whereas age (or age at diagnosis) was only associated with the risk of macrovascular events (1.33 [1.27, 1.39]) and death (1.56 [1.48, 1.64]). No interaction was observed between diabetes duration, age and the risk of macrovascular events or death (both p > 0.4). However, an interaction was observed between diabetes duration, age and the risk of microvascular events (p = 0.002), such that the effects of increasing diabetes duration were greatest at younger rather than older age.
  
  
  CONCLUSIONS
  In patients with type 2 diabetes, age or age at diagnosis and diabetes duration are independently associated with macrovascular events and death whereas only diabetes duration is independently associated with microvascular events and this effect is greater in the youngest patients.
authors.affiliation: The George Institute for Global Health, University of Sydney, PO Box M201, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia, szoungas@georgeinstitute.org.au.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cooper
authors.forename: Pavel
authors.initials: P
authors.lastname: Hamet
authors.forename: Stephen
authors.initials: S
authors.lastname: Harrap
authors.forename: Simon
authors.initials: S
authors.lastname: Heller
authors.forename: Michel
authors.initials: M
authors.lastname: Marre
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents