title: Treatment-dependent and treatment-independent risk factors associated with the risk of diabetes-related events: a retrospective analysis based on 229,042 patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  The aim of this study was to analyse which factors predict the real-world macro-/microvascular event, hospitalisation and death risk in patients with type 2 diabetes mellitus. Furthermore, we aimed to investigate whether there exists both an under- and over-treatment risk of these patients.
  
  
  METHODS
  We used a German claims/clinical data set covering the years 2010-12. Diabetes-related events were defined as (1) macro-, (2) microvascular events leading to inpatient hospitalisation, (3) other hospitalisations with type 2 diabetes mellitus as main diagnosis, (4) all-cause death and (5) a composite outcome including all event categories 1-4. Factors associated with event risk were analysed by a Kaplan-Meier curve analysis and by multivariable Cox regression models.
  
  
  RESULTS
  229,042 patients with type 2 diabetes mellitus (mean age 70.2 years; mean CCI 6.03) were included. Among factors that increased the event risk were patients' age, male gender, the adapted Charlson Comorbidity Index, the adapted Diabetes Complication Severity Index, previous events, and number of prescribed chronic medications. For systolic blood pressure/HbA1C, a double-J/U-curve pattern was detected: HbA1C of 6-6.5% (42-48 mmol/mol) and systolic blood pressure of 130-140 mmHg (17.3-18.7kPa) were associated with the lowest event risk, values below/above that range were associated with higher risk. However, this pattern was mainly driven by the death risk and was much less clearly observed for the macrovascular/microvascular/hospitalization risk and for young/less comorbid patients.
  
  
  CONCLUSIONS
  Both blood pressure and HbA1C seem to be very important treatment targets, especially in comorbid old patients. It is of particular clinical importance that both over- and under-treatment pose a threat to patients with type 2 diabetes mellitus.
authors: IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany. thomas.wilke@ipam-wismar.de.
authors: Thomas
authors: T
authors: Wilke
authors: IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany. sabrina.mueller@ipam-wismar.de.
authors: Sabrina
authors: S
authors: Mueller
authors: IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany. antje.groth@ipam-wismar.de.
authors: Antje
authors: A
authors: Groth
authors: AOK PLUS, Sternplatz 7, 01067, Dresden, Germany. andreas.fuchs@plus.aok.de.
authors: Andreas
authors: A
authors: Fuchs
authors: Novo Nordisk Pharma GmbH, Brucknerstraße 1, 55127, Mainz, Germany. lsiz@novonordisk.com.
authors: Lisa
authors: L
authors: Seitz
authors: Novo Nordisk Pharma GmbH, Brucknerstraße 1, 55127, Mainz, Germany. jkie@novonordisk.com.
authors: Joachim
authors: J
authors: Kienhöfer
authors: AOK PLUS, Sternplatz 7, 01067, Dresden, Germany. ulfdr.maywald@plus.aok.de.
authors: Ulf
authors: U
authors: Maywald
authors: Diabetes Centre Erfurt/Bad Berka, Thälmannstraße 25, 99085, Erfurt, Germany. r.lundershausen@gmx.de.
authors: Rainer
authors: R
authors: Lundershausen
authors: Clinical Pharmacology, Mannheim/Center for Gerontopharmacology, Medical Faculty Mannheim, University of Heidelberg, Maybachstr. 14, 68169, Mannheim, Germany. martin.wehling@medma.uni-heidelberg.de.
authors: Martin
authors: M
authors: Wehling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000639:trends; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents
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