A competing risk analysis of sequential complication development in Asian type 2 diabetes mellitus patients.
This retrospective cohort study investigated the progression risk of sequential complication in Asian type 2 diabetes (T2D) patients using the Taiwan Pay-for-Performance Diabetes Registry and claim data from November 2003 to February 2009. 226,310 adult T2D patients without complication were followed from diagnosis to complications, including myocardial infarction (MI), other ischemic heart disease (IHD), congestive heart failure (CHF), stroke, chronic kidney disease (CKD), retinopathy, amputation, death or to the end of study. Cumulative incidences (CIs) of first and second complications were analyzed in 30 and 4 years using the cumulative incidence competing risk method. IHD (29.8%), CKD (24.5%) and stroke (16.0%) are the most common first complications. The further development of T2D complications depends on a patient's existing complication profiles. Patients who initially developed cardiovascular complications had a higher risk (9.2% to 24.4%) of developing IHD or CKD, respectively. All-cause mortality was the most likely consequence for patients with a prior MI (12.0%), so as stroke in patients with a prior MI (10.8%) or IHD (8.9%). Patients with CKD had higher risk of developing IHD (16.3%), stroke (8.9%) and all-cause mortality (8.7%) than end-stage renal disease (4.0%). Following an amputation, patients had a considerable risk of all-cause mortality (42.1%).
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Li-Jen
LJ
Cheng
Department of Mathematical Sciences, National Chengchi University, Taipei, Taiwan.
Jeng-Huei
JH
Chen
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|National Applied Research Laboratories, Instrument Technology Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
Ming-Yen
MY
Lin
Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK.|Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Li-Chia
LC
Chen
Waikato Clinical School, The University of Auckland, Hamilton, New Zealand.
Chun-Huan
CH
Lao
Department of Mathematical Sciences, National Chengchi University, Taipei, Taiwan.
Hsing
H
Luh
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.|Faulty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Institute of Population Sciences, National Health Research Institute, Miaoli, Taiwan.
Shang-Jyh
SJ
Hwang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D048909:Diabetes Complications / Q000209:etiology / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology; D017202:Myocardial Ischemia / Q000209:etiology / Q000473:pathology; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000473:pathology; D013624:Taiwan; D055815:Young Adult