title: Multiple complications among people with diabetes from Finland: an 18-year follow-up in 1994-2011.
abstract: OBJECTIVE
  In this study, we examined trends in severe diabetes-related complications (acute myocardial infarction, stroke, lower extremity amputation, and end-stage renal disease) and prevalence of multiple complications in a total population with diabetes in Finland during an 18-year period.
  
  
  METHODS
  The total population with diabetes aged 30 years or older in 1994-2011 was obtained from several Finnish health registers. Only the first episode of each end point was included in the analysis. We examined trends in the prevalence of these end points using age-standardization and changes in these end points were analyzed using repeated-measures Poisson regression models.
  
  
  RESULTS
  The prevalence of single comorbidities decreased during the study period, especially for acute myocardial infarction and stroke. The age-adjusted and diabetes duration-adjusted risk of having one of these end points decreased throughout the study period among persons with type 2 diabetes. Among women, the risk ratio was 0.71 (0.63 to 0.79) in 2006-2011 compared to 1994-1999, and among men, the figure was 0.72 (0.66 to 0.78). In type 1 diabetes, the risk of multiple serious complications increased. We further found increased mortality risk among persons with any of these complications irrespective of diabetes type.
  
  
  CONCLUSIONS
  Our results concerning the development of risk of complications suggest improvements in the management of diabetes. More attention needs to be paid to the prevention of complications among older persons and those with longer history of diabetes to prevent clustering of complications and to prevent the diabetes epidemic in the population to reduce the public health burden of diabetes.
authors.affiliation: Service System Research Unit , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Erja
authors.initials: E
authors.lastname: Forssas
authors.affiliation: Service System Research Unit , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Martti
authors.initials: M
authors.lastname: Arffman
authors.affiliation: Service System Research Unit , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Manderbacka
authors.affiliation: Service System Research Unit, National Institute for Health and Welfare, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Ilmo
authors.initials: I
authors.lastname: Keskimäki
authors.affiliation: Service System Research Unit , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Iiris
authors.initials: I
authors.lastname: Ruuth
authors.affiliation: Centre for Research Methods, University of Helsinki , Helsinki , Finland.
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
keywords: Complication(s); Health Service Research