Suzanne V Arnold1, Kamlesh Khunti2, Fengming Tang3, Hungta Chen4, Javier Cid-Ruzafa5, Andrew Cooper6, Peter Fenici6, Marilia B Gomes7, Niklas Hammar8, Linong Ji9, Gabriela Luporini Saraiva4, Jesús Medina10, Antonio Nicolucci11, Larisa Ramirez12, Wolfgang Rathmann13, Marina V Shestakova14, Iichiro Shimomura15, Filip Surmont7, Jiten Vora16, Hirotaka Watada17, Mikhail Kosiborod18. 1. Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Medicine, University of Missouri, Kansas City, Missouri. 2. Diabetes Research Centre, University of Leicester, Leicester. 3. Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri. 4. AstraZeneca, Gaithersburg, Maryland. 5. Evidera, Barcelona, Spain. 6. AstraZeneca, Cambridge. 7. Departamento de Medicina Interna, Rio de Janeiro State University, Rio de Janeiro, Brazil. 8. Institute of Environmental Medicine, AstraZeneca Gothenburg, Mölndal, Sweden and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 9. Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China. 10. AstraZeneca, Madrid, Spain. 11. Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy. 12. AstraZeneca, Luton. 13. Leibniz Center for Diabetes Research at Heinrich Heine University, German Diabetes Center, Düsseldorf, Germany. 14. Endocrinology Research Centre, Diabetes Institute, Moscow, Russian Federation. 15. Graduate School of Medicine, Osaka University, Osaka, Japan. 16. Department of Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool. 17. Graduate School of Medicine, Juntendo University, Tokyo, Japan. 18. Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Medicine, University of Missouri, Kansas City, Missouri; The George Institute for Global Health and University of New South Wales, Sydney, Australia.
Abstract
BACKGROUND: Micro- and macrovascular complications are a major cause of morbidity and mortality in people with type 2 diabetes (T2D). We sought to understand the global incidence rates and predictors of these complications. METHODS: We examined the incidence of vascular complications over 3 years of follow-up in the DISCOVER study-a global, observational study of people with T2D initiating second-line glucose-lowering therapy. Hierarchical Cox proportional hazards regression models examined factors associated with development of micro- and macrovascular complications during follow-up. RESULTS: Among 11,357 people with T2D from 33 countries (mean age 56.9 ± 11.7 years, T2D duration 5.7 ± 5.1 years, HbA1c 8.4 ± 1.7%), 19.0% had a microvascular complication at enrolment (most commonly neuropathy), and 13.2% had a macrovascular complication (most commonly coronary disease). Over 3 years of follow-up, 16.0% developed an incident microvascular complication, and 6.6% had an incident macrovascular complication. At the end of 3 years of follow-up, 31.5% of patients had at least one microvascular complication, and 16.6% had at least one macrovascular complication. Higher HbA1c and smoking were associated with greater risk of both incident micro- and macrovascular complications. Known macrovascular complications at baseline was the strongest predictor for development of new microvascular complications (HR 1.40, 95% CI 1.21 -1.61) and new macrovascular complications (HR 3.39, 95% CI 2.84 -4.06). CONCLUSIONS: In this global study, both the prevalence and 3-year incidence of vascular complications were high in patients with relatively short T2D duration, highlighting the need for early risk-factor modification.
BACKGROUND: Micro- and macrovascular complications are a major cause of morbidity and mortality in people with type 2 diabetes (T2D). We sought to understand the global incidence rates and predictors of these complications. METHODS: We examined the incidence of vascular complications over 3 years of follow-up in the DISCOVER study-a global, observational study of people with T2D initiating second-line glucose-lowering therapy. Hierarchical Cox proportional hazards regression models examined factors associated with development of micro- and macrovascular complications during follow-up. RESULTS: Among 11,357 people with T2D from 33 countries (mean age 56.9 ± 11.7 years, T2D duration 5.7 ± 5.1 years, HbA1c 8.4 ± 1.7%), 19.0% had a microvascular complication at enrolment (most commonly neuropathy), and 13.2% had a macrovascular complication (most commonly coronary disease). Over 3 years of follow-up, 16.0% developed an incident microvascular complication, and 6.6% had an incident macrovascular complication. At the end of 3 years of follow-up, 31.5% of patients had at least one microvascular complication, and 16.6% had at least one macrovascular complication. Higher HbA1c and smoking were associated with greater risk of both incident micro- and macrovascular complications. Known macrovascular complications at baseline was the strongest predictor for development of new microvascular complications (HR 1.40, 95% CI 1.21 -1.61) and new macrovascular complications (HR 3.39, 95% CI 2.84 -4.06). CONCLUSIONS: In this global study, both the prevalence and 3-year incidence of vascular complications were high in patients with relatively short T2D duration, highlighting the need for early risk-factor modification.