Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes

IntroductionType 2 diabetes (T2D) is a common condition that, if left untreated or poorly managed, can lead to adverse microvascular and macrovascular complications. We estimated the prevalence and incidence of microvascular and macrovascular complications among patients newly diagnosed with T2D wit...

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Published in:BMJ open diabetes research & care Vol. 9; no. 1; p. e001847
Main Authors: An, Jaejin, Nichols, Gregory A, Qian, Lei, Munis, Mercedes A, Harrison, Teresa N, Li, Zhuoxin, Wei, Rong, Weiss, Tracey, Rajpathak, Swapnil, Reynolds, Kristi
Format: Journal Article
Language:English
Published: England American Diabetes Association 01.01.2021
BMJ Publishing Group LTD
BMJ Publishing Group
Subjects:
Age
Ambulatory care
Angina pectoris
Body mass index
Cardiovascular disease
Diabetes
diabetes complications
diabetes mellitus
Diabetic retinopathy
Electronic health records
Epidemiology
Epidemiology/Health services research
Ethnicity
Heart attacks
Heart failure
Hispanic people
Kidney diseases
Laboratories
Mortality
Patients
Peripheral neuropathy
Risk factors
Stroke
Survival analysis
type 2
United States > US
epidemiology
diabetes mellitus
type 2
diabetes complications
ISSN:2052-4897, 2052-4897
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Summary:IntroductionType 2 diabetes (T2D) is a common condition that, if left untreated or poorly managed, can lead to adverse microvascular and macrovascular complications. We estimated the prevalence and incidence of microvascular and macrovascular complications among patients newly diagnosed with T2D within a US integrated healthcare system.Research design and methodsWe conducted a retrospective cohort study among patients newly diagnosed with T2D between 2003 and 2014. We evaluated 13 complications, including chronic kidney disease (CKD), cardiovascular disease (CVD), and all-cause mortality through 2018. Multivariable Cox proportional hazards models were used to study factors associated with complications.ResultsWe identified 135 199 patients with incident T2D. The mean age was 58 years, and 48% were women. The prevalence of CKD was the highest of the complications at the time of T2D diagnosis (prevalence=12.3%, 95% CI 12.2% to 12.5%), while the prevalence of CVD was among the lowest at 3.3% (95% CI 3.2% to 3.3%). The median time to incidence of a T2D complication ranged from 3.0 to 5.2 years. High incidence rates (95% CI) of T2D complications included peripheral neuropathy (26.9, 95% CI 26.5 to 27.3 per 1000 person-years (PY)), CKD (21.2, 95% CI 20.9 to 21.6 per 1000 PY), and CVD (11.9, 95% CI 11.7 to 12.2 per 1000 PY). The trend of 5-year incidence rates of T2D complications by diagnosis year decreased over time (p value<0.001). Older age, non-Hispanic white race/ethnicity, sex, higher A1C, smoking, and hypertension were associated with increased CKD and CVD incidence.ConclusionThough incidence rates of T2D complications were lower in more recent years (2010–2014), a significant proportion of patients had complications at T2D diagnosis. Earlier preventive therapies as well as managing modifiable factors may help delay the development and progression of T2D complications.
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ISSN:2052-4897
2052-4897
DOI:10.1136/bmjdrc-2020-001847