Vascular complications ‘substantial’ in people with type 2 diabetes
The development of microvascular and macrovascular complications early in type 2 diabetes is a “substantial” global challenge, a study has suggested.
The conclusion was made following a study of almost 16,000 people with the condition initiating second-line therapy in 38 countries.
Published in Cardiovascular Diabetology, the DISCOVER study programme involved researchers from across the world, including Brazil’s Rio de Janeiro State University, the Center for Outcomes Research and Clinical Epidemiology in Pescara, Italy, the London School of Hygiene and Tropical Medicine, Institute for Biometrics and Epidemiology in German, Moscow’s Endocrinology Research Center, Tokyo’s Graduate School of Medicine, Juntendo University and the University of Leicester.
The research was launched because the global prevalence of type 2 diabetes-related complications was not previously well described.
Participants were recruited from primary and specialist healthcare settings, with data collected using a standardised case report form. Prevalence estimates of microvascular and macrovascular complications at baseline were assessed overall and by country and region, and were standardised for age and sex. Modified poisson regression was used to assess factors associated with the prevalence of complications.
The median duration of type 2 diabetes was 4.1 years, while the average HbA1c level was 8%, with the crude prevalence of microvascular complications standing at 18.8% and macrovascular complications being 12.7%.
Summarising the results, the researchers said: “Common microvascular complications were peripheral neuropathy (7.7%), chronic kidney disease (5.0%), and albuminuria (4.3%). Common macrovascular complications were coronary artery disease (8.2%), heart failure (3.3%) and stroke (2.2%). The age- and sex-standardized prevalence of microvascular complications was 17.9% (95% confidence interval [CI] 17.3–18.6%), ranging from 14.2% in the Americas to 20.4% in Europe.
“The age- and sex-standardized prevalence of macrovascular complications was 9.2% (95% CI 8.7–9.7%), ranging from 4.1% in South-East Asia to 18.8% in Europe. Factors positively associated with vascular complications included age (per 10-year increment), male sex, diabetes duration (per 1-year increment), and history of hypoglycemia, with rate ratios (95% CIs) for microvascular complications of 1.14 (1.09–1.19), 1.30 (1.20–1.42), 1.03 (1.02–1.04) and 1.45 (1.25–1.69), respectively, and for macrovascular complications of 1.41 (1.34–1.48), 1.29 (1.16–1.45), 1.02 (1.01–1.02) and 1.24 (1.04–1.48), respectively. HbA1c levels (per 1.0% increment) were positively associated with microvascular (1.05 [1.02–1.08]) but not macrovascular (1.00 [0.97–1.04]) complications.”
The researchers concluded: “The global burden of microvascular and macrovascular complications is substantial in these patients with type 2 diabetes who are relatively early in the disease process. These findings highlight an opportunity for aggressive early risk factor modification, particularly in regions with a high prevalence of complications.”