Risk Factors of Microvascular Complications Among Type 2 Diabetic Patients Using Cox Proportional Hazards Models: A Cohort Study in Tabuk Saudi Arabia

Abstract

The burden of type 2 diabetes (T2D) is high in Saudi Arabia, but data related to its complications are limited. This study aimed to determine the incidence of microvascular complications caused by T2D and evaluate the impact of the associated risk factors. Patients and Methods: This retrospective cohort study was conducted at two military hospitals in Tabuk, Saudi Arabia. Data on the socio-demographics, glycaemic profile, blood lipid indices, duration of T2D, and associated microvascular complications were collected from electronic health records and medical files. Descriptive statistics and Cox proportional hazards models were used for data analysis. Results: This study included 1563 T2D patients. The incidence of microvascular complications was 34.3% (95% confidence interval [CI], 32.0-36.6). Retinopathy was the most common complication (incidence=20.0%; 95% CI, 18.0-22.0%), while nephropathy was the least common complication (incidence=12.2%; 95% CI, 10.6-13.8%). Advanced age (≥65 years) showed the highest risk of retinopathy (Hazard ratios [HR], 2.86; 95% CI, 2.56-3.21), neuropathy (HR, 2.70; 95% CI, 2.40-3.05), and nephropathy (HR, 2.37; 95% CI, 2.12-2.64) compared with their counterparts. After adjusting for potential confounders, the study found that the significant risk factors for microvascular complications were longer duration (≥10 years) of T2D (

Diabetic microvascular complications and associated factors in patients with type 2 diabetes in Southern Ethiopia

“…Furthermore, in this study, the risk of diabetic microvascular complications was higher in patients with a T2DM duration ≥ 5 years. The finding is in accordance with the studies conducted in Ethiopia, Nigeria, Saudi Arabia, China, and Ireland ( 14 , 16 , 17 , 20 , 24 ). Moreover, the finding that the risk of diabetic microvascular complications was higher in patients with T2DM whose total cholesterol ≥ 200 mg/dl is consistent with previous studies done in Saudi Arabia and China ( 14 , 17 ).…”

“…However, the finding was higher than the finding of studies from Northern Ethiopia 19.5%, and Chandigarh, India 18.04% ( 13 , 21 ). The finding of this study was lower than the finding of the studies conducted in Jimma, Ethiopia 41.5%, Dessie, Ethiopia 37.9%, Gondar, Ethiopia 31.33%, Ayder, Ethiopia 42.6%, Jos, Nigeria 47.8%, Tabuk, Saudi Arabia 34.3%, Doha, Qatar 48.4%, South India 52.1%, Tianjin, China 34.5%, and Ningbo, China 57.5% ( 14 – 17 , 19 , 20 , 23 – 26 ). This discrepancy might be due to differences in diagnostic methods or criteria, sample size, and healthcare systems.…”

“…Microvascular complications are present in half of patients with T2DM ( 8 ). In previous studies conducted, the prevalence of microvascular complications was 18.0%-57.5% in Asia ( 13 – 16 ), 34.3%-48.4% in the Middle East ( 17 – 19 ), 47.8% in Nigeria ( 20 ), and 19.5%-42.6% in Ethiopia ( 21 – 26 ). Duration of diabetes, hypertension, triglycerides, age, dyslipidemia, poor glycemic control, sex, systolic blood pressure, and positive proteinuria were commonly associated factors with the development of diabetic microvascular complications in previous studies ( 13 , 14 , 16 , 17 , 21 , 22 , 24 – 27 ).…”

Factors associated with glycemic control and diabetes complications in a group of Saudi patients with type 2 diabetes

“…This is not uncommon; as such variations have been reported in previous studies. [ 26 , 33 ] Also, the cross-sectional study design could contribute to this, as these risk factors were assessed once.…”

“…This goes with a study from Saudi Arabia, where diabetic retinopathy was the most frequent microvascular complication, followed by neuropathy and, lastly, nephropathy. [ 33 ] Nevertheless, different results from the Indian population showed that peripheral neuropathy (44.9%) was the most frequent complication, followed by nephropathy (12.1%). [ 34 ] A Chinese study in patients with diabetes found the prevalence of neuropathy, retinopathy, and kidney disease to be 23.5%, 17.4%, and 10.8%, respectively.…”