Risk trajectories of complications in over one thousand newly diagnosed individuals with type 2 diabetes

Abstract

Although the increased risk of complications of type 2 diabetes (T2D) is well known, there is still little information about the long-term development of comorbidities in relation to risk factors. The purpose of the present study was to describe the risk trajectories of T2D complications over time in an observational cohort of newly diagnosed T2D patients, as well as to evaluate the effect of common risk factors on the development of comorbidities. This national cohort study investigated individuals with T2D in the Swedish National Diabetes Register regarding prevalence of comorbidities at the time of diagnosis, and the incidence of cardiovascular disease (CVD), chronic kidney disease (CKD) and heart failure in the entire patient cohort and stratified by HbA1c levels and age at baseline. Multivariable Cox regressions were used to evaluate risk factors predicting outcomes. We included 100,878 individuals newly diagnosed with T2D between 1998 and 2012 in the study, with mean 5.5 years follow-up (max 17 years). The mean age at diagnosis was 62.6 ± SD12.5 years and 42.7% of the patients were women. Prevalent CVD was reported for 17.5% at baseline. Although the prevalence of comorbidities was generally low for individuals 50 years or younger at diagnosis, the cumulative incidence of the investigated comorbidities increased over time. Newly diagnosed CVD was the most common comorbidity. Women were shown to have a lower risk of developing comorbid conditions than men. When following the risk trajectory of comorbidities over a period of up to 15 years in individuals with type 2 diabetes, we found that all comorbidities gradually increased over time. There was no distinct time point when onset suddenly increased.

Comparison of clinical characteristics and disease burden between early- and late-onset type 2 diabetes patients: a population-based cohort study

“…This suggests that patients with early-onset T2D have higher overall lipid levels, many are borderline hyperlipidemia, and may progress to hyperlipidemia more quickly in the future, which explains our main findings. A study of the risk trajectory of T2D complications found that the cumulative incidence of CVD increases with age in the T2D population [ 30 ], the higher prevalence of CVD risk in late-onset T2D may be because age as a risk factor for CVD risk is more pronounced in lat-onset patients in our study. Regarding medication use patterns, the results of a case‒control study indicated that there was a higher rate of antihypertensive medication use at diagnosis in late-onset T2D [ 31 ], which is consistent with our result in which patients with late-onset T2D had a higher rate of hypertension prevalence.…”

“…The results of previous studies, as well as ours, have indicated a more severe metabolic disorder in early-onset type 2 diabetes, both in general characteristics and treatment patterns. A cohort study conducted in Sweden described the cumulative incidence and risk factors for comorbid diseases for newly diagnosed T2D patients, but they didn’t evaluate the progression of hypertension or hyperlipidemia and the difference between early-onset and late-onset T2D [ 30 ]. One study showed that patients with early-onset diabetes are more likely to have combined hyperlipidemia [ 31 ], and another study of 1,421 cases revealed that patients with early-onset T2D had higher triglycerides (TG) and glycated hemoglobin (HbA1c) [ 32 ], all of which suggest that patients with early-onset diabetes are clinically characterized by metabolic disorders.…”

Determinants of Early Chronic Kidney Disease in Patients with Recently Diagnosed Type 2 diabetes mellitus: A study from the Taiwan Diabetes Registry

“…By the time of diagnosis, patients may have already developed some diabetic complications. Previous studies have shown that diabetic kidney disease (DKD) has the highest prevalence among diabetic complications when type 2 diabetes mellitus is diagnosed 2,3 . DKD is also a leading cause of diabetes-related cardiovascular disease and mortality 4 , resulting in high medical costs and healthcare burdens.…”