Survival in Patients With Type 2 Diabetes in a Swedish Community

Abstract

OBJECTIVE—To explore risk factors for all-cause mortality in patients with type 2 diabetes treated in primary care. RESEARCH DESIGN AND METHODS—A prospective population-based study of 400 patients with type 2 diabetes who consecutively completed an annual checkup in primary care in Skara, Sweden, during 1992–1993. Vital status was ascertained to year 2000. Baseline characteristics as predictors for mortality were analyzed by Cox regression and expressed as relative risks (RRs), with 95% CIs. RESULTS—During a mean follow-up time of 5.9 years, 131 patients died (56 deaths per 1,000 patients per year). In both sexes, all-cause mortality was predicted by HbA1c (by 1%; RR 1.14, 95% CI 1.01–1.27), and by LDL-to-HDL cholesterol ratios (1.15, 1.00–1.32). Increased mortality was also seen with prevalent hypertension (1.72, 1.21–2.44), microalbuminuria (1.87, 1.27–2.76), and previous cardiovascular disease (1.70, 1.15–2.50). Subanalyses revealed that increased mortality related to HbA1c was restricted to hypertensive patients with type 2 diabetes (1.23, 1.04–1.47). Serum triglycerides (by 1 mmol/l) predicted all-cause mortality in women (1.25, 1.06–1.47). CONCLUSIONS—Poor glucose and lipid control and hypertension predicted all-cause mortality. Survival was also predicted by prevalent microalbuminuria and by previous cardiovascular disease. Confirming results from clinical trials, this population-based study has implications for primary and secondary prevention.

Survival in patients with hypertension treated in primary care A population-based follow-up study in the Skaraborg Hypertension and Diabetes Project

“…However, once diabetes has developed, most of the individual risk factors lose their significant contribution to mortality and, instead, the presence of type 2 diabetes evolves as a major risk factor for mortality. The high mortality rates in patients with hypertension and diabetes combined in this study have been published earlier, although not gender specifically (13). These results are in accordance with other studies (14).…”

Fibrinogen and AER are major independent predictors of 11-year cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study

“…Firstly, whether the shape of the relationship between AER and cardiovascular mortality is continuous or discrete. Only the Heart Outcomes Prevention Evaluation (HOPE) and the Prevention of Renal and Vascular End-Stage Disease (PREVEND) studies have previously examined this issue, reporting an increasing trend in cardiovascular risk even below the cut-off value for microalbuminuria, though this was assessed according to albumin: creatinine ratios and urinary albumin concentrations in these studies [13,21]. Secondly, the role of AER as a predictor of long-term mortality in diabetic subjects has not been conclusively determined.…”

“…Recent prospective data from the Casale Monferrato Study have provided evidence that hyperfibrin-ogenaemia independently predicts progression to overt diabetic nephropathy in type 2 diabetes [11]. Since cardiovascular mortality is higher in subjects with diabetic nephropathy than in subjects with diabetes alone [12][13][14][15][16][17][18][19][20][21][22][23], it is clinically relevant to assess whether the role of fibrinogen as a predictor of cardiovascular mortality is independent of baseline AER and progression to overt diabetic nephropathy. Albuminuria is considered to be a marker of endothelial cell damage, whereas fibrinogen is an indicator of chronic inflammation, which has been implicated in the pathogenesis of atherosclerosis and unstable atherosclerotic plaque in the coronary arteries.…”

“…As regards albuminuria, its role as a cardiovascular risk factor in type 2 diabetic subjects has been highlighted in a systematic literature review [12] and in more recent studies [13][14][15][16][17][18][19][20][21][22][23][24]. However, the interpretation of the results from these studies has been hampered by: (1) the recruitment of clinic-based rather than population-based cohorts of subjects, which limits the extrapolation of the results to the whole diabetic population; (2) the small number of analysed events, which limits the power of the study for identifying risk factors and their interactions; and (3) the narrow spectrum of risk factors examined, which limits the assessment of inter-relationships between explanatory variables.…”

Gross proteinuria is a strong risk predictor for cardiovascular mortality in Brazilian type 2 diabetic patients

“…Smoking status was considered to be non-reliable data for this cohort. It has been reported as a mortality risk factor in some investigations (1,21,25), but not in others (4,6,8,26). Information on metabolic control provided by HbA 1c levels probably was, at least partially, provided by mean fasting glycemia levels obtained during the first year of follow-up.…”