Abstract
We analysed the risk factors associated with diabetic complications in the cohort of patients assisted by a type 2 diabetes mellitus (T2DM) shared-care program. We analysed registry data from 16,136 T2DM patients. Of them, 4,781 had microangiopathy, 3,469 CV events. They were 70.5 ± 17.1 years old, 50% were male, disease duration 13.3 ± 7.8 years, BMI 28.7 ± 4.9 kg/m2, HbA1c 7.08 ± 1.23%, FBG 134.7 ± 35.7 mg/dl, 2hPPBG 163.9 ± 47.8 mg/dl, 12.5% smokers. Cholesterol 202.5 ± 37.6 mg/dl, HDL 51.4 ± 20.4 mg/dl, LDL 126.5 ± 36.0 mg/dl, triglyceride 146.2 ± 72.4 mg/dl, SBP 137.8 ± 14.2 mmHg, DBP 80.7 ± 10.8 mmHg, 10-year CV risk score 13.7 ± 9.1; 70.4% had no microangiopathy—i.e. renal, retinal, peripheral nerve disease—and 78.5% of patients had no CV events. Age-adjusted risk factors associated with diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. FBG and SBP were associated with microangiopathy, whereas smoking with cardiovascular events. Optimal targets were reached in: FBG 17%, 2hPPBG 8%, HbA1c 21%, cholesterol 17%, HDL 8%, LDL 5%, triglyceride 20%, SBP 13%, DBP 30%. Drug profiles showed 13% using metformin, 28% sulphonilureas, 26% bitherapy, 4% insulin; 12% statins, 16% anti-platelets, 27% anti-hypertensives, 2% anti-coagulants. T2DM patients showed an acceptable CV risk profile. Joint risk factors for diabetic complications were male gender, HbA1c, 2hPPBG, HDL, and triglyceride. Distinct risk factors were FBG and SBP for micro- and smoking for macrovascular disease. A targeted-to-treat approach needs more attention in the care of T2DM patients.
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Abbreviations
- T2DM:
-
Type 2 diabetes mellitus
- CV:
-
Cardiovascular
- BMI:
-
Body mass index
- HbA1c:
-
Glycosylated haemoglobin
- HDL:
-
HDL-cholesterol
- LDL:
-
LDL-cholesterol
- SBP:
-
Systolic blood pressure
- DBP:
-
Diastolic blood pressure
- FBG:
-
Fasting blood glucose
- 2hPPBG:
-
2-h post-prandial blood glucose
- OR:
-
Odds ratio
References
Griffin S, Kinmonth A (1997) The management of diabetes by general practitioners and shared care. In: Pickup J, Williams G (eds) Textbook of diabetes. Blackwell, Oxford
Vrijhoef HJM, Spreeuwenberg C, Eijkelberg IMJG, Wolffenbuttel BHR, van Merode GG (2001) Adoption of disease management model for diabetes in region of Maastricht. BMJ 323:983–985
Laine C, Caro JF (1996) Preventing complications in diabetes mellitus: the role of the primary care physician. Med Clin North Am 80:457–474
Greenhalgh PM (1994) Shared care for diabetes: a systematic review. RCGP Occasional Paper 67. Royal College of General Practitioners, London
Griffin S (1998) Diabetes care in general practice: meta-analysis of randomised control trials. BMJ 317:390–396
AMD-SID-SIMG (2001) L’assistenza al paziente diabetico—Raccomandazioni AMD-SID-SIMG. [Italian clinical practice guidelines] Il Diabete 13: 81–99
Ciardullo AV, Daghio MM, Brunetti M, Bevini M, Daya G, Feltri G, Novi D, Goldoni CA, Guerzoni A, Messori A, Magrini N (2004) Audit of a shared-care program for persons with diabetes: baseline and 3 annual follow-ups. Acta Diabetol 41:9–13
Ciardullo AV, Daghio MM, Brunetti M, Bevini M, Daya G, Feltri G, Novi D, Goldoni CA, Messori A, Guerzoni A, Magrini N (2003) Changes in long-term glycemic control and performance indicators in a cohort of type 2 diabetic patients cared for by general practitioners: findings from the Modena Diabetes Project. Nutr Metab Cardiovasc Dis 13:372–376
Ciardullo AV, Brunetti M, Daghio MM, Bevini M, Daya G, Feltri G, Novi D, Guerzoni A (2005) Disease management of type 2 diabetes in Modena provinc: 7-year monitoring of outcomes and economic evaluation. Giorn Ital Diabetol Metabol 25:117–123
Ciardullo AV, Guerzoni A, Daghio MM, Corsari S, Bovini M, Feltri G, Novi D, Goldoni CA, Pini M, Cintori C, Brunetti M, Carapezzi C (2007) Disease management showed lower excess hospitalizations than usual care among people with diabetes living in Modena, Italy. Giorn Ital Diabetol Metabol 27:69–74
Kostner GM (1976) Enzymatic determination of cholesterol in high-density lipoprotein fractions prepared by polyanion precipitation. Clin Chem 22:695–698
Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH (1997) Collaborative management of chronic illness. Ann Intern Med 127:1097–1102
Ciardullo AV, Fattori G, Carrozzi G, Daghio MM (2004) Evaluation of an information tool for diabetic patient education. Diabetic Med 21:1056–1057
Balkau B, Shipley M, Jarrett RJ, Pyorala K, Pyorala M, Forhan A, Eschwege E (1998) High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men: 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen Study. Diabetes Care 21:360–367
The Diabetes Control and Complications Trial Research Group (1995) The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. Diabetes 44:968–983
Ceriello A (1988) The emerging role of post-prandial hyperglycaemic spikes in the pathogenesis of diabetic complications. Diabet Med 15:188–193
Laakso M (1999) Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes 48:937–942
Stamler J, Vaccaro O, Neaton J, Wentworth D, Multiple Risk Factor Intervention Trial Research Group (1993) Diabetes, other risk factors, and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 16:434–444
The DECODE Study (1999) Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 354:617–621
Ceriello A, Toboga C, Tonutti L, Giacomello R, Stel G, Motz E, Pirizi M (1996) Post-meal coagulation activation in diabetes mellitus: the effect of acarbose. Diabetologia 39:469–473
Ceriello A (1997) Acute hyperglycemia and oxidative stress generation. Diabet Med 14:45–50
Bouma M, Dekker J, de Sonnaville JJ, van der Does FE, de Vries H, Kriegsman DM, Kostense PJ, van Eijk JT (1999) How valid is fasting plasma glucose as a parameter of glycemic control on non-insulin-using patients with type 2 diabetes? Diabetes Care 22:904–907
Weitzman S, Wang C, Rosamond WD, Chambless LE, Cooper LS, Shahar E, Goff DC, ARIC (Atherosclerosis Risk in Communities) Surveillance Study (2004) Is diabetes an independent risk factor for mortality after myocardial infarction? The ARIC (Atherosclerosis Risk in Communities) Surveillance Study. Acta Diabetol 41:77–83
Abdella NA, Mojiminiyi OA, Akanji AO, Moussa MA (2002) Associations of plasma homocysteine concentration in subjects with type 2 diabetes mellitus. Acta Diabetol 39:183–190
Cerbone AM, Macarone-Palmieri N, Saldalamacchia G, Coppola A, Di Minno G, Rivellese AA (2008) Diabetes, vascular complications and antiplatelet therapy: open problems. Acta Diabetol Dec 2; published online
Cyganek K, Mirkiewicz-Sieradzka B, Malecki MT, Wolkow P, Skupien J, Bobrek J, Czogala M, Klupa T, Sieradzki J (2006) Clinical risk factors and the role of VDR gene polymorphisms in diabetic retinopathy in Polish type 2 diabetes patients. Acta Diabetol 43:114–119
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We thanks all the T2DM patients and the health operators involved in the shared-care diabetes program. This work has been supported by public health authorities.
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Ciardullo, A.V., Daghio, M.M., Bevini, M. et al. Joint and distinct risk factors associated with micro- and macrovascular complications in a cohort of type 2 diabetic patients cared through disease management. Acta Diabetol 47, 301–308 (2010). https://doi.org/10.1007/s00592-010-0186-4
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DOI: https://doi.org/10.1007/s00592-010-0186-4