Skip to main content
SpringerLink
Log in

Presence of diabetes related complication at the time of NIDDM diagnosis: An important prognostic factor

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

We studied the short-term natural history of patients with newly diagnosed non-insulin dependent diabetes mellitus (NIDDM), and the prognostic role of history of NIDDM related complication at the time of first NIDDM diagnosis in relation to the development of a new complication or death. We performed a cohort study using data from the General Practice Research Database in the UK. We identified patients aged 30 to 74 years with a newly diagnosed NIDDM between 1990 and 1992 and followed them from the day of NIDDM diagnosis until June 1995. Among the 1077 patients identified, 437 (41%) developed a NIDDM complication during the follow-up. NIDDM complications were more frequent among males and in the elderly. Sixty-seven percent of the study cohort was initially free of any complication while the remaining 360 patients presented already one or more NIDDM complication at the time of their NIDDM diagnosis. History of diabetic related complication was associated with an increased risk of developing a new NIDDM complication (RR: 1.8; 95% CI: 1.5–2.2). Mortality was also greater among patients with history of NIDDM complication (RR: 1.5; 95% CI: 1.0–2.2). Patients with a history of any disorder related to diabetes before their clinical diagnosis of NIDDM are at increased risk of developing a NIDDM complication after the NIDDM diagnosis, as well as at increased risk of dying compared to diabetic patients with no history.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Harris MI, Eastman RC. Early detection of undiagnosed non-insulin dependent diabetes mellitus. JAMA 1996; 276: 1261–1261.

    PubMed  Google Scholar 

  2. Harris MI. Undiagnosed NIDDM: Clinical and public health issues. Diabetes Care 1993; 16: 641–652.

    Google Scholar 

  3. Marks L. Counting the cost: The real impact of non-insulin dependent diabetes. King's Fund Policy Institute. London: British Diabetic Association, 1996: 12–17.

    Google Scholar 

  4. United Kingdom prospective diabetes study (UKPDS) 13: relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. Br Med J 1995; 310: 83–88.

  5. Turner R, Cull C, Holman R. United Kingdom Prospective Diabetes Study 17: A 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulin dependent diabetes mellitus. Ann Intern Med 1996; 124: 136–145.

    PubMed  Google Scholar 

  6. Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis. Diabetes Care 1992; 13: 815–819.

    Google Scholar 

  7. García Rodríguez LA, Pérez Gutthann S. Use of the UK General Practice Research Database for pharmacoepidemiology. Br J Clin Pharmacol 1998; 45: 419–426.

    Article  PubMed  Google Scholar 

  8. Jick H, Jick SS, Derby LE. Validation of information recorded on general practitioner based computerised data resource in the United Kingdom. Br Med J 1991; 302: 766–768.

    Google Scholar 

  9. Jick H, Terris BZ, Derby LE, Jick SS. Further validation of information recorded on a general practitioner based computerised data resource in the United Kingdom. Pharmacoepidemiol Drug Safety 1992; 1: 347–349.

    Google Scholar 

  10. Van Staa J-P, Abenhaim L. The quality of information recorded on a UK database of primary care records: A study of hospitalizations due to hypoglycemia and other conditions. Pharmacoepidemiol Drug Safety 1994, 3: 15–21.

    Google Scholar 

  11. UKPDS Group. UK Prospective diabetes study 6. Complications in newly dingnosed type 2 díabetic patients and their association with different clinical and biochemical risk factors. Diabetes Res 1990; 13: 1–11.

    Google Scholar 

  12. Cohen DL, Neil HAW, Thorogood M, Mann JJ. A population-based study of the incidence of complication associated with type 2 diabetes in the elderly. Diabetic Med 1991; 8: 928–933.

    PubMed  Google Scholar 

  13. Perri IJ, Wannamethee SG, Walker MK, Thomson AG, Whincup PH, Shaper AG. Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men. Br Med J 1995; 310: 560–564.

    Google Scholar 

  14. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy III, prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984; 102: 527–532.

    PubMed  Google Scholar 

  15. Dwyer MS, Melton LJ, Ballard DJ, Palumbo PJ, Trautman JC, Chu CP. Incidence of diabetic retinopathy and blindness: A population-based study in Rochester, Minnesota. Diabetes Care 1985; 8: 316–322.

    PubMed  Google Scholar 

  16. Klein R, Klein BEK. Vision disorders in diabetes. In: Harris MI, Cowie CC, Reiber G, Stern M, Bennett P (eds), Diabetes in America, 2nd ed. Washington, DC: US Government Printing Office, 1995: 293–338.

    Google Scholar 

  17. Nelson RG, Knowler WC, Pettitt DJ, Bennett PH. Kidney diseases in diabetes. In: Harris MI, Cowie CC, Reiber G, Stern M, Bennett P (eds), Diabetes in America, 2nd ed. Washington, DC: US Government Printing Office, 1995: 349–376.

    Google Scholar 

  18. Ballard DJ, Humphrey LL, Melton III LJ, Frohnert PP, Chu CP, O'Fallon WM, Palumbo PJ. Epidemiology of persistent proteinuria in type II diabetes mellitus. Population-based study in Rochester, Minnesota. Diabetes 1988; 37: 405–412.

    PubMed  Google Scholar 

  19. Humphrey LL, Ballard DJ, Frohnert PP, Chu PP, O'Fallon WM, Palumbo P. Chronic renal failure in non-insulin-dependent diabetes mellitus. A population-based study in Rochester, Minnesota. Ann Intern Med 1989; 111: 788–796.

    PubMed  Google Scholar 

  20. Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch HJ, Lindner J, The DIS Group. Risk factors for myocardial infarction and death in newly detected NIDDM: The Diabetes Intervention Study, 11-year follow-up. Diabetologia 1996; 39: 1577–1583.

    Article  PubMed  Google Scholar 

  21. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham Study. JAMA 1979: 2035–2038.

  22. Keen H, Jarrett RJ. The WHO multinational study of vascular disease in diabetes: 2. Macrovascular disease prevalence. Diabetes Care 1979; 2: 187–195.

    PubMed  Google Scholar 

  23. Rosengren A, Welin L, Tsipogianni A, Wilhelmsen L. Impact of cardiovascular risk factors on coronary heart disease and mortality among middle aged diabetic men: A general population study. Br Med J 1989; 299: 1127–1131.

    Google Scholar 

  24. Andersson DKG, Svärdsudd K. Long-term glycemic control related to mortality in Type II diabetes. Diabetes Care 1995; 18: 1534–1543.

    PubMed  Google Scholar 

  25. Chaturvedi N, Jarret J, Morrish N, Keen H, Fuller JH. Differences in mortality and morbidity in African carribean and European people with non-insulin dependent diabetes mellitus: Results of 20 year follow up of a London cohort of multinational study. Br Med J 1996; 313: 848–852.

    Google Scholar 

  26. Walters DP, Gatling W, Mulee MA, Hill RD. The prevalence of diabetic distal sensory neuropathy in an English community. Diabetic Med 1992; 9: 349–353.

    PubMed  Google Scholar 

  27. Geiss LS, Herman WH, Smith PJ. Mortality in non-insulin dependent diabetes. In: Harris MI, Cowie CC, Reiber G, Stern M, Bennett P (eds), Diabetes in America, 2nd ed. Washington, DC: US Government Printing Office, 1995: 233–258.

    Google Scholar 

  28. Panzram G. Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1987; 30: 123–131.

    Article  Google Scholar 

  29. Uusitupa MIJ, Niskanen LK, Siitonen O, Voutilainen E, Pyörälä K. Ten-year cardiovascular mortality in relation to risk factors and abnormalities in lipoprotein composition in Type 2 (non-insulin-dependent) diabetic and non-diabetic subjects. Diabetologia 1993; 36: 1175–1184.

    Article  PubMed  Google Scholar 

  30. Fontbonne A, Thibault N, Eschwège E, Ducimetière P. Body fat distribution and coronary heart disease mortality in subjects with impaired glucose tolerance or diabetes mellitus: The Paris Prospective Study, 15-year follow-up. Diabetologia 1992; 35: 464–468.

    PubMed  Google Scholar 

  31. Balkau B, Eschwege E, Papoz L, Richard J L, Claude J-R, Warnet J-M, Ducimetière P. Risk factors for early death in non-insulin dependent diabetes and men with known glucose tolerance status. Br Med J 1993; 307: 295–299.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Spanish Centre for Pharmacoepidemiologic Research, CEIFE, Madrid, Spain

    A. Ruigómez & L.A. García Rodríguez

Authors
  1. A. Ruigómez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L.A. García Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ruigómez, A., García Rodríguez, L. Presence of diabetes related complication at the time of NIDDM diagnosis: An important prognostic factor. Eur J Epidemiol 14, 439–445 (1998). https://doi.org/10.1023/A:1007484920656

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007484920656

Search

Navigation