Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes
Tóm tắt
Data are inconsistent regarding the associations between age, age at diagnosis of diabetes, diabetes duration and subsequent vascular complications. The associations between age (or age at diagnosis), diabetes duration and major macrovascular events, all-cause death and major microvascular events were examined in 11,140 patients with type 2 diabetes randomly allocated to intensive or standard glucose control in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Rates were calculated by 5 year baseline age (or age at diagnosis) and diabetes duration strata. Risks were estimated using Cox models adjusted for treatment assignment and HbA1c. The mean age (±SD) was 65.8 ± 6.4 years, age at diagnosis was 57.8 ± 8.7 years and diabetes duration was 7.9 ± 6.4 years. Diabetes duration was associated with the risk of macrovascular events (HR 1.13 [95% CI 1.08, 1.17]), microvascular events (1.28 [1.23, 1.33]) and death (1.15 [1.10, 1.20]) whereas age (or age at diagnosis) was only associated with the risk of macrovascular events (1.33 [1.27, 1.39]) and death (1.56 [1.48, 1.64]). No interaction was observed between diabetes duration, age and the risk of macrovascular events or death (both p > 0.4). However, an interaction was observed between diabetes duration, age and the risk of microvascular events (p = 0.002), such that the effects of increasing diabetes duration were greatest at younger rather than older age. In patients with type 2 diabetes, age or age at diagnosis and diabetes duration are independently associated with macrovascular events and death whereas only diabetes duration is independently associated with microvascular events and this effect is greater in the youngest patients.
Tài liệu tham khảo
International Diabetes Federation (2013) IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation. www.idf.org/diabetesatlas
Booth GL, Kapral MK, Fung K, Tu JV (2006) Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet 368:29–36
Vaccaro O, Eberly LE, Neaton JD, Yang L, Riccardi G, Stamler J, Multiple Risk Factor Intervention Trial Research Group (2004) Impact of diabetes and previous myocardial infarction on long-term survival: 25-year mortality follow-up of primary screenees of the Multiple Risk Factor Intervention Trial. Arch Intern Med 164:1438–1443
Fox CS, Sullivan L, D’Agostino RB Sr, Wilson PW (2004) The significant effect of diabetes duration on coronary heart disease mortality: the Framingham heart study. Diabetes Care 27:704–708
Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N (2011) Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med 171:404–410
Natarajan S, Liao Y, Sinha D, Cao G, McGee DL, Lipsitz SR (2005) Sex differences in the effect of diabetes duration on coronary heart disease mortality. Arch Intern Med 165:430–435
Davis TME, Stratton IM, Fox CJ, Holman RR, Turner RC (1997) UK Prospective Diabetes Study 22: effect of age at diagnosis on diabetic tissue damage during the first 6 years of NIDDM. Diabetes Care 20:1435–1441
Patel A, MacMahon S, Chalmers J et al (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560–2572
Patel A, MacMahon S, Chalmers J et al (2007) Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 370:829–840
ADVANCE Management, Committee (2001) Study rationale and design of ADVANCE: action in diabetes and vascular disease—preterax and diamicron MR controlled evaluation. Diabetologia 44:1118–1120
Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509
Krolewski AS, Warram JH, Rand LI, Kahn CR (1987) Epidemiologic approach to the etiology of type I diabetes mellitus and its complications. N Engl J Med 317:1390–1398
Jerneld B, Algvere P (1986) Relationship of duration and onset of diabetes to prevalence of diabetic retinopathy. Am J Ophthalmol 102:431–437
Gabir M, Hanson RL, Dabelea D, Imperatore G, Roumain J, Bennett PH, Knowler WC (2000) Plasma glucose and prediction of microvascular disease and mortality. Evaluation of 1997 American Diabetes Association and 1999 World Health Organization criteria for diagnosis of diabetes. Diabetes Care 23:1113–1118
Eppens MC, Craig ME, Cusumano J et al (2006) Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care 29:1300–1306
Copeland KC, Zeitler P, Geffner M et al (2011) Characteristics of adolescents and youth with recent-onset type 2 diabetes: the today cohort at baseline. J Clin Endocrinol Metab 96:159–167
Constantino MI, Molyneaux L, Limacher-Gisler F et al (2013) Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care 36:3863–3869
Singh GM, Danaei G, Farzadfar F et al (2013) The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis. PLoS One 8:e65174. doi:10.1371/journal.pone.0065174
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil A (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589
Harris MI, Klein R, Welborn TA, Knuiman MW (1992) Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis. Diabetes Care 15:815–819
Inzucchi SE, Bergenstal RM, Buse JB et al (2012) Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 55:1577–1596
Chalmers J, Arima H (2010) Importance of blood pressure lowering in type 2 diabetes: focus on ADVANCE. J Cardiovasc Pharmacol 55:340–547