Incidence of complications and mortality in a type 2 diabetes patient cohort study followed up from diagnosis in a primary healthcare centre.

AIMS: To determine the microvascular and macrovascular complications and mortality incidence rates and to identify the related factors in patients recently diagnosed with type 2 diabetes between 1991 and 2000 and followed until 2006. METHODS: Retrospective longitudinal study in a primary healthcare center. Patients without any measure of glycaemia in the 3 years previous to diabetes diagnosis were excluded. Annual incidence rates for microvascular and macrovascular complications and mortality were estimated. Analysis of KaplanMeier survival curves and Cox proportional risk models by gender were done. RESULTS: Of 469 patients [mean age: 60.4 (SD 10.7) years, 53.9% women], 80 died principally of tumoral (38.7%) and cardiovascular (30%) causes. The mean follow-up period was 8.81 years. (SD 3.21). The complication rates per 1000 patients/year (95% CI) were: microvascular complications 29.11 (22.97-36.38), macrovascular complications 24.10 (19.05-30.08) and mortality 19.23 (15.25-23.93), all of those being significantly greater in males except for cerebrovascular disease. Complications and mortality were associated with age, HbA1c, HDL-cholesterol, blood pressure and smoking with a different significance for each gender. HbA1c was related to microvascular complications in both sexes and to macrovascular complications only in women. CONCLUSION: The annual rates for death and complications in a Mediterranean type 2 diabetic patient cohort followed from diagnosis were lower than those published in Anglo-Saxon countries. Males showed higher death and complication rates except in terms of cerebrovascular disease. Predictors of complication and death were different depending on gender. In terms of mortality, unlike in other studies, only one-third of the deaths were for cardiovascular causes.

La aplicación de la HbA1c como único criterio podría retrasar el diagnóstico de la diabetes mellitus tipo 2 / Applying HbA1c as the only criterion for type 2 diabetes would delay its diagnosis

Introducción: La American Diabetes Association ha introducido el valor deHbA1c ≥6,5% para el diagnóstico de la diabetes en 2010. Se desconoce elimpacto de su aplicación en la población mediterránea. Objetivos: Determinarcuántos pacientes dejaríamos de diagnosticar y cuánto tiempo se retrasaríael diagnóstico si se aplicara exclusivamente la HbA1c. Material y métodos:Estudio retrospectivo en 598 pacientes con diabetes mellitus tipo 2(DM2) diagnosticados en un centro de atención primaria entre 1991 y 2000.Los pacientes sin HbA1c en los primeros 3 meses después del diagnósticofueron excluidos. Los pacientes incluidos fueron reclasificados según la HbA1c(<5,7% normoglucemia, 5,7-6,4% categoría de riesgo, y ≥6,5% diabetes)globalmente y según el método diagnóstico utilizado (glucemia ≥140 mg/dL,glucemia ≥126 mg/dL y test de tolerancia oral a la glucosa [TTOG]). Se calculóel intervalo entre el diagnóstico y la primera HbA1c ≥6,5% en los pacientescon HbA1c <6,5%. Resultados: Se incluyeron 377 pacientes, 17 (4,5%)fueron reclasificados como normoglucémicos, 87 (23,1%) como categoría deriesgo y 273 (72,4%) como diabéticos. Sólo un 52,7% de los diagnosticadospor glucemia ≥126 mg/dL serían considerados diabéticos. La media de tiempohasta la primera HbA1c ≥6,5% fue de 3,40 años (desviación estándar [DE]2,35), siendo de 3,80 años (DE 2,49) para los normoglucémicos y de 3,33años (DE 2,34) para la categoría de riesgo. Conclusiones: El uso de la HbA1ccomo único criterio dejaría de diagnosticar o retrasaría el diagnóstico DM2 encasi la mitad de los casos, por lo que sería conveniente mantener la glucemiaplasmática como criterio principal y la HbA1c como un criterio adicional(AU)

Introduction: In 2010 the American Diabetes Association introduced thevalue of HbA1c at ≥6.5% for the diagnosis of diabetes. The impact of its implementationin the Mediterranean population is unknown. Objective: To determinehow many patients would not be diagnosed and how long diagnosisof diabetes would be delayed if only HbA1c was applied. Material andmethods: Retrospective study with 598 type 2 diabetes mellitus (T2DM)patients diagnosed between 1991 and 2000 in an urban primary healthcarecentre. Patients without HbA1c during the 3 months after diagnosis were excluded.Included patients were reclassified by HbA1c (<5.7% normoglycaemic,5.7-6.4% risk category and ≥6.5 diabetes), globally and by diagnosticmethod (glycaemia ≥140 mg/dL, glycaemia ≥126 mg/dL and oral glucosetolerance test). The period between diagnosis and the first HbA1c ≥6.5% inpatients with an HbA1c <6.5% was calculated. Results: 377 patients wereincluded, 17 (4.5%) were reclassified as normoglycaemic, 87 (23.1%) asdiabetes risk category and 273 (72.4%) as diabetics. Only 52.7% of patientsdiagnosed with glycaemia ≥126 mg/dL were considered diabetics. Meantime to the first HbA1c ≥6.5% was 3.40 (standard deviation [SD] 2.35) years,while for normoglycaemic patients it was 3.80 (SD 2.49) years and 3.33 (SD2.34) years for the risk category. Conclusions: The use of HbA1c as a singlecriterion could delay diagnosis of T2DM in almost half of cases. It seems appropriateto maintain plasma glucose as the main criteria and HbA1c as anadditional criteria(AU)