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Mortality and cardiovascular outcomes in patients detected by screening or clinically diagnosed type 2 diabetes.: A 30-year follow-up study of 740 incident patients with type 2 diabetes
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.ORCID iD: 385375
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
(English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548Article in journal (Refereed) Submitted
Abstract [en]

Objective

Screening for type 2 diabetes among high-risk subjects is recommended by many organizations. The aim of this study was to analyse all-cause mortality and cardiovascular disease (CVD) outcomes in type 2 diabetes subjects detected by screening and those clinically diagnosed during 30 years of follow-up.

Research design and methods

A diabetes register was established at the primary healthcare centre (PHCC) in Laxå, beginning in 1972 and based on data from clinical records with information on medical treatment and laboratory data as well as information on all-cause mortality, CVD, myocardial infarction (MI), and stroke events from National Registers. A total of 740 incident patients with type 2 diabetes were registered between 1972- 2001. In addition, case-finding procedures involving 85% of residents aged 35 to 79 were performed from 1983 onwards.

Results

Baseline characteristics showed a significantly higher CVD risk, mainly depending on more prevalent CVD events in the screened as compared with the clinically detected group (propensity score 0.59 vs. 0.46, p<0.0001). After a mean follow-up of 10 and 11.5 years for screening detected and clinically detected subjects respectively, HRs incidences were for all-cause mortality 1.01 (p=0.97), CVD 1.00 (p=0.99), and MI 1.03 (p=0.87). For stroke a 24% non-significant lower risk for screening detected as compared with clinically detected subjects were found, HR 0.76 (p=0.15).

Conclusions

No reduction in total mortality and CVD outcomes was found in type 2 diabetes subjects detected by screening as compared with those clinically diagnosed, even though stroke incidence tended to be lower.

Keyword [en]
Diabetes, screening, clinically diagnosed, macrovascular outcomes, longitudinal
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-210918OAI: oai:DiVA.org:uu-210918DiVA: diva2:667549
Available from: 2013-11-26 Created: 2013-11-17 Last updated: 2017-12-06Bibliographically approved
In thesis
1. A Longitudinal Study of Diabetes Mellitus: With Special Reference to Incidence and Prevalence, and to Determinants of Macrovascular Complications and Mortality
Open this publication in new window or tab >>A Longitudinal Study of Diabetes Mellitus: With Special Reference to Incidence and Prevalence, and to Determinants of Macrovascular Complications and Mortality
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives. To investigate diabetes prevalence, incidence, mortality trends, the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment, and the effect of screening detection on total and cardiovascular disease (CVD), myocardial infarction (MI) and stroke incidence.

Study population and methods. Between 1972 and 2001 all patients with diabetes, some detected clinically and some by case-finding procedures (screening), were entered in a diabetes register at Laxå Primary Health Care Center in Sweden. The register included information on medical treatment and laboratory data as well as information on mortality and morbidity from National Registers. The register was supplemented with five non-diabetic subjects, matched to each diabetes patients by age, sex, and year of detection.

Results. During the study period 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. Age standardised incidence and prevalence rates for type 1 and type 2 diabetes did not increase over time. Diabetic patients had 17% higher mortality rate than non-diabetic persons, 22% in women and 13% in men. The corresponding over-mortality in CVD was 33%, 41% in women and 27% in men. CVD mortality decreased across time in non-diabetic subjects and in diabetic men but not in diabetic women. Results regarding coronary heart disease (CHD) were similar. CVD incidence increased with fasting blood glucose (FBG), body mass index (BMI), mean arterial blood pressure (MABP), and decreased with metformin treatment and sulfonylurea. Myocardial infarction incidence increased with FBG, BMI and MABP, and decreased with metformin treatment. Stroke incidence increased with MABP. There was no difference in prognoses between those detected by screening or clinically.

Conclusions. Diabetes prevalence and incidence did not change over time. The over-mortality according to diabetes was moderate. CVD and MI during follow up were negatively affected by hypertension and hyperglycaemia, and positively by pharmacological diabetic treatment. For stroke no pharmacological protective effect was seen. Screening did not improve prognosis.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 132 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 955
Keyword
Diabetes mellitus, clinical epidemiology, longitudinal study, prevalence, incidence, mortality, macrovascular complications, pharmacological diabetes treatment, hypertension treatment, screening
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-210916 (URN)978-91-554-8819-2 (ISBN)
Public defence
2014-01-17, Wilandersalen, Universitetssjukhuset, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2013-12-18 Created: 2013-11-17 Last updated: 2014-01-24

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Jansson, Stefan P.O.

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