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Effects of fasting blood glucose, diabetes treatment, blood pressure, and hypertension treatment on cardiovascular disease incidence: 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: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491Article in journal (Refereed) Submitted
Abstract [en]

Aims: To analyse the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment on total and various types of cardiovascular disease (CVD) incidence in patients with type 2 diabetes followed for 30 years.

Methods: 740 incident patients with type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Annual information on systolic, diastolic, and mean arterial blood pressure (MABP), mean fasting blood glucose (FBG), type of diabetes and hypertension treatment was obtained from the patient records, and information on CVD, myocardial infarction (MI), and stroke events from National Registers.

Results: During the follow-up period cumulative CVD incidence increased significantly with male sex (HR 1.48, 95% CI 1.21-1.82), number of previous CVD events (HR 1.13, 95% CI 1.08-1.18) age (HR 1.05, 95% CI 1.04-1.07), mean FBG (HR 1.05, 96% CI 1.00-1.10) BMI, (HR 1.04, 95% CI 1.01-1.06), MABP (HR 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (HR 0.58, 95% CI 0.38-0.90) and sulfonylurea (HR 0.73, 95% CI 0.55-0.97). Cumulative MI incidence increased significantly with male sex, number of previous MI events, mean FBG, BMI, age, and MABP, and decreased with metformin treatment. Cumulative stroke incidence increased with previous number of stroke events, age, and MABP.

Conclusions: Cumulative CVD and MI incidence increased with number of previous events and presence of hypertension and hyperglycaemia and decreased with pharmacological diabetic treatment. For stroke, previous number of events increased the incidence but no pharmacological protective effect was seen.

Keyword [en]
Diabetes, CVD, blood pressure, blood glucose, drug treatment, longitudinal
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-211531OAI: oai:DiVA.org:uu-211531DiVA: diva2:667550
Available from: 2013-11-26 Created: 2013-11-25 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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