Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population
Introduction Diabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Res...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e001413.full |
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| author | Charumathi Sabanayagam Ching-Yu Cheng Tien-Yin Wong Wan Ting Tay Jonathan Yap Daniel Ting Kamalesh Anbalakan Carol Yim Cheung Khung Keong Yeo |
| author_facet | Charumathi Sabanayagam Ching-Yu Cheng Tien-Yin Wong Wan Ting Tay Jonathan Yap Daniel Ting Kamalesh Anbalakan Carol Yim Cheung Khung Keong Yeo |
| author_sort | Charumathi Sabanayagam |
| collection | DOAJ |
| description | Introduction Diabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methods This was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.Results A total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).Conclusion Diabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes. |
| format | Article |
| id | doaj-art-919016799b7a48a497e628a9606d2f2f |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-919016799b7a48a497e628a9606d2f2f2024-12-12T10:25:12ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2020-001413Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian populationCharumathi Sabanayagam0Ching-Yu Cheng1Tien-Yin Wong2Wan Ting Tay3Jonathan Yap4Daniel Ting5Kamalesh Anbalakan6Carol Yim Cheung7Khung Keong Yeo83 Duke-NUS Medical School, National University of Singapore, SingaporeOcular Epidemiology Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, SingaporeDuke-NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Ophthalmology, Singapore Eye Research Institute, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong KongDepartment of Cardiology, National Heart Center Singapore, SingaporeIntroduction Diabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methods This was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.Results A total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).Conclusion Diabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.https://drc.bmj.com/content/9/1/e001413.full |
| spellingShingle | Charumathi Sabanayagam Ching-Yu Cheng Tien-Yin Wong Wan Ting Tay Jonathan Yap Daniel Ting Kamalesh Anbalakan Carol Yim Cheung Khung Keong Yeo Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population BMJ Open Diabetes Research & Care |
| title | Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population |
| title_full | Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population |
| title_fullStr | Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population |
| title_full_unstemmed | Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population |
| title_short | Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population |
| title_sort | impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic asian population |
| url | https://drc.bmj.com/content/9/1/e001413.full |
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