medwireNews: Patients initiating second-line therapy for type 2 diabetes have a substantial burden of both microvascular and macrovascular complications, which varies by global region, the DISCOVER study investigators report.
Mikhail Kosiborod (Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA) and co-authors say their findings “highlight an opportunity for aggressive early risk factor modification, particularly in regions with a high prevalence of complications.”
The researchers explain that DISCOVER is a prospective observational study of 15,992 patients (mean age 57.2 years, 54.2% men) with type 2 diabetes (median duration 4.1 years) initiating second-line glucose-lowering therapy at primary and specialist healthcare settings in 38 countries.
At baseline, after standardization for age and sex, 17.9% of study participants had a history of microvascular complications, namely nephropathy, retinopathy, or neuropathy, while 9.2% had a history of macrovascular complications such as coronary artery disease, cerebrovascular disease, peripheral artery disease, heart failure, or implantable cardioverter defibrillator use.
Peripheral neuropathy was the most common microvascular complication overall, with a crude prevalence of 7.7%, followed by chronic kidney disease (5.0%), and albuminuria (4.3%).
The most common macrovascular complications were coronary artery disease (8.2%), heart failure (3.3%), and stroke (2.2%).
Europe had the highest prevalence of both microvascular (20.4%) and macrovascular (18.8%) complications. Within Europe the highest rates were observed in Russia, at 37.3% and 41.6%, respectively, compared with corresponding ranges of 4.8–23.0% and 8.5–19.2% in the 11 other European countries studied.
However, when the Russian data were excluded from the analysis, Europe still had the highest rates of vascular complications, which Kosiborod and co-authors say could be due to the fact that European patients had the highest mean BMI and blood pressure. The European region also had higher rates of screening for complications and more patients being seen in specialty settings than other regions, they observe.
The lowest rates of microvascular and macrovascular complications were recorded in the Americas (excluding the USA; 14.2%) and South-East Asia (4.1%).
Multivariate analysis showed that men were a significant 30% and 29% more likely than women to develop microvascular and macrovascular complications, respectively, while every 10-year increase in age significantly increased the risk for each complication by 14% and 41% respectively.
In addition, every additional year of diabetes duration increased microvascular and macrovascular risk by 3% and 2%, respectively, while a history of hypoglycemia was associated with 45% and 24% increased risks, respectively.
Of note, higher glycated hemoglobin was associated with an increased risk for microvascular (rate ratio=1.05 per 1% increment) but not macrovascular complications.
Writing in Cardiovascular Diabetology, Kosiborod et al point out that their “study is one of the first to offer a truly global view of the prevalence of vascular complications among patients with type 2 diabetes who are at relatively early stages of their disease.”
They add: “Over the coming years, the DISCOVER study program will add to our understanding by providing follow-up longitudinal data on the incidence of complications following initiation of second- and later-line therapies.”
By Laura Cowen
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