Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational A1chieve study

Diabetology & Metabolic Syndrome

Mohammad E Khamseh¹  Vinay Prusty⁴  Rachid Malek²  Zanariah Hussein⁵  Su-Yen Goh⁶  Leon Litwak³ 

[1]Endocrine Research Centre (Firouzgar), Institute of Endocrinology & Metabolism, Tehran University of Medical Sciences, Tehran, Iran

[2]Department of Internal Medicine, CHU Sétif, Sétif, Algeria

[3]Endocrinology and Nuclear Medicine Unit, Diabetes and Metabolism Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

[4]Novo Nordisk A/S, Zürich, Switzerland

[5]Medical Department, Hospital Putrajaya, Putrajaya, Malaysia

[6]Department of Endocrinology, Singapore General Hospital, Singapore

关键词: Insulin analogues;    Type 2 diabetes;    Macro- and microvascular complications;    A₁chieve study;   

Others  :  812609
DOI  :  10.1186/1758-5996-5-57

 received in 2013-06-26, accepted in 2013-09-27,  发布年份 2013

【 摘 要 】

Background

Current International Diabetes Federation guidelines recommend a target HbA_1c <7.0%, but many people with diabetes worldwide find this difficult to achieve, increasing their risk of developing complications. This publication examines the prevalence of diabetes complications and its association with baseline characteristics in people with type 2 diabetes who participated in the A₁chieve study.

Methods

A₁chieve was a 24-week, multinational, open-label, observational study of 66,726 people with type 2 diabetes who had begun using biphasic insulin aspart 30, insulin aspart, or insulin detemir in routine clinical care. Participants were enrolled from 28 countries across four continents (Asia, Africa, Europe and South America). Baseline measurements of disease characteristics included: glycated haemoglobin (HbA_1c), fasting (FPG) and post-prandial plasma glucose (PPG), high- and low-density lipoprotein cholesterol (H- or LDL-C), systolic blood pressure (SBP), and body mass index (BMI). Data on complications and use of vascular disease preventative drugs were collected.

Results

Complication rates were high (27.2% had macrovascular complications and 53.5% had microvascular complications), particularly in Russia, and use of vascular disease preventative drugs was lower than expected. Age, BMI, diabetes duration, LDL-C, and SBP were positively associated, and HDL-C negatively associated, with macro- and microvascular complications (all p < 0.05). HbA_1c and FPG were negatively associated with macrovascular complications (both p < 0.05), which may be linked to the cross-sectional study design.

Conclusions

These results suggest a worldwide failure to achieve glycaemic targets. Better diabetes management with earlier initiation and optimisation of insulin regimens (e.g., with insulin analogues in the A₁chieve population) may reduce the prevalence of vascular complications, improve the lives of people with diabetes and reduce the burden on healthcare systems.

【 授权许可】

   
2013 Litwak et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000, 321:405-412.
• [2]Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA: 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008, 359:1577-1589.
• [3]International Diabetes Federation Clinical Guidelines Task Force: Global Guidelines for Type 2 Diabetes. 2012. http://www.idf.org/sites/default/files/IDF-Guideline-for-Type-2-Diabetes.pdf webcite
• [4]Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR: Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012, 35:1364-1379.
• [5]International Diabetes Federation: Guideline for Management of PostMeal Glucose in Diabetes. 2011. http://www.idf.org/sites/default/files/postmeal%20glucose%20guidelines.pdf webcite
• [6]National Institute for Health and Clinical Excellence: National Institute for Health and Clinical Excellence (NICE) Guidelines. Type 2 diabetes: The Management of Type 2 Diabetes. London: Royal College of Physicians; 2008.
• [7]Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD: Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet 2010, 375:481-489.
• [8]Saaddine JB, Cadwell B, Gregg EW, Engelgau MM, Vinicor F, Imperatore G, Narayan KM: Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002. Ann Intern Med 2006, 144:465-474.
• [9]Saydah SH, Fradkin J, Cowie CC: Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004, 291:335-342.
• [10]Vaag A, Lund SS: Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues. Eur J Endocrinol 2012, 166:159-170.
• [11]Chan JC, Gagliardino JJ, Baik SH, Chantelot JM, Ferreira SR, Hancu N, Ilkova H, Ramachandran A, Aschner P, IDMPS Investigators: Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS). Diabetes Care 2009, 32:227-233.
• [12]Delamater AM: Improving patient adherence. Clinical Diabetes 2006, 24:71-77.
• [13]Elgrably F, Costagliola D, Chwalow AJ, Varenne P, Slama G, Tchobroutsky G: Initiation of insulin treatment after 70 years of age: patient status 2 years later. Diabet Med 1991, 8:773-777.
• [14]Korytkowski M: When oral agents fail: practical barriers to starting insulin. Int J Obes Relat Metab Disord 2005, 26(Suppl. 3):S18-24.
• [15]Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE: Psychosocial problems and barriers to improved diabetes management: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabet Med 2005, 22:1379-1385.
• [16]Raman R, Gupta A, Kulothungan V, Sharma T: Prevalence and risk factors of diabetic retinopathy in subjects with suboptimal glycemic, blood pressure and lipid control. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, Report 33). Curr Eye Res 2012, 37:513-523.
• [17]Home P, Naggar NE, Khamseh M, Gonzalez-Galvez G, Shen C, Chakkarwar P, Wenying Y: An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study. Diabetes Res Clin Pract 2011, 94:352-363.
• [18]World Medical Association: Declaration of Helsinki - Ethical Principles for Medical Research involving Human Subjects. 2008. http://www.riip-influenza.org/wp-content/uploads/2011/08/Helsinki-2008-EN.pdf webcite
• [19]International Society for Pharmacoepidemiology: Guidelines for Good Pharmacoepidemiology Practices (GPP). 2007. Revision 2, 2007. http://www.pharmacoepi.org/resources/guidelines_08027.cfm webcite.
• [20]EuroQol Group: EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 1990, 16:199-208.
• [21]Li HJ, Liu J, Liu J, Wang W, Qin LP, Li Y, Wang M, Sun JY, Qi Y, Zhao D: Real world use of statins for secondary prevention in patients with high risk coronary heart disease in China. Zhonghua Xin Xue Guan Bing Za Zhi 2010, 38:1033-1037.
• [22]Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R, Kleinebreil L: Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care 2005, 28:2673-2679.
• [23]Moore DJ, Gregory JM, Kumah-Crystal YA, Simmons JH: Mitigating micro-and macro-vascular complications of diabetes beginning in adolescence. Vasc Health Risk Manag 2009, 5:1015-1031.
• [24]Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993, 16:434-444.
• [25]Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, Witte DR, Fuller JH: EURODIAB Prospective Complications Study Group. Vascular risk factors and diabetic neuropathy. N Engl J Med 2005, 352:341-350.
• [26]Wandell PE: Risk factors for microvascular and macrovascular complications in men and women with type 2 diabetes. Scand J Prim Health Care 1999, 17:116-121.
• [27]Zoppini G, Negri C, Stoico V, Casati S, Pichiri I, Bonora E: Triglyceride-high-density lipoprotein cholesterol is associated with microvascular complications in type 2 diabetes mellitus. Metabolism 2012, 61:22-29.
• [28]Toth P: The 'good cholesterol': high density lipoprotein. Circulation 2005, 111:e89-91.
• [29]Krauss RM, Siri PW: Dyslipidemia in type 2 diabetes. Med Clin North Am 2004, 88:897-909.
• [30]Gorodeski G: Update on cardiovascular disease in post-menopausal women. Best Pract Res Clin Obstet Gynaecol 2002, 16:329-355.
• [31]Hayashi T, Kawashima S, Nomura H, Itoh H, Watanabe H, Ohrui T, Yokote K, Sone H, Hattori Y, Yoshizumi M, Ina K, Kubota K, Japan Cholesterol and Diabetes Mellitus Investigation Group: Age, gender, insulin and blood glucose control status alter the risk of ischemic heart disease and stroke among elderly diabetic patients. Cardiovasc Diabetol 2011, 10:86. BioMed Central Full Text
• [32]Awa W, Fach E, Krakow D, Weilp R, Kunder J, Voll A, Zeyfang A, Wagner C, Schutt M, Boehm B, de Souza M, Holl R, DPV Initiative, German BMBF Competence Networks Diabetes Mellitus and Obesity: Type 2 diabetes from pediatric to geriatric age: analysis of gender and obesity among 120–183 patients from the German/Austrian DPV database. Eur J Endocrinol 2012, 167:245-254.