Year: 2013
Type: dissertation
Study design: Observational Study
Abstract: The prevalence of diabetes is increasing rapidly in Finland. The increase is mainly due to a sedentary lifestyle and obesity, but other unknown factors most certainly also play a role, especially in diabetes of children and young adults. Diabetes is a strong risk factor for macrovascular complications. Since the incidences of acute coronary syndrome (ACS), stroke and major amputations are decreasing in Finland, it is important that diabetic patients benefit from these favourable developments as well as does the general population. To study the development, we analysed the trends in case fatality (CF) of the first ACS and first ischaemic stroke, the incidence of lower-extremity amputations and population attributable-fractions (PAFs) of ACS and ischaemic stroke due to diabetes. We executed a register study combining information from the national reimbursement registers of medicines, Hospital Discharge Register and Causes-of-Death Register to identify all persons that have been treated with hypoglycaemic medication or registered with a diabetes diagnosis, and their macrovascular complications from 1992 to 2002. Comparisons were made in both genders and various age groups in the nondiabetic population. Data for comparison were available through the National Cardiovascular Disease Register. Our main findings were that the diabetic population has benefited from the favourable development to the same extent as the nondiabetic population (I, II). Prognoses after the first ACS and the first ischaemic stroke are improving. The incidence of lower-extremity amputation is decreasing (III). The prognoses of patients with diabetes are still, however, far from the prognoses of the nondiabetic population. Patients with type 2 diabetes (T2DM) had a total 1-year CF of 65.2% compared with 56.5% among nondiabetic men after their first ACS (I). The corresponding figures for women were 61.0% and 48.3%. The risk ratio (RR) for 28-day CF after the first ACS was 1.34 (95% CI (confidence interval) 1.24 1.45) among T2DM men 35 64 years of age compared with nondiabetic men in the same age group, and 1.69 (95% CI 1.44 1.97) among T2DM women with nondiabetic women, again in the same age group. The difference was greatest in the younger age groups and became less clear in the older age groups. The risk of fatal outcome within a year for 28-day survivors was considerable in patients with T2DM, RR 2.87 (95% CI 2.19 3.75) among men and 5.84 (3.70 9.23) among women 35 64 years of age. There was a statistically significant downward trend in 28-day CF and in 1-year CF of 28-day survivors both among patients with T2DM and nondiabetic patients. The trends did not differ between patients with T2DM and nondiabetic persons. The total 1-year cardiovascular disease (CVD) CF after the first ischaemic stroke was 1.2 1.6 times higher among patients with T2DM compared with nondiabetic persons, depending on gender and age group (II). The 28-day CF was 1.1 1.3 times higher among patients with T2DM. The difference was biggest in the younger age group of men. The 1-year CVD CF of 28-day survivors was 1.4 2.2 times higher in patients with T2DM and this difference was biggest in the younger age group of women. There was a statistically significant downward trend during the study period in CF of the first ischaemic stroke at 0 27 days and 28 364 days after the stroke. The trends did not differ between patients with T2DM and nondiabetic persons. The crude rate of first amputations decreased from 924 to 387 per 100 000 diabetic persons (III). The decrease was similar in men and women. There were major differences in the pace of development among the hospital districts. The ratio of minor and major amputations had a positive development during the study period and the rate of first major amputations among diabetic patients decreased in the Finnish population. The PAF of the first CVD event due to diabetes showed an upward trend among men from 11.4% (95% CI 10.8 12.0%) to 13.8% (95% CI 13.2 14.5%), p for trend less than 0.0001, and a downward trend among women from 20.1% (95% CI 19.2 21.0%) to 16.9% (95% CI 15.9 17.8%), p for trend 0.0005 (IV). The upward trend was statistically significant in the first ACS event among men and the downward trend was statistically significant in the first ischaemic stroke in women. In conclusion, our results showed that the contribution of diabetes to the burden of first CVD events remained considerable. However, despite the increase in prevalence of diabetes, the PAF of the first CVD event decreased in women and increased only slightly in men. Strong actions should be taken to improve comprehensive treatment of risk factors after diagnosis of diabetes mellitus and efficiency of secondary prevention after a cardiovascular event. Special attention should be focused on better secondary prevention, because the largest difference between T2DM and nondiabetic persons was in 1-year prognosis of 28-day survivors after the first ACS or ischaemic stroke.
Source: Työväentutkimus Vuosikirja
Author: Klas Winell
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1529623476