TY - JOUR
T1 - Trends in mortality, cardiovascular complications, and risk factors in type 2 diabetes
AU - Heintjes, E. M.
AU - Houben, E.
AU - Beekman-Hendriks, W. L.
AU - Lighaam, E.
AU - Cremers, S. M.
AU - Penning-van Beest, F. J. A.
AU - Stehouwer, C. D. A.
AU - Herings, R. M. C.
N1 - Funding Information:
This study was sponsored by AstraZeneca BV. Previous publications: Some of the study results were presented as a poster at the European Associate for the Study of Diabetes meeting held October 1st – 4th, 2018 in Berlin, Germany; and as an oral presentation at The Professional Society for Health Economics and Outcomes Research Europe 2018 Conference held November 10-14th, 2018 in Barcelona, Spain; as well as the Annual Dutch Diabetes Research Meeting 2018 held November 28-29th, 2018 in Oosterbeek, the Netherlands.
Funding Information:
The authors would like to thank all the healthcare providers contributing information to the PHARMO Database Network. This study was sponsored by AstraZeneca BV. Previous publications: Some of the study results were presented as a poster at the European Associate for the Study of Diabetes meeting held October 1st - 4th, 2018 in Berlin, Germany; and as an oral presentation at The Professional Society for Health Economics and Outcomes Research Europe 2018 Conference held November 10-14th, 2018 in Barcelona, Spain; as well as the Annual Dutch Diabetes Research Meeting 2018 held November 28-29th, 2018 in Oosterbeek, the Netherlands.
Publisher Copyright:
© MacChain. All rights reserved.
PY - 2019/11
Y1 - 2019/11
N2 - Background: Quality of diabetes care in the Netherlands ranked second in the Euro Diabetes Index 2014, but data on outcomes are lacking. We assessed trends in cardiovascular disease and mortality among type 2 diabetes (T2DM) patients in the context of risk factor control.Methods: Annual cohorts of adult T2DM patients were constructed from the PHARMO Database Network. Age-standardised mortality rates and incidence rates (IR) of hospitalisations for acute myocardial infarction (AMI), stroke, and congestive heart failure (CHF) were compared with a diabetes-free population matched on age, sex, and general practitioner. Life years lost (LYL) to T2DM or cardiovascular disease were determined by comparing life expectancy between matched groups. Proportions attaining glycated haemoglobin (HbAic), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) goals were assessed annually.Results: Among 53,602 T2DM patients, slight increases in IR between 2008 and 2016 were proportional to those in diabetes-free controls; on average T2DM increased the risk of mortality by 86%, hospitalisation for AMI 69%, stroke 57%, and CHF 185%. At age 55, LYL to T2DM averaged 3.5 years and established CVD added 1.8 years, irrespective of sex. HbAIc goal attainment increased from 58% to 65%, LDL-C from 56% to 65%, and systolic BP from 57% to 72%. Conclusion: Despite highly organised diabetes care, excess incident cardiovascular events and mortality due to T2DM did not decrease over the study period. Life expectancy of T2DM patients is significantly reduced and risk factor control is suboptimal. This suggests there is considerable room for improvement of diabetes care in the Netherlands.
AB - Background: Quality of diabetes care in the Netherlands ranked second in the Euro Diabetes Index 2014, but data on outcomes are lacking. We assessed trends in cardiovascular disease and mortality among type 2 diabetes (T2DM) patients in the context of risk factor control.Methods: Annual cohorts of adult T2DM patients were constructed from the PHARMO Database Network. Age-standardised mortality rates and incidence rates (IR) of hospitalisations for acute myocardial infarction (AMI), stroke, and congestive heart failure (CHF) were compared with a diabetes-free population matched on age, sex, and general practitioner. Life years lost (LYL) to T2DM or cardiovascular disease were determined by comparing life expectancy between matched groups. Proportions attaining glycated haemoglobin (HbAic), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) goals were assessed annually.Results: Among 53,602 T2DM patients, slight increases in IR between 2008 and 2016 were proportional to those in diabetes-free controls; on average T2DM increased the risk of mortality by 86%, hospitalisation for AMI 69%, stroke 57%, and CHF 185%. At age 55, LYL to T2DM averaged 3.5 years and established CVD added 1.8 years, irrespective of sex. HbAIc goal attainment increased from 58% to 65%, LDL-C from 56% to 65%, and systolic BP from 57% to 72%. Conclusion: Despite highly organised diabetes care, excess incident cardiovascular events and mortality due to T2DM did not decrease over the study period. Life expectancy of T2DM patients is significantly reduced and risk factor control is suboptimal. This suggests there is considerable room for improvement of diabetes care in the Netherlands.
KW - Cardiovascular events
KW - glucose-lowering drugs
KW - mortality
KW - risk factor control
KW - type 2 diabetes
KW - MICROVASCULAR OUTCOMES
KW - METAANALYSIS
KW - DISEASE
M3 - Article
SN - 0300-2977
VL - 77
SP - 317
EP - 329
JO - Netherlands Journal of Medicine
JF - Netherlands Journal of Medicine
IS - 9
ER -