2286-P: Macrovascular Outcomes in Aging Patients with Type 2 Diabetes Mellitus

Introduction and Objective: Guidelines recommend control of A1c and cardiovascular (CVD) risk factors for T2DM management, but clinicians often emphasize A1c. To better understand the importance of age-appropriate CVD risk factor control, we evaluated the risks of a first macrovascular and a first serious microvascular event as patients with T2DM age. Methods: We utilized electronic health records data from a large health system between 2006-2024. Eligible patients had T2DM and were aged 40-85 y. For each age, we modeled the 5-year risks of a first macrovascular event (myocardial infarction, stroke, peripheral artery disease) and a first serious microvascular event (end-stage renal disease, painful diabetic neuropathy, proliferative retinopathy), using flexible parametric Gompertz survival models. Risks were estimated as the probability of each event type within 5 years among those event-free at the starting age. We defined the “crossover age” as the age at which the 5-year risk of first macrovascular event exceeded that for a first serious microvascular event. Results were estimated overall and stratified by A1c, 10 y ASCVD risk score, and smoking status. Results: Among 186,102 patients, the overall 5-year risk of first macrovascular event exceeded that for first microvascular event beginning at age 66 y (95% CI, 65.9-66.7). Patients with poor glycemic control had a crossover age as late as 73 y, reflecting increased microvascular risk (A1c <7.0%, 57 y [95% CI, 56.8-57.2]; 7.0-8.9%, 71 y [70.6-71.4]; ≥9.0%, 73 y [72.6-73.5]). However, patients with poor CVD risk factor control had a crossover age as early as 55 y, reflecting increased macrovascular risk (10 y ASCVD risk score <10.0%, 68 y [67.8-68.2]; 10.0-19.9%, 66 y [65.7-66.3]; ≥20.0%, 55 y [54.6-55.4]). For current smokers, the crossover age was just 52 y (95% CI, 49.3-54.7). Conclusion: While A1c control is critical for T2DM management, aging patients may benefit from increased focus on controlling BP, lipids, and smoking cessation to prevent the macrovascular sequelae of T2DM. Disclosure N.I. Hunter: None. B.J. Fesko: None. C. Boyer: None. M. Rothberg: Consultant; Current; Blue Cross Blue Shield Association. G.B. Taksler: None. Funding National Institutes of Aging (5T35AG086098-02)