Key result
Later calendar period linked to ~29% lower severe complication risk in type 2 diabetes.
Why the study?
This study was conducted to examine long-term trends in severe diabetes-related complications (acute myocardial infarction, stroke, lower extremity amputation, and end-stage renal disease) and the prevalence of multiple complications in the total population with diabetes in Finland over an 18-year period.
Did the prevalence and risk of single and multiple severe diabetes-related complications (AMI, stroke, lower extremity amputation, and ESRD) change between 1994–1999 and 2006–2011 among adults aged ≥30 years with type 1 and type 2 diabetes in Finland?
Cohort (n=342,028)
Yes
Did the prevalence and risk of single and multiple severe diabetes-related complications (AMI, stroke, lower extremity amputation, and ESRD) change between 1994–1999 and 2006–2011 among adults aged ≥30 years with type 1 and type 2 diabetes in Finland?
Answers are grounded in this paper and cite their sources.
Over 18 years in Finland, the risk of single and multiple severe vascular and renal complications declined substantially among people with type 2 diabetes—driven largely by reductions in acute myocardial infarction and stroke—whereas the risk of multiple complications increased in type 1 diabetes, and any severe complication remained strongly associated with excess mortality.
OBJECTIVE: In this study, we examined trends in severe diabetes-related complications (acute myocardial infarction, stroke, lower extremity amputation, and end-stage renal disease) and prevalence of multiple complications in a total population with diabetes in Finland during an 18-year period. RESEARCH DESIGN AND METHODS: The total population with diabetes aged 30 years or older in 1994-2011 was obtained from several Finnish health registers. Only the first episode of each end point was included in the analysis. We examined trends in the prevalence of these end points using age-standardization and changes in these end points were analyzed using repeated-measures Poisson regression models. RESULTS: The prevalence of single comorbidities decreased during the study period, especially for acute myocardial infarction and stroke. The age-adjusted and diabetes duration-adjusted risk of having one of these end points decreased throughout the study period among persons with type 2 diabetes. Among women, the risk ratio was 0.71 (0.63 to 0.79) in 2006-2011 compared to 1994-1999, and among men, the figure was 0.72 (0.66 to 0.78). In type 1 diabetes, the risk of multiple serious complications increased. We further found increased mortality risk among persons with any of these complications irrespective of diabetes type. CONCLUSIONS: Our results concerning the development of risk of complications suggest improvements in the management of diabetes. More attention needs to be paid to the prevention of complications among older persons and those with longer history of diabetes to prevent clustering of complications and to prevent the diabetes epidemic in the population to reduce the public health burden of diabetes.
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Forssas et al. (2016) conducted a cohort in Type 1 and Type 2 diabetes (n=342,028). Later time period (2006–2011) of diabetes management vs. Earlier time period (1994–1999) was evaluated on Age- and diabetes duration-adjusted risk of having one severe diabetes-related complication (AMI, stroke, lower extremity amputation, or ESRD) among women with type 2 diabetes (RR 0.71, 95% CI 0.63-0.79, p=<0.001). Later calendar period (2006–2011 vs 1994–1999) was associated with a reduced risk of a single severe complication in type 2 diabetes (RR 0.71 in women; RR 0.72 in men), driven by declines in AMI and stroke.
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