Multivariate Trajectories of Cardiometabolic Risk Factors and Complications in Elderly Chinese Patients With Type 2 Diabetes: A Retrospective Cohort Study

Background The current study aimed to identify the multivariate trajectories of cardiometabolic risk factors in elderly patients with type 2 diabetes and investigate their associations with cardiovascular disease and diabetic kidney disease (DKD). Methods A retrospective cohort of 27 288 patients with type 2 diabetes aged ≥60 years from China's National Basic Public Health Service Program was analyzed. All participants had ≥3 medical examinations from 2018 to 2023. A multivariate latent class mixed model was used to identify the sex‐specific multitrajectories of fasting plasma glucose, low‐density lipoprotein cholesterol, and diastolic blood pressure. Binary logistic regression estimated odds ratios (ORs) and 95% CIs for associations with cardiovascular disease, coronary heart disease, stroke, and DKD. Results Among elderly male patients, 3 quadratic trajectory groups were identified: stable (87.16%; n=7997), U shape (3.78%; n=347), and inverse U shape (9.06%; n=831). In elderly women, 2 quadratic trajectory groups were identified: stable (87.29%; n=15 810) and inverse U shape (12.71%; n=2303). In men, the U‐shape group had elevated risks of cardiovascular disease (OR, 1.66 [95% CI, 1.26–2.20]), coronary heart disease (OR, 1.60 [95% CI, 1.09–2.33]), stroke (OR, 1.58 [95% CI, 1.12–2.23]), and DKD (OR, 1.39 [95% CI, 1.11–1.74]); the inverse U‐shape group had increased DKD risk (OR, 1.35 [95% CI, 1.16–1.57]). In women, the inverse U‐shape group was associated with coronary heart disease (OR, 1.31 [95% CI, 1.12–1.53]) and DKD (OR, 1.65 [95% CI, 1.51–1.81]). Conclusions Distinct sex‐specific trajectories of cardiometabolic risk factors were associated with different risks of cardiovascular and diabetic kidney complications in elderly patients with type 2 diabetes. These findings support early identification and personalized management of adverse trajectories to potentially reduce long‐term complications in this population.