Diabetes heterogeneity and risk for microvascular complications

  • Maddaloni E & al.
  • Lancet Diabetes Endocrinol
  • 1 Mar 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Patients with latent autoimmune diabetes have a lower risk of developing microvascular complications over 9 years vs those with type 2 diabetes (T2D), followed by a later higher risk of complications vs T2D, secondary to worse glycaemic control.

Why this matters

  • Implementation of strict glycaemic control from the time of diagnosis may lower the later risk for microvascular complications in patients with latent autoimmune diabetes.

Study design

  • A post-hoc analysis of 30-year data from the UK Prospective Diabetes Study (UKPDS) included 5028 participants with newly diagnosed T2D.
  • Primary outcome: composite microvascular outcomes (first occurrence of renal failure, renal death, blindness, vitreous haemorrhage and retinal photocoagulation).
  • Funding: European Foundation for the Study of Diabetes Mentorship Programme (AstraZeneca).

Key results

  • Of 5028 participants, 564 were diagnosed with latent autoimmune diabetes and 4464 diagnosed with T2D.
  • After median 17.3 (interquartile range, 12.6-20.7) years of follow-up, the composite microvascular outcome occurred in 1041 (21%) participants
  • The incidence for the composite microvascular outcome was 15.8 (95% CI, 13.4-18.7) per 1000 person-years in latent autoimmune diabetes vs 14.2 (95% CI, 13.3-15.2] per 1000 person-years in T2D.
  • During the follow-up of 9 years, patients with latent autoimmune diabetes were at a lower risk for the composite outcome vs those with T2D (adjusted HR [aHR], 0.45; 95% CI, 0.30-0.68; P<.0001 whereas the risk was higher in subsequent years ci p=".047).</li">
  • Correcting for the higher updated 9-year mean haemoglobin A1c demonstrated a higher risk for composite microvascular outcome in patients with autoimmune diabetes vs those with T2D (aHR, 0.99; 95% CI, 0.80-1.23; P=.93).

Limitations

  • Post-hoc analysis.