Influence of glycaemic control on CV outcomes in diabetes

  • Tancredi M & al.
  • Open Heart
  • 1 Jan 2019

  • International Clinical Digest
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Takeaway

  • Excess risks for acute myocardial infarction (AMI) and coronary heart disease (CHD) death in patients with type 2 diabetes (T2D) without prior AMI are seen primarily in patients with worsening glucose control and renal function.
  • Excess risk is greatly attenuated in patients with on-target HbA1c without renal complications.

Why this matters

  • Cardiovascular disease is the major contributor to excess death in T2D.

Study design

  • Included 431,579 patients with T2D in the Swedish National Diabetes Register, 1998-2012, and 2,173,620 general population controls.  
  • Funding: Swedish Society of Medicine; Swedish State; Swedish Research Council.

Key results

  • Coronary events per 1000 person-years were 14.64 among persons with T2D (8.4%) and 8.73 in controls (5.3%).
  • After adjustments for sex, age, diabetes duration, country, education, and comorbidities, HR for AMI and CHD death was 1.42 for those with vs without T2D (95% CI, 1.41-1.44).
  • HRs for coronary events decreased with older age and were lower for men vs women across age groups.
  • With T2D and mean HbA1c 6.9%, normoalbuminuria, and estimated glomerular filtration rate ≥60 mL/minute/1.73 m2, HRs for coronary events were 0.94 (P=.0014) for men and 0.98 (P=.56) for women, vs controls.

Limitations

  • Some relevant variables were unavailable.
  • Possible residual confounders.
  • All-Swedish population.