| Title: | Diabetes-Related Macrovascular Complications Are Associated With an Increased Risk of Diabetic Microvascular Complications: A Prospective Study of 1518 Patients With Type 1 Diabetes and 20 802 Patients With Type 2 Diabetes in the UK Biobank |
| Journal: | Journal of the American Heart Association |
| Published: | 31 May 2024 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/38818935/ |
| DOI: | https://doi.org/10.1161/jaha.123.032626 |
| URL: | http://dx.doi.org/10.1161/jaha.123.032626 |
Publication 11947
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Abstract
BACKGROUND: Diabetic vascular complications share common pathophysiological mechanisms, but the relationship between diabetes-related macrovascular complications (MacroVCs) and incident diabetic microvascular complications remains unclear. We aimed to investigate the impact of MacroVCs on the risk of microvascular complications.</p>
METHODS AND RESULTS: There were 1518 participants with type 1 diabetes (T1D) and 20 802 participants with type 2 diabetes from the UK Biobank included in this longitudinal cohort study. MacroVCs were defined by the presence of macrovascular diseases diagnosed after diabetes at recruitment, including coronary heart disease, peripheral artery disease, stroke, and ≥2 MacroVCs. The primary outcome was incident microvascular complications, a composite of diabetic retinopathy, diabetic kidney disease, and diabetic neuropathy. During a median (interquartile range) follow-up of 11.61 (5.84-13.12) years and 12.2 (9.50-13.18) years, 596 (39.3%) and 4113 (19.8%) participants developed a primary outcome in T1D and type 2 diabetes, respectively. After full adjustment for conventional risk factors, Cox regression models showed significant associations between individual as well as cumulative MacroVCs and the primary outcome, except for coronary heart disease in T1D (T1D: diabetes coronary heart disease: 1.25 [0.98-1.60]; diabetes peripheral artery disease: 3.00 [1.86-4.84]; diabetes stroke: 1.71 [1.08-2.72]; ≥2: 2.57 [1.66-3.99]; type 2 diabetes: diabetes coronary heart disease: 1.59 [1.38-1.82]; diabetes peripheral artery disease: 1.60 [1.01-2.54]; diabetes stroke: 1.50 [1.13-1.99]; ≥2: 2.66 [1.92-3.68]). Subgroup analysis showed that strict glycemic (glycated hemoglobin <6.5%) and blood pressure (<140/90 mm Hg) control attenuated the association.</p>
CONCLUSIONS: Individual and cumulative MacroVCs confer significant risk of incident microvascular complications in patients with T1D and type 2 diabetes. Our results may facilitate cost-effective high-risk population identification and development of precise prevention strategies.</p>
19 Keywords
- Adult
- Aged
- Biological Specimen Banks
- Diabetes Mellitus, Type 1
- Diabetes Mellitus, Type 2
- Diabetic Angiopathies
- Diabetic Nephropathies
- Diabetic Neuropathies
- Diabetic Retinopathy
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Prospective Studies
- Risk Assessment
- Risk Factors
- UK Biobank
- United Kingdom
12 Authors
- Xinyu Zhang
- Shuzhi Zhao
- Yikeng Huang
- Mingming Ma
- Bo Li
- Chenxin Li
- Xinyu Zhu
- Xun Xu
- Haibin Chen
- Yili Zhang
- Chuandi Zhou
- Zhi Zheng
1 Application
| Application ID | Title |
|---|---|
| 88982 | To explore the role and underlying mechanisms of circadian rhythm in the development and progression of diabetic retinopathy (DR) |
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