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Association of type 2 diabetes remission and risk of cardiovascular disease in pre-defined subgroups

Association of type 2 diabetes remission and risk of cardiovascular disease in pre-defined subgroups
Association of type 2 diabetes remission and risk of cardiovascular disease in pre-defined subgroups
Aim: to quantify the association between type 2 diabetes remission and 5-year incidence of cardiovascular disease outcomes, overall and in pre-defined subgroups. Methods: retrospective cohort analysis of 60,287 adults with type 2 diabetes from the Care and Health Information Analytics (CHIA) database. Multivariable Cox models were used to assess the association between remission within the first two years of follow-up and incidence of cardiovascular disease (CVD) outcomes including events, microvascular and macrovascular complications at 7-year follow-up. Effect modification by age, sex, diabetes duration, pre-existing CVD, baseline body mass index (BMI) and HbA1c level were assessed. Results: 7489 (12.4%) people achieved remission during the first two years of follow-up. Overall, remission was associated with lower risk of CVD outcomes. Remission was associated with lower risk of microvascular complications for younger compared to older age groups (for example, aHR: 0.59 (0.41-0.84) and aHR: 0.78 (0.67-0.92) for those aged <45 years and 75-84 years, respectively). Among those achieving remission, those with no or 1-2 comorbidities had lower risk of microvascular complications (aHR: 0.65 (0.56-0.75) compared to those with more than 3 comorbidities (aHR: 0.83 (0.69-0.99), respectively). There were no significant interactions in the remaining subgroups or for models assessing CVD events or macrovascular complications. Conclusions: achieving remission of type 2 diabetes is associated with a lower risk of microvascular complications, particularly for younger groups and those with fewer comorbidities. Targeted interventions that focus on promoting remission in these groups may reduce the impact of microvascular complications and associated health costs.
epidemiology, healthcare delivery, lifestyle, macrovascular disease, microvascular disease
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Farmer, Andrew
c384123c-1276-4d06-a2b5-d5419bd83b1d
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Farmer, Andrew
c384123c-1276-4d06-a2b5-d5419bd83b1d
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1

Hounkpatin, Hilda, Stuart, Beth, Farmer, Andrew and Dambha-Miller, Hajira (2021) Association of type 2 diabetes remission and risk of cardiovascular disease in pre-defined subgroups. Endocrinology, Diabetes & Metabolism, 4 (3), [e00280]. (doi:10.1002/edm2.280). (In Press)

Record type: Article

Abstract

Aim: to quantify the association between type 2 diabetes remission and 5-year incidence of cardiovascular disease outcomes, overall and in pre-defined subgroups. Methods: retrospective cohort analysis of 60,287 adults with type 2 diabetes from the Care and Health Information Analytics (CHIA) database. Multivariable Cox models were used to assess the association between remission within the first two years of follow-up and incidence of cardiovascular disease (CVD) outcomes including events, microvascular and macrovascular complications at 7-year follow-up. Effect modification by age, sex, diabetes duration, pre-existing CVD, baseline body mass index (BMI) and HbA1c level were assessed. Results: 7489 (12.4%) people achieved remission during the first two years of follow-up. Overall, remission was associated with lower risk of CVD outcomes. Remission was associated with lower risk of microvascular complications for younger compared to older age groups (for example, aHR: 0.59 (0.41-0.84) and aHR: 0.78 (0.67-0.92) for those aged <45 years and 75-84 years, respectively). Among those achieving remission, those with no or 1-2 comorbidities had lower risk of microvascular complications (aHR: 0.65 (0.56-0.75) compared to those with more than 3 comorbidities (aHR: 0.83 (0.69-0.99), respectively). There were no significant interactions in the remaining subgroups or for models assessing CVD events or macrovascular complications. Conclusions: achieving remission of type 2 diabetes is associated with a lower risk of microvascular complications, particularly for younger groups and those with fewer comorbidities. Targeted interventions that focus on promoting remission in these groups may reduce the impact of microvascular complications and associated health costs.

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Remission and CVD events_CLEAN_26 Apr 21 - Accepted Manuscript
Restricted to Repository staff only until 1 May 2022.
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Accepted/In Press date: 1 May 2021
Additional Information: HDM is a National Institute for Health Research funded Academic Clinical Lecturer and has received NIHR SPCR funding (SPCR2014-10043) for this project. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the UK National Institute for Health Research (NIHR) or the Department of Health and Social Care. AF is a NIHR Senior Investigator and receives support from NIHR Oxford BioMedical Research Centre. The funders had no input into the interpretation or publication of the study results
Keywords: epidemiology, healthcare delivery, lifestyle, macrovascular disease, microvascular disease

Identifiers

Local EPrints ID: 449408
URI: http://eprints.soton.ac.uk/id/eprint/449408
PURE UUID: c9b30e24-3930-443b-b64a-c3fc8bfefdbd
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Hajira Dambha-Miller: ORCID iD orcid.org/0000-0003-0175-443X

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Date deposited: 27 May 2021 16:31
Last modified: 10 Jan 2022 03:17

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Author: Beth Stuart ORCID iD
Author: Andrew Farmer

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