A community study of newly diagnosed type 2 diabetes - incidence, cardiovascular risk and early mortality : the Poole Diabetes Study

Abstract

The Poole Diabetes Study commenced in 1996 to investigate the prevalence of diagnosed type 2 diabetes in a defined community.

In July 2001, I undertook a further review of all records and physical examination of available survivors to establish outcomes. I evaluate the performance of the Framingham and UKPDS cardiovascular and coronary heart disease risk calculators demonstrating that at the level of the individual, these calculators have modest discrimination and poor calibration. I have shown that the metabolic syndrome is associated with a twofold hazard of primary cardiovascular disease in people newly diagnosed with type 2 diabetes and disease-free survival incrementally worsens with the number of features present. The mortality data shows that people with newly diagnosed type 2 diabetes have an appropriate doubling in their odds of dying. The increased risk is seen in all age groups, including the elderly, and for all the causes of mortality. Early mortality in middle-aged women appears to be most affected by a diagnosis of type 2 diabetes. I have explored the relationship between geographic deprivation indices and both cardiovascular disease and early mortality showing that there is a strong and consistent association and have documented the lack of association between mild to modest reductions in calculated glomerular filtration rate at diagnosis and early mortality in type 2 diabetes.

I hope that by defining disease burden, particularly cardiovascular and mortality outcomes and the predictors of these outcomes in people with newly diagnosed type 2 diabetes, this study will help establish the basis for intervention trials and the development of risk calculation tools and clinical services for individuals who develop type 2 diabetes in the future.

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