Date Published: March 21, 2019
Publisher: Public Library of Science
Author(s): Myriam Rheinberger, Bettina Jung, Thomas Segiet, Johann Nusser, Günther Kreisel, Axel Andreae, Jochen Manz, Gerhard Haas, Bernhard Banas, Klaus Stark, Alexander Lammert, Mathias Gorski, Iris M. Heid, Bernhard K. Krämer, Carsten A. Böger, Karin Jandeleit-Dahm.
Patients with diabetes mellitus type 2 (DM2) are at high risk for micro- and macrovascular disease. Here, we explore the degree of traditional risk factor control in the baseline visit of a cohort of DM2 outpatients.
DIACORE (DIAbetes COhoRtE) is a prospective cohort study of 3000 adult DM2 outpatients. Here, we present results from the baseline visit. Sociodemographic and anthropometric variables, cardiovascular risk factors, comorbidities and medication were assessed by interview and medical exams. Serum-creatinine based estimated glomerular filtration rate (eGFRcrea) and urinary albumin-creatinine ratio (UACR) were determined for classification of chronic kidney disease (CKD). The proportion of patients with adequate control of traditional risk factors (blood pressure<140/90mmHg, HbA1c<7.5%, LDL<100mg/dl) was calculated in 2892 patients with non-missing data in 9 relevant variables within each KDIGO 2012 CKD class. In the analyzed baseline data (n = 2892, 60.2% men), mean (standard deviation) values for age, DM2 duration and HbA1c were 65.3 (9.3) years, 10.3 (8.4) years and 6.9% (1.1) respectively. Of these 2892 patients, 18.7% had CKD stage 3 or higher, 25.7% had UACR≥30mg/g. Adequate blood pressure, HbA1c and LDL control was achieved in 55.7%, 78.5% and 34.4%, respectively. In 16.4% of patients (473), all three risk factors were below recommended targets. The proportion of adequate risk factor control was similar across KDIGO eGFRcrea classes. Adequate blood pressure and HbA1c control were significantly associated with lower UACR category without and with controlling for other risk factors (p<0.0001, p = 0.0002, respectively). In our study of patients with diabetes mellitus type 2, we observed a low level of risk factor control indicating potential for risk reduction.
Prevalence of diabetes mellitus type 2 (DM2) is increasing worldwide and is already a major global public health issue [1, 2]. Patients with DM2 have an increased risk for micro- and macrovascular diseases such as coronary heart disease, peripheral arterial disease, retinopathy, chronic kidney disease (CKD) and end-stage renal disease (ESRD). Indeed, in every third patient with renal replacement therapy, diabetic nephropathy is claimed to be the underlying cause, making it the single most frequent cause of ESRD [3–5]. Similarly, DM2 patients have an up to four-fold risk of developing coronary heart disease and a significantly increased risk for cardiovascular mortality .
This analysis of the baseline visit of the DIACORE study provides important insights into an unselected outpatient DM2 collective: first, we observed the expected high prevalence of macro- and microvascular comorbidity. Second, blood pressure, HbA1c and lipid goals were attained in only 55.7%, 78.5% and 34.4% of patients respectively, despite a high number of prescribed drugs. This indicates a large potential for reducing macro- and microvascular risk in DM2 patients. Finally, adequate control of blood pressure and HbA1c control was significantly associated with decreased risk for higher categories of albuminuria levels.
DIACORE represents a large cohort of DM2 patients with a significant comorbidity, for which we present results from the baseline survey. Our findings suggest that there is a potential to further reduce macro- and microvascular burden through better risk factor control. Given the high comorbidity burden, further research on other disease mechanisms and risk factors is warranted. Due to its long-term follow-up as well as prospective data collection and bio-banking, we expect DIACORE to have an impact on future diagnostic and therapeutic strategies in DM2 patients.