September 12, 2014
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Age, diabetes duration increases risk for macrovascular complications

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For patients with type 2 diabetes, macrovascular events and death are associated with age or age at diagnosis and diabetes duration, according to research published in Diabetologia.

Microvascular events, however, are only connected with diabetes duration and the effect is greater in younger patients, a study involving patients from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial showed.

“Older age or age at diagnosis and longer diabetes duration proportionally increased the risk of macrovascular events and death, with the greatest risks observed in the oldest age groups with the longest duration of diabetes,” the researchers wrote. “The adverse effects of longer diabetes duration on the risk of microvascular events were reduced with older age or age at diagnosis, such that the greatest risks of microvascular events were observed in the youngest age groups with the longest duration of diabetes.”

Sophia Zoungas, MD, of the George Institute for Global Health, University of Sydney, Australia, and colleagues studied 11,140 patients who were randomly assigned to intensive or standard glucose control during ADVANCE. The mean age of patients was 65.8±6.4 years, age at diagnosis 57.8±8.7 years and diabetes duration 7.9±6.4 years.

The researchers examined associations between age (or age at diagnosis), diabetes duration and major macrovascular events, all-cause death and major microvascular events. The team calculated rates by 5-year baseline age (or age at diagnosis) and diabetes duration strata and estimated risks using Cox models, with adjustments for treatment assignment and HbA1c.

Diabetes duration was associated with the risk of macrovascular events (HR=1.13; 95% CI, 1.08– 1.17), microvascular events (HR=1.28; 95% CI, 1.23–1.33) and death (HR=1.15; 95%, 1.1–1.2). However, age (or age at diagnosis) was only associated with the risk of macrovascular events (HR=1.33; 95% CI, 1.27–1.39) and death (HR=1.56; 95% CI, 1.48–1.64).

Interaction was not seen between diabetes duration, age and the risk of macrovascular events or death (both P>.4) but was seen between diabetes duration, age and the risk of microvascular events (P=.002); the effects of increasing diabetes duration were greatest at younger ages.

“Intensive glycemic control of young people diagnosed with type 2 diabetes is warranted early to minimize the risk of microvascular complications,” the researchers wrote.

Disclosures: The trial was funded by grants from Servier and the National Health and Medical Research Council of Australia; one researcher reports holding a research grant from the council, one receiving a fellowship and others lecture fees. One researcher was supported by a Heart Foundation of Australia award.