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Important predictors of mortality in type 2 diabetic patients

Predictors of 5-year mortality of 1,323 patients newly diagnosed with clinical type 2 diabetes in general practice With special emphasis on self-rated health Niels de Fine Olivarius Volkert Siersma Anni B. S. Nielsen Lars J. Hansen Lotte Rosenvinge Carl Erik Mogensen.

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Important predictors of mortality in type 2 diabetic patients

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  1. Predictors of 5-year mortality of 1,323 patients newlydiagnosedwithclinical type 2 diabetes in general practice With specialemphasisonself-ratedhealth Niels de Fine Olivarius Volkert Siersma Anni B. S. Nielsen Lars J. Hansen Lotte Rosenvinge Carl Erik Mogensen

  2. Important predictors of mortality in type 2 diabetic patients • Age • Sex • Blood glucose level • Blood pressure • Lipids • Urinary albumin excretion • Smoking • Cardiovascular disease

  3. Self-rated general health (SRH) Question to patients: "In general, how would you rate your health at present?" • Excellent • Good • Fair • Poor • Verypoor

  4. Implications of SRH In the general population SRH predicts both future morbidity such as ischaemic heart disease and mortality independently of established risk indicators, but evidence of this is scarce for people with diabetes

  5. Aim of the study To investigate the contribution to 5-year all-cause and cardiovascular mortality of the characteristics found at the more or less acute state at diabetes diagnosis. In particular, we evaluated the possible independent effect of SRH on mortality.

  6. Flow chart Inclusion criteria: 1) Diabetes mellitus diagnosed from 1 March 1989 to 28 February 1992 2) Whole blood or plasma glucose concentration ≥ 7.0/8.0 mmol/l measured at a major laboratory 3) Age 40 years or older Eligible patients, n=1,543 Primary exclusions: Severe somatic disease, n=50 Severe mental illness, n=50 Declined to consent, n=62 Available patient sample, n=1,381 Secondary exclusions: Steroid treatment at diagnosis, n=46 Non-white ethnicity, n=12 Analysed, n=1,323

  7. Outcome variables • From the Danish National Death Register: • All-cause mortality • Cardiovascular mortality • Median observation time: 5.2 years • Number of deaths: 298

  8. Baseline predictor variables

  9. StatisticalanalysisPredictors of 5-year mortality The influence on all-cause and cardiovascular mortality of patient characteristics measured at diabetes diagnosis was investigated in Cox proportional hazard models. In these models the death intensity was represented as a function of patient age, multiplicatively affected by the characteristics.

  10. Predictors of 5-year mortalityCox regression analyses * p<0.05 ** p<0.01 *** p<0.001

  11. Estimatedlifeexpectancyaccording to predictors at diagnosis. Men only Values are median life expectancy according to baseline characteristics calculated from a Cox model which includes all baseline characteristics. The other faxtors in the model are kept fixed.

  12. Implications 1 – the easy part • In newly diagnosed diabetic patients: be attentive to patients who are/have • - Relatively young • - Inactive • - Cardiovascular disease • - (Micro)albuminuria

  13. WhatdoesSRHmeasure? • SRH ≈ A personal estimation of longevity? • … taking into account • - Current and previous health • - Symptom perception • - Personal resources • - Physical functioning • - Health behaviour • - Comparison with age peers • - Familial disposition

  14. The SRHhypothesis SRH primarily carries risk information which cannot be uncovered by present-day technology, and this information has to a considerable degree a biological basis

  15. A question from a colleague Non-excellent SRH Increased mortality “Does it mean that GPs can concentrate on making the patients feel content and happy about their lives and not worry so much about blood glucose, blood pressure and lipids” ?

  16. Implications 2 - SRH Non-excellent SRH Increased mortality This finding could motivate general practitioners and practice nurses to discuss perceptions of health with newly diagnosed diabetic patients and be attentive to patients with suboptimal health ratings

  17. The problem of frailty Frailty ≈ Heterogeneity among our patients in their susceptibility to dying Undiagnosed or even unascertainable conditions may have contributed to precipitate the diabetes diagnosis, and these conditions may be associated with both poor SRH or low physical activity and high risk of death.

  18. Approachingheterogeneity • Sub-group analysis of "healthy" patients (n=696) without CVD, diabetic retinopathy, peripheral neuropathy, cancer and proteinuria • Analysis of deaths occurring within 3 years of diabetes diagnosis (n=153) and after this time (n=145) • Analyses excluding deaths occurring within 6 months of diabetes diagnosis (n=25)

  19. Predictors of 5-year all-causemortalityCox regression analysis Bold: p<0.05

  20. The excessmortality of type 2 diabetic patients

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