Diabetes Q&A

In Diabetes, Risk Factor Modification Could Eliminate Mortality Risk

Patients with type 2 diabetes but without other risk factors appeared to have no little to no excess mortality risk compared to the general population, according to the results of a recent study.

 

In order to examine whether excess cardiovascular and mortality risk could be reduced in patients with type 2 diabetes, researchers conducted a cohort study involving 271,174 patients registered in the Swedish National Diabetes Register. These patients were matched with 1,355,870 controls on the basis of age, sex, and country.

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Patients with diabetes were assessed based on the presence of 5 risk factors: elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure.

 

Overall, 175,245 deaths occurred over a median follow-up of 5.7 years. In patients with type 2 diabetes, excess risk of death and cardiovascular outcomes increased in a step-wise fashion for each risk-factor variable within target ranges.

 

Among patients with type 2 diabetes and all 5 variables within target ranges, hazard ratios (HRs) were as follows:

  • All-cause mortality: 1.06
  • Acute myocardial infarction: 0.84
  • Stroke: 0.95

However, the risk of hospitalization for heart failure was consistently higher among patients with diabetes (HR 1.45).

 

“Patients with type 2 diabetes who had 5 risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population,” the researchers concluded.

 

—Michael Potts

 

Reference:

Rawshani A, Rawshani A, Franzen S, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes N Engl J Med. 2018; 379:633-644.