ClinicalCodes.org

An online clinical codes repository to improve validity and reproducibility of medical database research

Research article:

Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study

Reference:

Evangelos Kontopantelis, David A Springate, David Reeves, Darren M Ashcroft, Martin Rutter, Iain Buchan, Tim Doran(2015) Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study. Diabetologia, doi: 10.1007/s00125-014-3473-8

Link to fulltext article
http://link.springer.com/article/10.1007/s00125-014-3473-8
Abstract
Background: Observational data have been used to inform target levels for modifiable risk factors in type 2 diabetes but these data are limited by confounding. We aimed to describe the shape of observed relationships between risk factor levels and clinically important outcomes in type 2 diabetes after adjusting for multiple confounders. Methods: We used retrospective longitudinal data on 246,544 adults with type 2 diabetes from 600 practices contributing to the Clinical Practice Research Datalink between 2006 and 2012. Proportional hazards regression models quantified the risks of mortality, microvascular or macrovascular events associated with four modifiable risk factors: glycated haemoglobin (HbA1c), systolic and diastolic blood pressure and total cholesterol, while controlling for numerous patient and practice covariates. Findings: U-shaped relationships were observed between all-cause mortality and levels of the four risk factors. The lowest risks were associated with HbA1c 7.25-7.75%; total cholesterol 3.5-4.5 mmol/L; systolic blood pressure 135-145 mmHg; and diastolic blood pressure 82.5-87.5 mmHg. coronary and stroke mortality related to the four risk factors in a positive, curvilinear way, with the exception of blood pressure which related to coronary deaths in a U-shape. Macrovascular events showed a positive and curvilinear relationship with HbA1c but U-shaped for total cholesterol and systolic blood pressure. Microvascular related to the four risk factors in a curvilinear way: positive for HbA1c and systolic blood pressure but negative for cholesterol and diastolic blood pressure. Interpretation: We identified several relationships which, when considered in the light of relevant trial data, support a call for major changes to clinical practice. Most importantly, our results support trial data indicating that normalisation of glucose and blood pressure can lead to poorer outcomes, which makes a strong case for target ranges for these risk factors rather than target levels.
Author for correspondence
Evangelos Kontopantelis
Email for correspondence
E.Kontopantelis@manchester.ac.uk

Clinical code lists:

Click to view and download

Code list
Microvascular_complications Download this codelist
Hypertension Download this codelist
Res9: diuretics_thiazide Download this codelist
Res9: dpp4 Download this codelist
Res9: gpl1 Download this codelist
Res9: insulin Download this codelist
Res9: lipid_lowering_other Download this codelist
Res9: loop_diuretics Download this codelist
Res9: meglitinide Download this codelist
Res9: metformin Download this codelist
Res9: statins_plus_other_ll Download this codelist
Res9: statins Download this codelist
Res9: sulfonylureas Download this codelist
Res9: thiazolidinediones Download this codelist
Stroke Download this codelist
Asthma_drugs Download this codelist
Influenza_immunisation Download this codelist
Smoking_status Download this codelist
Coronary_Heart_Disease Download this codelist
Chronic_obstructive_pulmonary_disease Download this codelist
Neuropathy Download this codelist
HbA1C_testing Download this codelist
Proteinuria Download this codelist
Osteoporosis Download this codelist
Depression Download this codelist
Micro-albuminuria_testing Download this codelist
Retinal_screening Download this codelist
Diabetes Download this codelist
Asthma_clinicals Download this codelist
Epilepsy_clinicals Download this codelist
Epilepsy_drugs Download this codelist
Macrovascular_complications Download this codelist
Osteoarthritis Download this codelist
Cancer Download this codelist
Type 2 Diabetes Download this codelist
Heart Failure Download this codelist
Chronic Kidney Disease Download this codelist
Res9: ACE_inhibitors Download this codelist
Res9: acerbose Download this codelist
Res9: alpha_blockers Download this codelist
Res9: anticoagulants Download this codelist
Res9: antiplatelets Download this codelist
Res9: beta_blockers Download this codelist
Res9: ca_channel_blockers Download this codelist

0 comments have been posted.

Please log in to leave a comment.