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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
- 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
Code list: Chronic Kidney Disease
74 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 10081 | Read | Chronic uraemia | diagnostic | Chronic Kidney Disease | |||
| 10647 | Read | Nephritis - chronic | diagnostic | Chronic Kidney Disease | |||
| 10809 | Read | Chronic membranous glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 11553 | Read | Kidney transplant failure and rejection | diagnostic | Chronic Kidney Disease | |||
| 11875 | Read | Nephropathy - chronic | diagnostic | Chronic Kidney Disease | |||
| 12479 | Read | Chronic kidney disease stage 4 | diagnostic | Chronic Kidney Disease | |||
| 12566 | Read | Chronic kidney disease stage 3 | diagnostic | Chronic Kidney Disease | |||
| 12585 | Read | Chronic kidney disease stage 5 | diagnostic | Chronic Kidney Disease | |||
| 15097 | Read | Chronic glomerulonephritis NOS | diagnostic | Chronic Kidney Disease | |||
| 17253 | Read | Renal transplant planned | diagnostic | Chronic Kidney Disease | |||
| 17365 | Read | Nephrotic syndrome; diffuse crescentic glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 1803 | Read | Nephrotic syndrome with membranous glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 18774 | Read | Renal transplant with complication; without blame | diagnostic | Chronic Kidney Disease | |||
| 19316 | Read | Nephrotic syndrome; diffuse membranous glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 21158 | Read | Chronic pyelitis | diagnostic | Chronic Kidney Disease | |||
| 21947 | Read | Nephrotic syn difus mesangial prolifertiv glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 21989 | Read | Nephrotic syn;diffuse mesangiocapillary glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 22205 | Read | Lupus nephritis | diagnostic | Chronic Kidney Disease | |||
| 22852 | Read | Nephrotic syndrome; focal and segmental glomerular lesions | diagnostic | Chronic Kidney Disease | |||
| 23913 | Read | Nephrotic syndrome; minor glomerular abnormality | diagnostic | Chronic Kidney Disease | |||
| 2471 | Read | Nephrotic syndrome in diabetes mellitus | diagnostic | Chronic Kidney Disease | |||
| 25055 | Read | Chronic pyonephrosis | diagnostic | Chronic Kidney Disease | |||
| 26862 | Read | Exploration of renal transplant | diagnostic | Chronic Kidney Disease | |||
| 27427 | Read | Nephrotic syndrome NOS | diagnostic | Chronic Kidney Disease | |||
| 2939 | Read | Calculous pyelonephritis | diagnostic | Chronic Kidney Disease | |||
| 29634 | Read | Nephrotic syndrome with minimal change glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 2999 | Read | Nephrotic syndrome | diagnostic | Chronic Kidney Disease | |||
| 34998 | Read | Chronic proliferative glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 35360 | Read | Nonobstructive reflux-associated chronic pyelonephritis | diagnostic | Chronic Kidney Disease | |||
| 40349 | Read | Lipoid nephrosis | diagnostic | Chronic Kidney Disease | |||
| 45499 | Read | Kimmelstiel - Wilson disease | diagnostic | Chronic Kidney Disease | |||
| 4654 | Read | Chronic pyelonephritis | diagnostic | Chronic Kidney Disease | |||
| 4669 | Read | Chronic focal glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 47672 | Read | Nephrotic syndrome in systemic lupus erythematosus | diagnostic | Chronic Kidney Disease | |||
| 47922 | Read | Nephrotic syndrome in amyloidosis | diagnostic | Chronic Kidney Disease | |||
| 48111 | Read | Chronic pyelonephritis NOS | diagnostic | Chronic Kidney Disease | |||
| 48855 | Read | Chronic obstructive pyelonephritis | diagnostic | Chronic Kidney Disease | |||
| 50472 | Read | Nephrotic syn;difus endocapilary proliftv glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 512 | Read | Chronic renal failure | diagnostic | Chronic Kidney Disease | |||
| 53852 | Read | End stage renal failure | diagnostic | Chronic Kidney Disease | |||
| 54990 | Read | Kidney transplant with complication; without blame | diagnostic | Chronic Kidney Disease | |||
| 56987 | Read | Nephrotic syndrome; dense deposit disease | diagnostic | Chronic Kidney Disease | |||
| 57568 | Read | Chronic pyelonephritis with medullary necrosis | diagnostic | Chronic Kidney Disease | |||
| 57926 | Read | Steroid sensitive nephrotic syndrome | diagnostic | Chronic Kidney Disease | |||
| 58750 | Read | Nephrotic syndrome in polyarteritis nodosa | diagnostic | Chronic Kidney Disease | |||
| 5911 | Read | [V]Kidney transplanted | diagnostic | Chronic Kidney Disease | |||
| 60960 | Read | Other chronic glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 61494 | Read | Chronic membranoproliferative glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 63615 | Read | Other chronic glomerulonephritis NOS | diagnostic | Chronic Kidney Disease | |||
| 63786 | Read | Congenital nephrotic syndrome | diagnostic | Chronic Kidney Disease | |||
| 65064 | Read | Chronic rapidly progressive glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 65400 | Read | Chronic diffuse glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 6712 | Read | End stage renal failure | diagnostic | Chronic Kidney Disease | |||
| 72303 | Read | Finnish nephrosis syndrome | diagnostic | Chronic Kidney Disease | |||
| 7804 | Read | Chronic glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 8330 | Read | End-stage renal disease | diagnostic | Chronic Kidney Disease | |||
| 94373 | Read | Nephrotic syndrome with other pathological kidney lesions | diagnostic | Chronic Kidney Disease | |||
| 94793 | Read | Chronic kidney disease stage 3 with proteinuria | diagnostic | Chronic Kidney Disease | |||
| 94965 | Read | Chronic kidney disease stage 3A | diagnostic | Chronic Kidney Disease | |||
| 95122 | Read | Chronic kidney disease stage 4 with proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95123 | Read | Chronic kidney disease stage 3 without proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95175 | Read | Chronic kidney disease stage 3A without proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95177 | Read | Chronic kidney disease stage 3B without proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95178 | Read | Chronic kidney disease stage 3B with proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95179 | Read | Chronic kidney disease stage 3B | diagnostic | Chronic Kidney Disease | |||
| 95405 | Read | Chronic kidney disease stage 5 without proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95406 | Read | Chronic kidney disease stage 4 without proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95408 | Read | Chronic kidney disease stage 3A with proteinuria | diagnostic | Chronic Kidney Disease | |||
| 95508 | Read | Chronic kidney disease stage 5 with proteinuria | diagnostic | Chronic Kidney Disease | |||
| 97758 | Read | Chronic glomerulonephritis + diseases EC | diagnostic | Chronic Kidney Disease | |||
| 9840 | Read | Nephrotic syndrome with proliferative glomerulonephritis | diagnostic | Chronic Kidney Disease | |||
| 99201 | Read | Nephrotic syndrome in malaria | diagnostic | Chronic Kidney Disease | |||
| 99631 | Read | Chronic pyelonephritis without medullary necrosis | diagnostic | Chronic Kidney Disease | |||
| 99644 | Read | Nephrotic syndrome+membranoproliferative glomerulonephritis | diagnostic | Chronic Kidney Disease |
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The codes provided for chronic kidney disease here do not match the 5-byte read code v2 and Clinical Terms(The Read Codes) version 3. for example Chronic Kidney disease stage 4 = 1Z13.00 (5-byte read code v2) not 12479 as above