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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: Coronary_Heart_Disease
79 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| G3...00 | Read | Ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G31..00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G310.00 | Read | Postmyocardial infarction syndrome | diagnostic | Coronary_Heart_Disease | |||
| G310.11 | Read | Dressler's syndrome | diagnostic | Coronary_Heart_Disease | |||
| G3...11 | Read | Arteriosclerotic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G311.00 | Read | Preinfarction syndrome | diagnostic | Coronary_Heart_Disease | |||
| G311100 | Read | Unstable angina | diagnostic | Coronary_Heart_Disease | |||
| G311.11 | Read | Crescendo angina | diagnostic | Coronary_Heart_Disease | |||
| G311.12 | Read | Impending infarction | diagnostic | Coronary_Heart_Disease | |||
| G311.13 | Read | Unstable angina | diagnostic | Coronary_Heart_Disease | |||
| G311.14 | Read | Angina at rest | diagnostic | Coronary_Heart_Disease | |||
| G311200 | Read | Angina at rest | diagnostic | Coronary_Heart_Disease | |||
| G311300 | Read | Refractory angina | diagnostic | Coronary_Heart_Disease | |||
| G311500 | Read | Acute coronary syndrome | diagnostic | Coronary_Heart_Disease | |||
| G311z00 | Read | Preinfarction syndrome NOS | diagnostic | Coronary_Heart_Disease | |||
| G3...12 | Read | Atherosclerotic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G3...13 | Read | IHD - Ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G31y.00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G31y000 | Read | Acute coronary insufficiency | diagnostic | Coronary_Heart_Disease | |||
| G31y200 | Read | Subendocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G31y300 | Read | Transient myocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G31yz00 | Read | Other acute and subacute ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| G32..00 | Read | Old myocardial infarction | diagnostic | Coronary_Heart_Disease | |||
| G32..11 | Read | Healed myocardial infarction | diagnostic | Coronary_Heart_Disease | |||
| G32..12 | Read | Personal history of myocardial infarction | diagnostic | Coronary_Heart_Disease | |||
| G33..00 | Read | Angina pectoris | diagnostic | Coronary_Heart_Disease | |||
| G330.00 | Read | Angina decubitus | diagnostic | Coronary_Heart_Disease | |||
| G330000 | Read | Nocturnal angina | diagnostic | Coronary_Heart_Disease | |||
| G330z00 | Read | Angina decubitus NOS | diagnostic | Coronary_Heart_Disease | |||
| G331.00 | Read | Prinzmetal's angina | diagnostic | Coronary_Heart_Disease | |||
| G331.11 | Read | Variant angina pectoris | diagnostic | Coronary_Heart_Disease | |||
| G332.00 | Read | Coronary artery spasm | diagnostic | Coronary_Heart_Disease | |||
| G33z.00 | Read | Angina pectoris NOS | diagnostic | Coronary_Heart_Disease | |||
| G33z000 | Read | Status anginosus | diagnostic | Coronary_Heart_Disease | |||
| G33z100 | Read | Stenocardia | diagnostic | Coronary_Heart_Disease | |||
| G33z200 | Read | Syncope anginosa | diagnostic | Coronary_Heart_Disease | |||
| G33z300 | Read | Angina on effort | diagnostic | Coronary_Heart_Disease | |||
| G33z400 | Read | Ischaemic chest pain | diagnostic | Coronary_Heart_Disease | |||
| G33z500 | Read | Post infarct angina | diagnostic | Coronary_Heart_Disease | |||
| G33z600 | Read | New onset angina | diagnostic | Coronary_Heart_Disease | |||
| G33z700 | Read | Stable angina | diagnostic | Coronary_Heart_Disease | |||
| G33zz00 | Read | Angina pectoris NOS | diagnostic | Coronary_Heart_Disease | |||
| G34..00 | Read | Other chronic ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G340.00 | Read | Coronary atherosclerosis | diagnostic | Coronary_Heart_Disease | |||
| G340000 | Read | Single coronary vessel disease | diagnostic | Coronary_Heart_Disease | |||
| G340100 | Read | Double coronary vessel disease | diagnostic | Coronary_Heart_Disease | |||
| G340.11 | Read | Triple vessel disease of the heart | diagnostic | Coronary_Heart_Disease | |||
| G340.12 | Read | Coronary artery disease | diagnostic | Coronary_Heart_Disease | |||
| G342.00 | Read | Atherosclerotic cardiovascular disease | diagnostic | Coronary_Heart_Disease | |||
| G343.00 | Read | Ischaemic cardiomyopathy | diagnostic | Coronary_Heart_Disease | |||
| G344.00 | Read | Silent myocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G34y.00 | Read | Other specified chronic ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G34y000 | Read | Chronic coronary insufficiency | diagnostic | Coronary_Heart_Disease | |||
| G34y100 | Read | Chronic myocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G34yz00 | Read | Other specified chronic ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| G34z.00 | Read | Other chronic ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| G34z000 | Read | Asymptomatic coronary heart disease | diagnostic | Coronary_Heart_Disease | |||
| G3y..00 | Read | Other specified ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G3z..00 | Read | Ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| Gyu3.00 | Read | [X]Ischaemic heart diseases | diagnostic | Coronary_Heart_Disease | |||
| Gyu3200 | Read | [X]Other forms of acute ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| Gyu3300 | Read | [X]Other forms of chronic ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| 4119B | OXMIS | ISCHAEMIC HEART DISEASE SUBACUTE | diagnostic | Coronary_Heart_Disease | |||
| 4120A | OXMIS | ISCHAEMIC HEART DISEASE HYPERTENSIVE | diagnostic | Coronary_Heart_Disease | |||
| 4129 | OXMIS | ISCHAEMIC HEART DISEASE CHRONIC | diagnostic | Coronary_Heart_Disease | |||
| 4129AN | OXMIS | ISCHAEMIC HEART DISEASE | diagnostic | Coronary_Heart_Disease | |||
| 4129N | OXMIS | ISCHAEMIC HEART DISEASE ASYMPTOMATIC | diagnostic | Coronary_Heart_Disease | |||
| 4130 | OXMIS | ANGINA PECTORIS WITH HYPERTENSION | diagnostic | Coronary_Heart_Disease | |||
| 4130E | OXMIS | ANGINA EFFORT WITH HYPERTENSION | diagnostic | Coronary_Heart_Disease | |||
| 4139 | OXMIS | ANGINA PECTORIS | diagnostic | Coronary_Heart_Disease | |||
| 4139AT | OXMIS | ANGINA ATYPICAL | diagnostic | Coronary_Heart_Disease | |||
| 4139C | OXMIS | CARDIAC ANGINA | diagnostic | Coronary_Heart_Disease | |||
| 4139CO | OXMIS | ANGINA CRESCENDO | diagnostic | Coronary_Heart_Disease | |||
| 4139E | OXMIS | ANGINA EFFORT | diagnostic | Coronary_Heart_Disease | |||
| 4139M | OXMIS | SYNDROME ANGINAL | diagnostic | Coronary_Heart_Disease | |||
| 4139N | OXMIS | ANGINA | diagnostic | Coronary_Heart_Disease | |||
| 4139PA | OXMIS | ANGINA INVERSA | diagnostic | Coronary_Heart_Disease | |||
| 4139U | OXMIS | UNSTABLE ANGINA | diagnostic | Coronary_Heart_Disease | |||
| 4149 | OXMIS | ASYMPTOMATIC ISCHAEMIC HEART DISEASE | diagnostic | Coronary_Heart_Disease |
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Code list links:
ClinicalCodes is a project at the University of Manchester Institute of Population Health
The ClinicalCodes project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR)
Codes used to identify patients with CHD. CHD treated as a chronic condition. Patients with any codes from this list prior to the end of a given QOF year are included for that year.