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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: depression

212 codes in list

Code Coding system Description Entity type List name QOF analysis screened
1465.00 Read H/O: depression diagnostic depression 0 Sensitivity 0
1B17.00 Read Depressed diagnostic depression 0 0
1B17.00 Read Depressed diagnostic depression 0 Main 0
1B17.11 Read C/O - feeling depressed diagnostic depression 0 Sensitivity 1
1B1U.00 Read Symptoms of depression diagnostic depression 0 Sensitivity 1
1B1U.11 Read Depressive symptoms diagnostic depression 0 Sensitivity 1
1BT..00 Read Depressed mood diagnostic depression 0 Sensitivity 1
212S.00 Read Depression resolved diagnostic depression 0 Resolve 0
212S.00 Read Depression resolved diagnostic depression 1 0
2257 Read O/E - depressed diagnostic depression 0 0
2257.00 Read O/E - depressed diagnostic depression 0 Main 0
62T1.00 Read Puerperal depression diagnostic depression 0 Main 0
62T1.00 Read Puerperal depression diagnostic depression 0 0
8CAa.00 Read Patient given advice about management of depression diagnostic depression 0 Sensitivity 1
8HHq.00 Read Referral for guided self-help for depression diagnostic depression 0 Sensitivity 1
9H90.00 Read Depression annual review diagnostic depression 0 Sensitivity 1
9H91.00 Read Depression medication review diagnostic depression 0 Sensitivity 1
9H92.00 Read Depression interim review diagnostic depression 0 Sensitivity 1
9HA0.00 Read On depression register diagnostic depression 0 Sensitivity 1
9HA1.00 Read Removed from depression register diagnostic depression 1 0
9HA1.00 Read Removed from depression register diagnostic depression 0 Resolve 0
E001300 Read Presenile dementia with depression diagnostic depression 1 Main 0
E001300 Read Presenile dementia with depression diagnostic depression 0 0
E002100 Read Senile dementia with depression diagnostic depression 1 Main 0
E002100 Read Senile dementia with depression diagnostic depression 0 0
E004300 Read Arteriosclerotic dementia with depression diagnostic depression 0 Main 0
E004300 Read Arteriosclerotic dementia with depression diagnostic depression 0 0
E112.00 Read Single major depressive episode diagnostic depression 0 0
E112.00 Read Single major depressive episode diagnostic depression 1 Main 0
E112000 Read Single major depressive episode; unspecified diagnostic depression 1 Main 0
E112000 Read Single major depressive episode; unspecified diagnostic depression 0 0
E112100 Read Single major depressive episode; mild diagnostic depression 0 0
E112100 Read Single major depressive episode; mild diagnostic depression 1 Main 0
E112.11 Read Agitated depression diagnostic depression 1 Main 0
E112.11 Read Agitated depression diagnostic depression 0 0
E112.12 Read Endogenous depression first episode diagnostic depression 0 0
E112.12 Read Endogenous depression first episode diagnostic depression 1 Main 0
E112.13 Read Endogenous depression first episode diagnostic depression 0 0
E112.13 Read Endogenous depression first episode diagnostic depression 1 Main 0
E112.14 Read Endogenous depression diagnostic depression 0 0
E112.14 Read Endogenous depression diagnostic depression 1 Main 0
E112200 Read Single major depressive episode; moderate diagnostic depression 1 Main 0
E112200 Read Single major depressive episode; moderate diagnostic depression 0 0
E112300 Read Single major depressive episode; severe; without psychosis diagnostic depression 0 0
E112300 Read Single major depressive episode; severe; without psychosis diagnostic depression 1 Main 0
E112500 Read Single major depressive episode; partial or unspec remission diagnostic depression 1 0
E112500 Read Single major depressive episode; partial or unspec remission diagnostic depression 1 Resolve 0
E112600 Read Single major depressive episode; in full remission diagnostic depression 1 Resolve 0
E112600 Read Single major depressive episode; in full remission diagnostic depression 1 0
E112z00 Read Single major depressive episode NOS diagnostic depression 1 Main 0
E112z00 Read Single major depressive episode NOS diagnostic depression 0 0
E113.00 Read Recurrent major depressive episode diagnostic depression 0 1
E113.00 Read Recurrent major depressive episode diagnostic depression 1 Main 0
E113000 Read Recurrent major depressive episodes; unspecified diagnostic depression 1 Main 0
E113000 Read Recurrent major depressive episodes; unspecified diagnostic depression 0 1
E113100 Read Recurrent major depressive episodes; mild diagnostic depression 1 Main 0
E113100 Read Recurrent major depressive episodes; mild diagnostic depression 0 1
E113.11 Read Endogenous depression - recurrent diagnostic depression 1 Main 0
E113.11 Read Endogenous depression - recurrent diagnostic depression 0 1
E113200 Read Recurrent major depressive episodes; moderate diagnostic depression 1 Main 0
E113200 Read Recurrent major depressive episodes; moderate diagnostic depression 0 1
E113300 Read Recurrent major depressive episodes; severe; no psychosis diagnostic depression 0 1
E113300 Read Recurrent major depressive episodes; severe; no psychosis diagnostic depression 1 Main 0
E113500 Read Recurrent major depressive episodes;partial/unspec remission diagnostic depression 1 1
E113500 Read Recurrent major depressive episodes;partial/unspec remission diagnostic depression 1 Resolve 0
E113600 Read Recurrent major depressive episodes; in full remission diagnostic depression 1 Resolve 0
E113600 Read Recurrent major depressive episodes; in full remission diagnostic depression 1 1
E113700 Read Recurrent depression diagnostic depression 1 Main 0
E113700 Read Recurrent depression diagnostic depression 0 1
E113z00 Read Recurrent major depressive episode NOS diagnostic depression 1 Main 0
E113z00 Read Recurrent major depressive episode NOS diagnostic depression 0 1
E118.00 Read Seasonal affective disorder diagnostic depression 1 Main 0
E118.00 Read Seasonal affective disorder diagnostic depression 0 1
E11y200 Read Atypical depressive disorder diagnostic depression 0 0
E11y200 Read Atypical depressive disorder diagnostic depression 1 Main 0
E11z200 Read Masked depression diagnostic depression 1 Main 0
E11z200 Read Masked depression diagnostic depression 0 0
E135.00 Read Agitated depression diagnostic depression 0 0
E135.00 Read Agitated depression diagnostic depression 1 Main 0
E200300 Read Anxiety with depression diagnostic depression 0 0
E200300 Read Anxiety with depression diagnostic depression 1 Main 0
E204.00 Read Neurotic depression reactive type diagnostic depression 0 0
E204.00 Read Neurotic depression reactive type diagnostic depression 0 Main 0
E204.11 Read Postnatal depression diagnostic depression 0 Main 0
E204.11 Read Postnatal depression diagnostic depression 0 0
E211200 Read Depressive personality disorder diagnostic depression 0 Sensitivity 0
E290.00 Read Brief depressive reaction diagnostic depression 0 Main 0
E290.00 Read Brief depressive reaction diagnostic depression 0 0
E290z00 Read Brief depressive reaction NOS diagnostic depression 0 0
E290z00 Read Brief depressive reaction NOS diagnostic depression 0 Main 0
E291.00 Read Prolonged depressive reaction diagnostic depression 0 1
E291.00 Read Prolonged depressive reaction diagnostic depression 1 Main 0
E2B..00 Read Depressive disorder NEC diagnostic depression 0 0
E2B..00 Read Depressive disorder NEC diagnostic depression 0 Main 0
E2B0.00 Read Postviral depression diagnostic depression 0 Main 0
E2B0.00 Read Postviral depression diagnostic depression 0 0
E2B1.00 Read Chronic depression diagnostic depression 0 1
E2B1.00 Read Chronic depression diagnostic depression 0 Main 0
Eu32.00 Read [X]Depressive episode diagnostic depression 1 Main 0
Eu32.00 Read [X]Depressive episode diagnostic depression 0 0
Eu32000 Read [X]Mild depressive episode diagnostic depression 0 Main 0
Eu32000 Read [X]Mild depressive episode diagnostic depression 0 0
Eu32100 Read [X]Moderate depressive episode diagnostic depression 0 0
Eu32100 Read [X]Moderate depressive episode diagnostic depression 0 Main 0
Eu32.11 Read [X]Single episode of depressive reaction diagnostic depression 1 Main 0
Eu32.11 Read [X]Single episode of depressive reaction diagnostic depression 0 0
Eu32.12 Read [X]Single episode of psychogenic depression diagnostic depression 1 Main 0
Eu32.12 Read [X]Single episode of psychogenic depression diagnostic depression 0 0
Eu32.13 Read [X]Single episode of reactive depression diagnostic depression 0 0
Eu32.13 Read [X]Single episode of reactive depression diagnostic depression 1 Main 0
Eu32200 Read [X]Severe depressive episode without psychotic symptoms diagnostic depression 0 0
Eu32200 Read [X]Severe depressive episode without psychotic symptoms diagnostic depression 0 Main 0
Eu32211 Read [X]Single episode agitated depressn w'out psychotic symptoms diagnostic depression 0 Main 0
Eu32211 Read [X]Single episode agitated depressn w'out psychotic symptoms diagnostic depression 0 0
Eu32212 Read [X]Single episode major depression w'out psychotic symptoms diagnostic depression 0 Main 0
Eu32212 Read [X]Single episode major depression w'out psychotic symptoms diagnostic depression 0 0
Eu32213 Read [X]Single episode vital depression w'out psychotic symptoms diagnostic depression 0 0
Eu32213 Read [X]Single episode vital depression w'out psychotic symptoms diagnostic depression 0 Main 0
Eu32400 Read [X]Mild depression diagnostic depression 0 Main 0
Eu32400 Read [X]Mild depression diagnostic depression 0 0
Eu32y00 Read [X]Other depressive episodes diagnostic depression 0 Main 0
Eu32y00 Read [X]Other depressive episodes diagnostic depression 0 0
Eu32y11 Read [X]Atypical depression diagnostic depression 0 0
Eu32y11 Read [X]Atypical depression diagnostic depression 0 Main 0
Eu32y12 Read [X]Single episode of masked depression NOS diagnostic depression 0 Main 0
Eu32y12 Read [X]Single episode of masked depression NOS diagnostic depression 0 0
Eu32z00 Read [X]Depressive episode; unspecified diagnostic depression 0 Main 0
Eu32z00 Read [X]Depressive episode; unspecified diagnostic depression 0 0
Eu32z11 Read [X]Depression NOS diagnostic depression 0 0
Eu32z11 Read [X]Depression NOS diagnostic depression 0 Main 0
Eu32z12 Read [X]Depressive disorder NOS diagnostic depression 0 Main 0
Eu32z12 Read [X]Depressive disorder NOS diagnostic depression 0 0
Eu32z13 Read [X]Prolonged single episode of reactive depression diagnostic depression 0 Main 0
Eu32z13 Read [X]Prolonged single episode of reactive depression diagnostic depression 0 0
Eu32z14 Read [X] Reactive depression NOS diagnostic depression 0 0
Eu32z14 Read [X] Reactive depression NOS diagnostic depression 0 Main 0
Eu33.00 Read [X]Recurrent depressive disorder diagnostic depression 1 Main 0
Eu33.00 Read [X]Recurrent depressive disorder diagnostic depression 0 1
Eu33000 Read [X]Recurrent depressive disorder; current episode mild diagnostic depression 1 Main 0
Eu33000 Read [X]Recurrent depressive disorder; current episode mild diagnostic depression 0 1
Eu33100 Read [X]Recurrent depressive disorder; current episode moderate diagnostic depression 1 Main 0
Eu33100 Read [X]Recurrent depressive disorder; current episode moderate diagnostic depression 0 1
Eu33.11 Read [X]Recurrent episodes of depressive reaction diagnostic depression 1 Main 0
Eu33.11 Read [X]Recurrent episodes of depressive reaction diagnostic depression 0 1
Eu33.12 Read [X]Recurrent episodes of psychogenic depression diagnostic depression 1 Main 0
Eu33.12 Read [X]Recurrent episodes of psychogenic depression diagnostic depression 0 1
Eu33.13 Read [X]Recurrent episodes of reactive depression diagnostic depression 0 1
Eu33.13 Read [X]Recurrent episodes of reactive depression diagnostic depression 1 Main 0
Eu33.14 Read [X]Seasonal depressive disorder diagnostic depression 1 Main 0
Eu33.14 Read [X]Seasonal depressive disorder diagnostic depression 0 1
Eu33.15 Read [X]SAD - Seasonal affective disorder diagnostic depression 0 1
Eu33.15 Read [X]SAD - Seasonal affective disorder diagnostic depression 1 Main 0
Eu33200 Read [X]Recurr depress disorder cur epi severe without psyc sympt diagnostic depression 1 Main 0
Eu33200 Read [X]Recurr depress disorder cur epi severe without psyc sympt diagnostic depression 0 1
Eu33211 Read [X]Endogenous depression without psychotic symptoms diagnostic depression 1 Main 0
Eu33211 Read [X]Endogenous depression without psychotic symptoms diagnostic depression 0 0
Eu33212 Read [X]Major depression; recurrent without psychotic symptoms diagnostic depression 0 1
Eu33212 Read [X]Major depression; recurrent without psychotic symptoms diagnostic depression 1 Main 0
Eu33214 Read [X]Vital depression; recurrent without psychotic symptoms diagnostic depression 0 1
Eu33214 Read [X]Vital depression; recurrent without psychotic symptoms diagnostic depression 1 Main 0
Eu33400 Read [X]Recurrent depressive disorder; currently in remission diagnostic depression 1 Main 0
Eu33400 Read [X]Recurrent depressive disorder; currently in remission diagnostic depression 0 1
Eu33y00 Read [X]Other recurrent depressive disorders diagnostic depression 0 1
Eu33y00 Read [X]Other recurrent depressive disorders diagnostic depression 1 Main 0
Eu33z00 Read [X]Recurrent depressive disorder; unspecified diagnostic depression 0 1
Eu33z00 Read [X]Recurrent depressive disorder; unspecified diagnostic depression 1 Main 0
Eu33z11 Read [X]Monopolar depression NOS diagnostic depression 1 Main 0
Eu33z11 Read [X]Monopolar depression NOS diagnostic depression 0 0
Eu34100 Read [X]Dysthymia diagnostic depression 1 Main 0
Eu34100 Read [X]Dysthymia diagnostic depression 0 0
Eu34111 Read [X]Depressive neurosis diagnostic depression 0 Main 0
Eu34111 Read [X]Depressive neurosis diagnostic depression 0 0
Eu34113 Read [X]Neurotic depression diagnostic depression 0 0
Eu34113 Read [X]Neurotic depression diagnostic depression 0 Main 0
Eu34114 Read [X]Persistant anxiety depression diagnostic depression 0 Main 0
Eu34114 Read [X]Persistant anxiety depression diagnostic depression 0 1
Eu3y111 Read [X]Recurrent brief depressive episodes diagnostic depression 0 Main 0
Eu3y111 Read [X]Recurrent brief depressive episodes diagnostic depression 0 1
Eu41200 Read [X]Mixed anxiety and depressive disorder diagnostic depression 1 Main 0
Eu41200 Read [X]Mixed anxiety and depressive disorder diagnostic depression 0 0
Eu41211 Read [X]Mild anxiety depression diagnostic depression 0 0
Eu41211 Read [X]Mild anxiety depression diagnostic depression 0 Main 0
Eu53011 Read [X]Postnatal depression NOS diagnostic depression 0 Main 0
Eu53011 Read [X]Postnatal depression NOS diagnostic depression 0 0
Eu53012 Read [X]Postpartum depression NOS diagnostic depression 0 0
Eu53012 Read [X]Postpartum depression NOS diagnostic depression 0 Main 0
Eu92000 Read [X]Depressive conduct disorder diagnostic depression 0 Main 0
Eu92000 Read [X]Depressive conduct disorder diagnostic depression 0 0
2960AC OXMIS CHRONIC AGITATED DEPRESSION diagnostic depression 0 Main 0
2960AD OXMIS DEPRESSION AGITATED diagnostic depression 0 Main 0
2962A OXMIS DEPRESSION CHRONIC diagnostic depression 0 Main 0
2962AF OXMIS REACTION DEPRESSIVE AFFECTIVE diagnostic depression 0 Main 0
2962B OXMIS DEPRESSION ACUTE diagnostic depression 0 Main 0
2962EN OXMIS ENDOGENOUS DEPRESSION diagnostic depression 0 Main 0
2962R OXMIS RECURRENT DEPRESSION diagnostic depression 0 Main 0
3000E OXMIS ANXIETY DEPRESSION diagnostic depression 0 Main 0
3004 OXMIS NEUROSIS DEPRESSIVE diagnostic depression 0 Main 0
3004A OXMIS DEPRESSION diagnostic depression 0 Main 0
3004AB OXMIS OBSERVED DEPRESSION diagnostic depression 0 Main 0
3004AM OXMIS MOOD DEPRESSED diagnostic depression 0 Main 0
3004B OXMIS PREGNANCY DEPRESSION diagnostic depression 0 Main 0
3004C OXMIS PUERPERAL DEPRESSION diagnostic depression 0 Main 0
3004CA OXMIS POSTNATAL DEPRESSION diagnostic depression 0 Main 0
3004E OXMIS EXOGENOUS DEPRESSION diagnostic depression 0 Main 0
3004ER OXMIS REACTIVE DEPRESSION diagnostic depression 0 Main 0
3004M OXMIS MORNING DEPRESSION diagnostic depression 0 Main 0
3004PP OXMIS POSTOPERATIVE DEPRESSION diagnostic depression 0 Main 0
3091N OXMIS INFLUENZAL DEPRESSION diagnostic depression 0 Main 0
3091PF OXMIS POSTINFECTIVE DEPRESSION diagnostic depression 0 Main 0
3091PL OXMIS DEPRESSION POSTVIRAL diagnostic depression 0 Main 0
3091PN OXMIS POSTINFLUENZA DEPRESSION diagnostic depression 0 Main 0
7902DC OXMIS POSTVIRAL DEPRESSION diagnostic depression 0 Main 0

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