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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: Macrovascular_complications
146 codes in list
| Code | Coding system | Description | Entity type | List name | type | ||
|---|---|---|---|---|---|---|---|
| 7L06.00 | Read | Amputation of leg | diagnostic | Macrovascular_complications | 4 | ||
| 7L06400 | Read | Amputation below knee | diagnostic | Macrovascular_complications | 4 | ||
| 7L07.00 | Read | Amputation of foot | diagnostic | Macrovascular_complications | 4 | ||
| 7L07000 | Read | Amputation through ankle | diagnostic | Macrovascular_complications | 4 | ||
| 7L07012 | Read | Syme amputation of foot through ankle | diagnostic | Macrovascular_complications | 4 | ||
| 7L07300 | Read | Amputation through metatarsal bones | diagnostic | Macrovascular_complications | 4 | ||
| 7L07y00 | Read | Other specified amputation of foot | diagnostic | Macrovascular_complications | 4 | ||
| 7L07z00 | Read | Amputation of foot NOS | diagnostic | Macrovascular_complications | 4 | ||
| 7L08.00 | Read | Amputation of toe | diagnostic | Macrovascular_complications | 4 | ||
| 7L08011 | Read | Amputation great toe | diagnostic | Macrovascular_complications | 4 | ||
| 7L08100 | Read | Amputation of phalanx of toe | diagnostic | Macrovascular_complications | 4 | ||
| 7L08300 | Read | Amputation lesser toe | diagnostic | Macrovascular_complications | 4 | ||
| 7L08y00 | Read | Other specified amputation of toe | diagnostic | Macrovascular_complications | 4 | ||
| 7L08z00 | Read | Amputation of toe NOS | diagnostic | Macrovascular_complications | 4 | ||
| 7L0L200 | Read | Amputation of supernumerary toe | diagnostic | Macrovascular_complications | 4 | ||
| G30..00 | Read | Acute myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G300.00 | Read | Acute anterolateral infarction | diagnostic | Macrovascular_complications | 2 | ||
| G301.00 | Read | Other specified anterior myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G301000 | Read | Acute anteroapical infarction | diagnostic | Macrovascular_complications | 2 | ||
| G301100 | Read | Acute anteroseptal infarction | diagnostic | Macrovascular_complications | 2 | ||
| G30..12 | Read | Coronary thrombosis | diagnostic | Macrovascular_complications | 2 | ||
| G30..13 | Read | Cardiac rupture following myocardial infarction (MI) | diagnostic | Macrovascular_complications | 2 | ||
| G30..15 | Read | MI - acute myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G30..16 | Read | Thrombosis - coronary | diagnostic | Macrovascular_complications | 2 | ||
| G30..17 | Read | Silent myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G301z00 | Read | Anterior myocardial infarction NOS | diagnostic | Macrovascular_complications | 2 | ||
| G302.00 | Read | Acute inferolateral infarction | diagnostic | Macrovascular_complications | 2 | ||
| G303.00 | Read | Acute inferoposterior infarction | diagnostic | Macrovascular_complications | 2 | ||
| G304.00 | Read | Posterior myocardial infarction NOS | diagnostic | Macrovascular_complications | 2 | ||
| G305.00 | Read | Lateral myocardial infarction NOS | diagnostic | Macrovascular_complications | 2 | ||
| G306.00 | Read | True posterior myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G307.00 | Read | Acute subendocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G307000 | Read | Acute non-Q wave infarction | diagnostic | Macrovascular_complications | 2 | ||
| G307100 | Read | Acute non-ST segment elevation myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G308.00 | Read | Inferior myocardial infarction NOS | diagnostic | Macrovascular_complications | 2 | ||
| G309.00 | Read | Acute Q-wave infarct | diagnostic | Macrovascular_complications | 2 | ||
| G30B.00 | Read | Acute posterolateral myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G30X.00 | Read | Acute transmural myocardial infarction of unspecif site | diagnostic | Macrovascular_complications | 2 | ||
| G30X000 | Read | Acute ST segment elevation myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G30y.00 | Read | Other acute myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G30y100 | Read | Acute papillary muscle infarction | diagnostic | Macrovascular_complications | 2 | ||
| G30y200 | Read | Acute septal infarction | diagnostic | Macrovascular_complications | 2 | ||
| G30yz00 | Read | Other acute myocardial infarction NOS | diagnostic | Macrovascular_complications | 2 | ||
| G30z.00 | Read | Acute myocardial infarction NOS | diagnostic | Macrovascular_complications | 2 | ||
| G311000 | Read | Myocardial infarction aborted | diagnostic | Macrovascular_complications | 2 | ||
| G311011 | Read | MI - myocardial infarction aborted | diagnostic | Macrovascular_complications | 2 | ||
| G311500 | Read | Acute coronary syndrome | diagnostic | Macrovascular_complications | 2 | ||
| G35..00 | Read | Subsequent myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G350.00 | Read | Subsequent myocardial infarction of anterior wall | diagnostic | Macrovascular_complications | 2 | ||
| G351.00 | Read | Subsequent myocardial infarction of inferior wall | diagnostic | Macrovascular_complications | 2 | ||
| G353.00 | Read | Subsequent myocardial infarction of other sites | diagnostic | Macrovascular_complications | 2 | ||
| G35X.00 | Read | Subsequent myocardial infarction of unspecified site | diagnostic | Macrovascular_complications | 2 | ||
| G360.00 | Read | Haemopericardium/current comp folow acut myocard infarct | diagnostic | Macrovascular_complications | 2 | ||
| G362.00 | Read | Ventric septal defect/curr comp fol acut myocardal infarctn | diagnostic | Macrovascular_complications | 2 | ||
| G363.00 | Read | Ruptur cardiac wall w'out haemopericard/cur comp fol ac MI | diagnostic | Macrovascular_complications | 2 | ||
| G364.00 | Read | Ruptur chordae tendinae/curr comp fol acute myocard infarct | diagnostic | Macrovascular_complications | 2 | ||
| G365.00 | Read | Rupture papillary muscle/curr comp fol acute myocard infarct | diagnostic | Macrovascular_complications | 2 | ||
| G38..00 | Read | Postoperative myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G380.00 | Read | Postoperative transmural myocardial infarction anterior wall | diagnostic | Macrovascular_complications | 2 | ||
| G381.00 | Read | Postoperative transmural myocardial infarction inferior wall | diagnostic | Macrovascular_complications | 2 | ||
| G384.00 | Read | Postoperative subendocardial myocardial infarction | diagnostic | Macrovascular_complications | 2 | ||
| G38z.00 | Read | Postoperative myocardial infarction; unspecified | diagnostic | Macrovascular_complications | 2 | ||
| G574011 | Read | Cardiac arrest-ventricular fibrillation | diagnostic | Macrovascular_complications | 2 | ||
| G575.00 | Read | Cardiac arrest | diagnostic | Macrovascular_complications | 2 | ||
| G575000 | Read | Cardiac arrest with successful resuscitation | diagnostic | Macrovascular_complications | 2 | ||
| G575100 | Read | Sudden cardiac death; so described | diagnostic | Macrovascular_complications | 2 | ||
| G575.11 | Read | Cardio-respiratory arrest | diagnostic | Macrovascular_complications | 2 | ||
| G575.12 | Read | Asystole | diagnostic | Macrovascular_complications | 2 | ||
| G575z00 | Read | Cardiac arrest; unspecified | diagnostic | Macrovascular_complications | 2 | ||
| G61..00 | Read | Intracerebral haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G610.00 | Read | Cortical haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G611.00 | Read | Internal capsule haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G61..11 | Read | CVA - cerebrovascular accid due to intracerebral haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G61..12 | Read | Stroke due to intracerebral haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G612.00 | Read | Basal nucleus haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G613.00 | Read | Cerebellar haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G614.00 | Read | Pontine haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G615.00 | Read | Bulbar haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G616.00 | Read | External capsule haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| G617.00 | Read | Intracerebral haemorrhage; intraventricular | diagnostic | Macrovascular_complications | 3 | ||
| G618.00 | Read | Intracerebral haemorrhage; multiple localized | diagnostic | Macrovascular_complications | 3 | ||
| G61X.00 | Read | Intracerebral haemorrhage in hemisphere; unspecified | diagnostic | Macrovascular_complications | 3 | ||
| G61X000 | Read | Left sided intracerebral haemorrhage; unspecified | diagnostic | Macrovascular_complications | 3 | ||
| G61X100 | Read | Right sided intracerebral haemorrhage; unspecified | diagnostic | Macrovascular_complications | 3 | ||
| G61z.00 | Read | Intracerebral haemorrhage NOS | diagnostic | Macrovascular_complications | 3 | ||
| G63..00 | Read | Precerebral arterial occlusion | diagnostic | Macrovascular_complications | 3 | ||
| G63..11 | Read | Infarction - precerebral | diagnostic | Macrovascular_complications | 3 | ||
| G632.00 | Read | Vertebral artery occlusion | diagnostic | Macrovascular_complications | 3 | ||
| G63y000 | Read | Cerebral infarct due to thrombosis of precerebral arteries | diagnostic | Macrovascular_complications | 3 | ||
| G63y100 | Read | Cerebral infarction due to embolism of precerebral arteries | diagnostic | Macrovascular_complications | 3 | ||
| G640.00 | Read | Cerebral thrombosis | diagnostic | Macrovascular_complications | 3 | ||
| G640000 | Read | Cerebral infarction due to thrombosis of cerebral arteries | diagnostic | Macrovascular_complications | 3 | ||
| G641.00 | Read | Cerebral embolism | diagnostic | Macrovascular_complications | 3 | ||
| G641000 | Read | Cerebral infarction due to embolism of cerebral arteries | diagnostic | Macrovascular_complications | 3 | ||
| G641.11 | Read | Cerebral embolus | diagnostic | Macrovascular_complications | 3 | ||
| G64..12 | Read | Infarction - cerebral | diagnostic | Macrovascular_complications | 3 | ||
| G64..13 | Read | Stroke due to cerebral arterial occlusion | diagnostic | Macrovascular_complications | 3 | ||
| G64z.00 | Read | Cerebral infarction NOS | diagnostic | Macrovascular_complications | 3 | ||
| G64z000 | Read | Brainstem infarction | diagnostic | Macrovascular_complications | 3 | ||
| G64z.11 | Read | Brainstem infarction NOS | diagnostic | Macrovascular_complications | 3 | ||
| G64z111 | Read | Lateral medullary syndrome | diagnostic | Macrovascular_complications | 3 | ||
| G64z.12 | Read | Cerebellar infarction | diagnostic | Macrovascular_complications | 3 | ||
| G64z200 | Read | Left sided cerebral infarction | diagnostic | Macrovascular_complications | 3 | ||
| G64z300 | Read | Right sided cerebral infarction | diagnostic | Macrovascular_complications | 3 | ||
| G64z400 | Read | Infarction of basal ganglia | diagnostic | Macrovascular_complications | 3 | ||
| G66..00 | Read | Stroke and cerebrovascular accident unspecified | diagnostic | Macrovascular_complications | 3 | ||
| G661.00 | Read | Anterior cerebral artery syndrome | diagnostic | Macrovascular_complications | 3 | ||
| G66..11 | Read | CVA unspecified | diagnostic | Macrovascular_complications | 3 | ||
| G66..12 | Read | Stroke unspecified | diagnostic | Macrovascular_complications | 3 | ||
| G66..13 | Read | CVA - Cerebrovascular accident unspecified | diagnostic | Macrovascular_complications | 3 | ||
| G662.00 | Read | Posterior cerebral artery syndrome | diagnostic | Macrovascular_complications | 3 | ||
| G663.00 | Read | Brain stem stroke syndrome | diagnostic | Macrovascular_complications | 3 | ||
| G664.00 | Read | Cerebellar stroke syndrome | diagnostic | Macrovascular_complications | 3 | ||
| G665.00 | Read | Pure motor lacunar syndrome | diagnostic | Macrovascular_complications | 3 | ||
| G666.00 | Read | Pure sensory lacunar syndrome | diagnostic | Macrovascular_complications | 3 | ||
| G667.00 | Read | Left sided CVA | diagnostic | Macrovascular_complications | 3 | ||
| G668.00 | Read | Right sided CVA | diagnostic | Macrovascular_complications | 3 | ||
| G671.00 | Read | Generalised ischaemic cerebrovascular disease NOS | diagnostic | Macrovascular_complications | 3 | ||
| G671000 | Read | Acute cerebrovascular insufficiency NOS | diagnostic | Macrovascular_complications | 3 | ||
| G671z00 | Read | Generalised ischaemic cerebrovascular disease NOS | diagnostic | Macrovascular_complications | 3 | ||
| G676000 | Read | Cereb infarct due cerebral venous thrombosis; nonpyogenic | diagnostic | Macrovascular_complications | 3 | ||
| G6W..00 | Read | Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | Macrovascular_complications | 3 | ||
| G6X..00 | Read | Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | Macrovascular_complications | 3 | ||
| G70..00 | Read | Atherosclerosis | diagnostic | Macrovascular_complications | 1 | ||
| G700.00 | Read | Aortic atherosclerosis | diagnostic | Macrovascular_complications | 1 | ||
| G73..00 | Read | Other peripheral vascular disease | diagnostic | Macrovascular_complications | 1 | ||
| G73..12 | Read | Ischaemia of legs | diagnostic | Macrovascular_complications | 1 | ||
| G73y.00 | Read | Other specified peripheral vascular disease | diagnostic | Macrovascular_complications | 1 | ||
| G73yz00 | Read | Other specified peripheral vascular disease NOS | diagnostic | Macrovascular_complications | 1 | ||
| G73z.00 | Read | Peripheral vascular disease NOS | diagnostic | Macrovascular_complications | 1 | ||
| G73z000 | Read | Intermittent claudication | diagnostic | Macrovascular_complications | 1 | ||
| G73z011 | Read | Claudication | diagnostic | Macrovascular_complications | 1 | ||
| G73zz00 | Read | Peripheral vascular disease NOS | diagnostic | Macrovascular_complications | 1 | ||
| G742z00 | Read | Peripheral arterial embolism and thrombosis NOS | diagnostic | Macrovascular_complications | 1 | ||
| G74y300 | Read | Embolism and thrombosis of the iliac artery unspecified | diagnostic | Macrovascular_complications | 1 | ||
| G76z000 | Read | Iliac artery occlusion | diagnostic | Macrovascular_complications | 1 | ||
| Gyu3400 | Read | [X]Acute transmural myocardial infarction of unspecif site | diagnostic | Macrovascular_complications | 2 | ||
| Gyu3600 | Read | [X]Subsequent myocardial infarction of unspecified site | diagnostic | Macrovascular_complications | 2 | ||
| Gyu6200 | Read | [X]Other intracerebral haemorrhage | diagnostic | Macrovascular_complications | 3 | ||
| Gyu6300 | Read | [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | Macrovascular_complications | 3 | ||
| Gyu6400 | Read | [X]Other cerebral infarction | diagnostic | Macrovascular_complications | 3 | ||
| Gyu6F00 | Read | [X]Intracerebral haemorrhage in hemisphere; unspecified | diagnostic | Macrovascular_complications | 3 | ||
| Gyu6G00 | Read | [X]Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | Macrovascular_complications | 3 | ||
| Gyu7400 | Read | [X]Other specified peripheral vascular diseases | diagnostic | Macrovascular_complications | 1 | ||
| M271000 | Read | Ischaemic ulcer diabetic foot | diagnostic | Macrovascular_complications | 4 | ||
| R054300 | Read | [D]Widespread diabetic foot gangrene | diagnostic | Macrovascular_complications | 4 |
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