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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: res9: antiplatelets

45 codes in list

Code Coding system Description Entity type List name multilexcode bnfcode bnfchapter
16 CPRD_product_code aspirin tablets 75mg drug res9: antiplatelets 6424001 2090100 Aspirin (as antiplatelet drug)
18329 CPRD_product_code ENPRIN enteric coated tablets 75mg [GALPHARM] drug res9: antiplatelets 11179001 2090100 Aspirin (as antiplatelet drug)
19189 CPRD_product_code MICROPIRIN enteric coated tablets 75mg [RATIOPHARM] drug res9: antiplatelets 9856001 2090100 Aspirin (as antiplatelet drug)
22618 CPRD_product_code SOLPRIN tablets 75mg [RECKITT B] drug res9: antiplatelets 2839001 2090100 Aspirin (as antiplatelet drug)
23593 CPRD_product_code POSTMI dispersible tablet 75mg [ASHBOURNE] drug res9: antiplatelets 8462001 2090100 Aspirin (as antiplatelet drug)
23878 CPRD_product_code NU-SEALS CARDIO EC tablets 75mg [GENUS] drug res9: antiplatelets 10374001 2090100 Aspirin (as antiplatelet drug)
25335 CPRD_product_code POSTMI EC tablets 75mg [ASHBOURNE] drug res9: antiplatelets 8462002 2090100 Aspirin (as antiplatelet drug)
25718 CPRD_product_code ANGETTES tablets 75mg [BRISTOL] drug res9: antiplatelets 6423001 2090100 Aspirin (as antiplatelet drug)
2607 CPRD_product_code PAYNOCIL tablets [BEECHAM] drug res9: antiplatelets 5786001 02090100/04070101 Aspirin (as antiplatelet drug)/Aspirin
2628 CPRD_product_code NU-SEALS ASPIRIN EC tablets 75mg [LILLY] drug res9: antiplatelets 665003 2090100 Aspirin (as antiplatelet drug)
3 CPRD_product_code aspirin dispersible tablet 75mg drug res9: antiplatelets 1223001 2090100 Aspirin (as antiplatelet drug)
31211 CPRD_product_code ASPIRIN dispersible tablet 75mg [AAH(VANT)] drug res9: antiplatelets 2081009 2090100 Aspirin (as antiplatelet drug)
31938 CPRD_product_code ASPIRIN EC tablets 75mg [SANDOZ] drug res9: antiplatelets 2462009 2090100 Aspirin (as antiplatelet drug)
31953 CPRD_product_code ASPIRIN dispersible tablet 75mg [IVAX] drug res9: antiplatelets 2758009 2090100 Aspirin (as antiplatelet drug)
31954 CPRD_product_code ASPIRIN dispersible tablet 75mg [TEVA] drug res9: antiplatelets 1407009 2090100 Aspirin (as antiplatelet drug)
31956 CPRD_product_code ASPIRIN enteric coated tablets 75mg [KENT] drug res9: antiplatelets 3563009 2090100 Aspirin (as antiplatelet drug)
32036 CPRD_product_code ASPIRIN dispersible tablet 75mg [ACTAVIS] drug res9: antiplatelets 191009 2090100 Aspirin (as antiplatelet drug)
32992 CPRD_product_code ASPIRIN enteric coated tablets 75mg [GEN (UK)] drug res9: antiplatelets 3609009 2090100 Aspirin (as antiplatelet drug)
33293 CPRD_product_code ASPIRIN enteric coated tablets 75mg [STERWIN] drug res9: antiplatelets 3555009 2090100 Aspirin (as antiplatelet drug)
33320 CPRD_product_code ASPIRIN dispersible tablet 75mg [SOVEREIGN] drug res9: antiplatelets 4689009 2090100 Aspirin (as antiplatelet drug)
33656 CPRD_product_code ASPIRIN dispersible tablet 75mg [HILLCROSS] drug res9: antiplatelets 192009 2090100 Aspirin (as antiplatelet drug)
33676 CPRD_product_code ASPIRIN dispersible tablet 75mg [KENT] drug res9: antiplatelets 3798009 2090100 Aspirin (as antiplatelet drug)
34 CPRD_product_code aspirin gastro-resistant tablets 75mg drug res9: antiplatelets 1223002 2090100 Aspirin (as antiplatelet drug)
34385 CPRD_product_code ASPIRIN soluble tablet 75mg [CO-OPERATI] drug res9: antiplatelets 1486010 2090100 Aspirin (as antiplatelet drug)
34434 CPRD_product_code ASPIRIN dispersible tablet 75mg [T & R] drug res9: antiplatelets 2322010 2090100 Aspirin (as antiplatelet drug)
34485 CPRD_product_code ASPIRIN enteric coated tablets 75mg [IVAX] drug res9: antiplatelets 2758010 2090100 Aspirin (as antiplatelet drug)
34611 CPRD_product_code ASPIRIN enteric coated tablets 75mg [CP PHARM] drug res9: antiplatelets 717011 2090100 Aspirin (as antiplatelet drug)
34796 CPRD_product_code ASPIRIN enteric coated tablets 75mg [GALEN] drug res9: antiplatelets 2817009 2090100 Aspirin (as antiplatelet drug)
34797 CPRD_product_code ASPIRIN enteric coated tablets 75mg [ACTAVIS] drug res9: antiplatelets 2902009 2090100 Aspirin (as antiplatelet drug)
34942 CPRD_product_code ASPIRIN dispersible tablet 75mg [NUCARE] drug res9: antiplatelets 4647009 2090100 Aspirin (as antiplatelet drug)
40381 CPRD_product_code ASPIRIN soluble tablet 75mg [CP PHARM] drug res9: antiplatelets 717010 2090100 Aspirin (as antiplatelet drug)
40913 CPRD_product_code GREPID film coated tablets 75mg [BEACON] drug res9: antiplatelets 17315001 2090200 Clopidogrel and related drugs
41512 CPRD_product_code ASPIRIN enteric coated tablets 75mg [TEVA] drug res9: antiplatelets 2839009 2090100 Aspirin (as antiplatelet drug)
42750 CPRD_product_code CLOPIDOGREL film coated tablets 75mg [ACTAVIS] drug res9: antiplatelets 7750009 2090200 Clopidogrel and related drugs
43709 CPRD_product_code ASPIRIN enteric coated tablets 75mg [ALMUS] drug res9: antiplatelets 5558009 2090100 Aspirin (as antiplatelet drug)
45643 CPRD_product_code ASPIRIN soluble tablet 75mg [CELLTECH] drug res9: antiplatelets 189011 2090100 Aspirin (as antiplatelet drug)
46891 CPRD_product_code clopidogrel oral suspension 75mg/5ml drug res9: antiplatelets 18860001 2090200 Clopidogrel and related drugs
47937 CPRD_product_code ASPIRIN dispersible tablet 75mg [WOCKHARDT] drug res9: antiplatelets 8280009 2090100 Aspirin (as antiplatelet drug)
47992 CPRD_product_code ASPIRIN enteric coated tablets 75mg [HILLCROSS] drug res9: antiplatelets 3011010 2090100 Aspirin (as antiplatelet drug)
48021 CPRD_product_code ASPIRIN tablets 75mg [HILLCROSS] drug res9: antiplatelets 7914009 2090100 Aspirin (as antiplatelet drug)
489 CPRD_product_code clopidogrel film coated tablets 75mg drug res9: antiplatelets 10614001 2090200 Clopidogrel and related drugs
6006 CPRD_product_code NU-SEALS ASPIRIN EC tablets 75mg [ALLIANCE] drug res9: antiplatelets 10781001 2090100 Aspirin (as antiplatelet drug)
6696 CPRD_product_code MICROPIRIN enteric coated tablets 75mg [DEXCEL] drug res9: antiplatelets 7984001 2090100 Aspirin (as antiplatelet drug)
836 CPRD_product_code PLAVIX film coated tablets 75mg [SANOFI BMS] drug res9: antiplatelets 10606001 2090200 Clopidogrel and related drugs
9144 CPRD_product_code CAPRIN EC tablets 75mg [WOCKHARDT] drug res9: antiplatelets 9288001 2090100 Aspirin (as antiplatelet drug)

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