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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: Retinal_screening
67 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 2BB..00 | Read | O/E - retinal inspection | test | Retinal_screening | |||
| 2BB1.00 | Read | O/E - retina normal | test | Retinal_screening | |||
| 2BB..11 | Read | O/E - retina | test | Retinal_screening | |||
| 2BB2.00 | Read | O/E - retinal vessel narrowing | test | Retinal_screening | |||
| 2BB3.00 | Read | O/E - retinal A-V nipping | test | Retinal_screening | |||
| 2BB4.00 | Read | O/E - retinal microaneurysms | test | Retinal_screening | |||
| 2BB5.00 | Read | O/E - retinal haemorrhages | test | Retinal_screening | |||
| 2BB6.00 | Read | O/E - retinal exudates | test | Retinal_screening | |||
| 2BB7.00 | Read | O/E - retinal vascular prolif. | test | Retinal_screening | |||
| 2BB8.00 | Read | O/E - vitreous haemorrhages | test | Retinal_screening | |||
| 2BB9.00 | Read | O/E - retinal pigmentation | test | Retinal_screening | |||
| 2BBa.00 | Read | O/E- non-referable retinopathy | test | Retinal_screening | |||
| 2BBA.00 | Read | Examination of retina | test | Retinal_screening | |||
| 2BBb.00 | Read | O/E - fundus not adequately seen | test | Retinal_screening | |||
| 2BBB.00 | Read | O/E - Right retina not seen | test | Retinal_screening | |||
| 2BBc.00 | Read | O/E - No retinal laser photocoagulation scars | test | Retinal_screening | |||
| 2BBC.00 | Read | O/E - Left retina not seen | test | Retinal_screening | |||
| 2BBd.00 | Read | O/E - Red reflex absent | test | Retinal_screening | |||
| 2BBD.00 | Read | O/E - Right retina normal | test | Retinal_screening | |||
| 2BBe.00 | Read | O/E - right retina partially assessable | test | Retinal_screening | |||
| 2BBE.00 | Read | O/E - Left retina normal | test | Retinal_screening | |||
| 2BBF.00 | Read | Retinal abnormality - diabetes related | test | Retinal_screening | |||
| 2BBg.00 | Read | O/E - right retina fully assessable | test | Retinal_screening | |||
| 2BBG.00 | Read | Retinal abnormality - non-diabetes | test | Retinal_screening | |||
| 2BBH.00 | Read | Retinal drusen | test | Retinal_screening | |||
| 2BBi.00 | Read | O/E - right eye no maculopathy | test | Retinal_screening | |||
| 2BBI.00 | Read | O/E - no retinopathy | test | Retinal_screening | |||
| 2BBj.00 | Read | O/E - left eye no maculopathy | test | Retinal_screening | |||
| 2BBJ.00 | Read | O/E - no right diabetic retinopathy | test | Retinal_screening | |||
| 2BBk.00 | Read | O/E - right eye stable treated prolif diabetic retinopathy | test | Retinal_screening | |||
| 2BBK.00 | Read | O/E - no left diabetic retinopathy | test | Retinal_screening | |||
| 2BBl.00 | Read | O/E - left eye stable treated prolif diabetic retinopathy | test | Retinal_screening | |||
| 2BBL.00 | Read | O/E - diabetic maculopathy present both eyes | test | Retinal_screening | |||
| 2BBm.00 | Read | O/E - right eye clinically significant macular oedema | test | Retinal_screening | |||
| 2BBM.00 | Read | O/E - diabetic maculopathy absent both eyes | test | Retinal_screening | |||
| 2BBn.00 | Read | O/E - left eye clinically significant macular oedema | test | Retinal_screening | |||
| 2BBN.00 | Read | Myelinated retinal nerve fibres | test | Retinal_screening | |||
| 2BBo.00 | Read | O/E - sight threatening diabetic retinopathy | test | Retinal_screening | |||
| 2BBO.00 | Read | O/E - Laser photocoagulation scars | test | Retinal_screening | |||
| 2BBP.00 | Read | O/E - right eye background diabetic retinopathy | test | Retinal_screening | |||
| 2BBQ.00 | Read | O/E - left eye background diabetic retinopathy | test | Retinal_screening | |||
| 2BBR.00 | Read | O/E - right eye preproliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBS.00 | Read | O/E - left eye preproliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBT.00 | Read | O/E - right eye proliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBV.00 | Read | O/E - left eye proliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBW.00 | Read | O/E - right eye diabetic maculopathy | test | Retinal_screening | |||
| 2BBX.00 | Read | O/E - left eye diabetic maculopathy | test | Retinal_screening | |||
| 2BBY.00 | Read | O/E - referable retinopathy | test | Retinal_screening | |||
| 2BBZ.00 | Read | O/E - retinal inspection NOS | test | Retinal_screening | |||
| 3128.00 | Read | Fundoscopy | test | Retinal_screening | |||
| 3128000 | Read | Fundoscopy normal | test | Retinal_screening | |||
| 3128100 | Read | Fundoscopy abnormal | test | Retinal_screening | |||
| 3128.11 | Read | Retinoscopy | test | Retinal_screening | |||
| 3128200 | Read | Dilated fundoscopy normal | test | Retinal_screening | |||
| 3128300 | Read | Camera fundoscopy | test | Retinal_screening | |||
| 3128400 | Read | Indirect fundoscopy following mydriatic | test | Retinal_screening | |||
| 3128Z00 | Read | Fundoscopy NOS | test | Retinal_screening | |||
| 3129.00 | Read | Eye fundus photography | test | Retinal_screening | |||
| 312E.00 | Read | Direct fundoscopy following mydriatic | test | Retinal_screening | |||
| 312G.00 | Read | Indirect fundoscopy following mydriatic | test | Retinal_screening | |||
| 58C1.00 | Read | Retinal photography | test | Retinal_screening | |||
| 66AD.00 | Read | Fundoscopy - diabetic check | test | Retinal_screening | |||
| 68A7.00 | Read | Diabetic retinopathy screening | test | Retinal_screening | |||
| 68A8.00 | Read | Digital retinal screening | test | Retinal_screening | |||
| X962 | OXMIS | FUNDOSCOPY | test | Retinal_screening | |||
| X962 AB | OXMIS | FUNDOSCOPY ABNORMAL | test | Retinal_screening | |||
| X962 NM | OXMIS | FUNDOSCOPY NORMAL | test | Retinal_screening |
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QOF indicator DM 8