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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: smoking_status

151 codes in list

Code Coding system Description Entity type List name smoking_status cessation_advice
137..00 Read Tobacco consumption observation smoking_status NA 0
1371.00 Read Never smoked tobacco observation smoking_status 0 0
137..11 Read Smoker - amount smoked observation smoking_status 2 0
1371.11 Read Non-smoker observation smoking_status 0 0
1372.00 Read Trivial smoker - < 1 cig/day observation smoking_status 2 0
1372.11 Read Occasional smoker observation smoking_status 2 0
1373.00 Read Light smoker - 1-9 cigs/day observation smoking_status 2 0
1374.00 Read Moderate smoker - 10-19 cigs/d observation smoking_status 2 0
1375.00 Read Heavy smoker - 20-39 cigs/day observation smoking_status 2 0
1376.00 Read Very heavy smoker - 40+cigs/d observation smoking_status 2 0
1377.00 Read Ex-trivial smoker (<1/day) observation smoking_status 1 0
1378.00 Read Ex-light smoker (1-9/day) observation smoking_status 1 0
1379.00 Read Ex-moderate smoker (10-19/day) observation smoking_status 1 0
137a.00 Read Pipe tobacco consumption observation smoking_status 2 0
137A.00 Read Ex-heavy smoker (20-39/day) observation smoking_status 1 0
137b.00 Read Ready to stop smoking observation smoking_status 2 0
137B.00 Read Ex-very heavy smoker (40+/day) observation smoking_status 1 0
137c.00 Read Thinking about stopping smoking observation smoking_status 2 0
137C.00 Read Keeps trying to stop smoking observation smoking_status 2 0
137d.00 Read Not interested in stopping smoking observation smoking_status 2 0
137D.00 Read Admitted tobacco cons untrue ? observation smoking_status 2 0
137e.00 Read Smoking restarted observation smoking_status 2 0
137E.00 Read Tobacco consumption unknown observation smoking_status NA 0
137f.00 Read Reason for restarting smoking observation smoking_status 2 0
137F.00 Read Ex-smoker - amount unknown observation smoking_status 1 0
137g.00 Read Cigarette pack-years observation smoking_status NA 0
137G.00 Read Trying to give up smoking observation smoking_status 2 0
137h.00 Read Minutes from waking to first tobacco consumption observation smoking_status 2 0
137H.00 Read Pipe smoker observation smoking_status 2 0
137I.00 Read Passive smoker observation smoking_status NA 0
137J.00 Read Cigar smoker observation smoking_status 2 0
137K.00 Read Stopped smoking observation smoking_status 1 0
137L.00 Read Current non-smoker observation smoking_status 1 0
137M.00 Read Rolls own cigarettes observation smoking_status 2 0
137N.00 Read Ex pipe smoker observation smoking_status 1 0
137O.00 Read Ex cigar smoker observation smoking_status 1 0
137P.00 Read Cigarette smoker observation smoking_status 2 0
137P.11 Read Smoker observation smoking_status 2 0
137Q.00 Read Smoking started observation smoking_status 2 0
137Q.11 Read Smoking restarted observation smoking_status 2 0
137R.00 Read Current smoker observation smoking_status 2 0
137S.00 Read Ex smoker observation smoking_status 1 0
137T.00 Read Date ceased smoking observation smoking_status 1 0
137U.00 Read Not a passive smoker observation smoking_status NA 0
137V.00 Read Smoking reduced observation smoking_status 2 0
137W.00 Read Chews tobacco observation smoking_status NA 0
137X.00 Read Cigarette consumption observation smoking_status 2 0
137Y.00 Read Cigar consumption observation smoking_status 2 0
137Z.00 Read Tobacco consumption NOS observation smoking_status 2 0
13cA.00 Read Smokes drugs observation smoking_status NA 0
13p..00 Read Smoking cessation milestones observation smoking_status NA 1
13p0.00 Read Negotiated date for cessation of smoking observation smoking_status NA 1
13p1.00 Read Smoking status at 4 weeks observation smoking_status NA 1
13p2.00 Read Smoking status between 4 and 52 weeks observation smoking_status NA 1
13p3.00 Read Smoking status at 52 weeks observation smoking_status NA 1
13p4.00 Read Smoking free weeks observation smoking_status NA 1
13p5.00 Read Smoking cessation programme start date observation smoking_status NA 1
13WF.00 Read Family smoking history observation smoking_status NA 0
13WF100 Read Father smokes observation smoking_status NA 0
13WF.11 Read Smoker in the family observation smoking_status NA 0
13WF200 Read Mother smokes observation smoking_status NA 0
13WF300 Read Both parents smoke observation smoking_status NA 0
13WF400 Read Passive smoking risk observation smoking_status NA 0
13WI.00 Read Parents do not smoke observation smoking_status NA 0
13WK.00 Read No smokers in the household observation smoking_status NA 0
177..00 Read Smoke inhalation observation smoking_status NA 0
6791.00 Read Health ed. - smoking observation smoking_status NA 1
67A3.00 Read Pregnancy smoking advice observation smoking_status NA 1
67H1.00 Read Lifestyle advice regarding smoking observation smoking_status NA 1
745H.00 Read Smoking cessation therapy observation smoking_status NA 1
745H000 Read Nicotine replacement therapy using nicotine patches observation smoking_status NA 1
745H100 Read Nicotine replacement therapy using nicotine gum observation smoking_status NA 1
745H200 Read Nicotine replacement therapy using nicotine inhalator observation smoking_status NA 1
745H300 Read Nicotine replacement therapy using nicotine lozenges observation smoking_status NA 1
8B2B.00 Read Nicotine replacement therapy observation smoking_status NA 1
8B3f.00 Read Nicotine replacement therapy provided free observation smoking_status NA 1
8B3Y.00 Read Over the counter nicotine replacement therapy observation smoking_status NA 1
8BP3.00 Read Nicotine replacement therapy provided by community pharmacis observation smoking_status NA 1
8CAg.00 Read Smoking cessation advice provided by community pharmacist observation smoking_status NA 1
8CAL.00 Read Smoking cessation advice observation smoking_status NA 1
8H7i.00 Read Referral to smoking cessation advisor observation smoking_status NA 1
8HTK.00 Read Referral to stop-smoking clinic observation smoking_status NA 1
8I2I.00 Read Nicotine replacement therapy contraindicated observation smoking_status NA 0
8I39.00 Read Nicotine replacement therapy refused observation smoking_status NA 0
8I6H.00 Read Smoking review not indicated observation smoking_status NA 0
9hG..00 Read Exception reporting: smoking quality indicators observation smoking_status NA 0
9hG0.00 Read Excepted from smoking quality indicators: Patient unsuitable observation smoking_status NA 0
9hG1.00 Read Excepted from smoking quality indicators: Informed dissent observation smoking_status NA 0
9N2k.00 Read Seen by smoking cessation advisor observation smoking_status NA 1
9N4M.00 Read DNA - Did not attend smoking cessation clinic observation smoking_status NA 1
9OO..00 Read Anti-smoking monitoring admin. observation smoking_status NA 1
9OO1.00 Read Attends stop smoking monitor. observation smoking_status NA 1
9OO..11 Read Stop smoking clinic admin. observation smoking_status NA 1
9OO..12 Read Stop smoking monitoring admin. observation smoking_status NA 1
9OO2.00 Read Refuses stop smoking monitor observation smoking_status NA 1
9OO3.00 Read Stop smoking monitor default observation smoking_status NA 1
9OO4.00 Read Stop smoking monitor 1st lettr observation smoking_status NA 1
9OO5.00 Read Stop smoking monitor 2nd lettr observation smoking_status NA 1
9OO6.00 Read Stop smoking monitor 3rd lettr observation smoking_status NA 1
9OO7.00 Read Stop smoking monitor verb.inv. observation smoking_status NA 1
9OO8.00 Read Stop smoking monitor phone inv observation smoking_status NA 1
9OO9.00 Read Stop smoking monitoring delete observation smoking_status NA 1
9OOA.00 Read Stop smoking monitor.chck done observation smoking_status NA 1
9OOZ.00 Read Stop smoking monitor admin.NOS observation smoking_status NA 0
H310100 Read Smokers' cough observation smoking_status NA 0
SM7y200 Read Smoke inhalation observation smoking_status NA 0
SM7z.11 Read Smoke inhalation observation smoking_status NA 0
ZG23300 Read Advice on smoking observation smoking_status NA 1
ZRaM.00 Read Motives for smoking scale observation smoking_status NA 1
ZRh4.00 Read Reasons for smoking scale observation smoking_status NA 1
ZRh4.11 Read RFS - Reasons for smoking scale observation smoking_status NA 1
5020M OXMIS SMOKERS' THROAT observation smoking_status NA 0
5287MK OXMIS SMOKERS' MOUTH PATCHES observation smoking_status NA 0
9879MK OXMIS SMOKE INHALATION observation smoking_status NA 0
L5090B OXMIS PARENTS BOTH SMOKE observation smoking_status NA 0
L5091S OXMIS SMOKING STARTED observation smoking_status NA 1
T509 OXMIS SMOKER observation smoking_status 2 0
T5090OR OXMIS SMOKER OWN ROLLED observation smoking_status 2 0
T5090XC OXMIS SMOKER CIGARETTES observation smoking_status 2 0
T5091 OXMIS STOPPED SMOKING observation smoking_status 1 0
T5091ES OXMIS FORMER SMOKER observation smoking_status 1 0
T5091HS OXMIS EX HEAVY SMOKER observation smoking_status 1 0
T5092 OXMIS SMOKING ADVISED TO STOP observation smoking_status 2 1
T5092S OXMIS SMOKING WISHES TO STOP observation smoking_status 2 0
T5092SA OXMIS SMOKING WANTS TO STOP observation smoking_status 2 0
T5093 OXMIS SMOKER NON observation smoking_status 1 0
T5093N OXMIS SMOKED NEVER observation smoking_status 0 0
T5094F OXMIS SMOKER IN FAMILY observation smoking_status NA 0
T5094FS OXMIS FATHER SMOKES observation smoking_status NA 0
T5094MS OXMIS MOTHER SMOKES observation smoking_status NA 0
T5094PR OXMIS PASSIVE SMOKING RISK observation smoking_status NA 0
T509 SR OXMIS SMOKING RESTARTED observation smoking_status 2 0
T510 OXMIS EXCESSIVE SMOKING observation smoking_status 2 0
T510 HS OXMIS HEAVY SMOKER (20-PLUS PER DAY) observation smoking_status 2 0
T510 SE OXMIS SMOKING EXCESSIVE observation smoking_status 2 0
T510 SH OXMIS SMOKER HEAVY (20-PLUS PER DAY) observation smoking_status 2 0
T511 OXMIS SMOKER MODERATE (LESS THAN 20 PER DAY) observation smoking_status 2 0
T5112 OXMIS SMOKER (20 PER DAY) observation smoking_status 2 0
T5113 OXMIS SMOKER (15 PER DAY) observation smoking_status 2 0
T5114 OXMIS SMOKER (10 PER DAY) observation smoking_status 2 0
T5115 OXMIS SMOKER (LESS THAN 10 PER DAY) observation smoking_status 2 0
T5115M OXMIS SMOKER MILD (5 OR LESS PER DAY) observation smoking_status 2 0
T5116 OXMIS SMOKER(OCCASIONAL) observation smoking_status 2 0
T5117 OXMIS SMOKER (30 PER DAY) observation smoking_status 2 0
T512 OXMIS SMOKER PIPE observation smoking_status 2 0
T513 OXMIS SMOKER CIGARS observation smoking_status 2 0
Y0601JJ OXMIS CLINIC ANTI-SMOKING ATTENDANCE observation smoking_status NA 1
Y0601KA OXMIS SMOKING CLINIC ATTENDANCE observation smoking_status NA 1
Y060 J1 OXMIS STOP SMOKING GROUP observation smoking_status NA 1
Y060 JJ OXMIS CLINIC ANTI-SMOKING observation smoking_status NA 1
Y060 KA OXMIS SMOKING CLINIC observation smoking_status NA 1

1 comment has been posted.

Jan. 27, 2014, 5:36 a.m. - David Springate

Codes used to identify patients meeting QOF indicators ASTHMA 4, ASTHMA 5, CHD 3, CHD 4, COPD 4, COPD 5, DM 3, DM 4, STROKE 3, STROKE 4. Smoking_status codes: 0 : Non smoker 1 : Ex smoker 2 : Current smoker

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