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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: Stroke
84 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| G61..00 | Read | Intracerebral haemorrhage | diagnostic | Stroke | |||
| G610.00 | Read | Cortical haemorrhage | diagnostic | Stroke | |||
| G611.00 | Read | Internal capsule haemorrhage | diagnostic | Stroke | |||
| G61..11 | Read | CVA - cerebrovascular accid due to intracerebral haemorrhage | diagnostic | Stroke | |||
| G61..12 | Read | Stroke due to intracerebral haemorrhage | diagnostic | Stroke | |||
| G612.00 | Read | Basal nucleus haemorrhage | diagnostic | Stroke | |||
| G613.00 | Read | Cerebellar haemorrhage | diagnostic | Stroke | |||
| G614.00 | Read | Pontine haemorrhage | diagnostic | Stroke | |||
| G615.00 | Read | Bulbar haemorrhage | diagnostic | Stroke | |||
| G616.00 | Read | External capsule haemorrhage | diagnostic | Stroke | |||
| G618.00 | Read | Intracerebral haemorrhage; multiple localized | diagnostic | Stroke | |||
| G61X.00 | Read | Intracerebral haemorrhage in hemisphere; unspecified | diagnostic | Stroke | |||
| G61X000 | Read | Left sided intracerebral haemorrhage; unspecified | diagnostic | Stroke | |||
| G61X100 | Read | Right sided intracerebral haemorrhage; unspecified | diagnostic | Stroke | |||
| G61z.00 | Read | Intracerebral haemorrhage NOS | diagnostic | Stroke | |||
| G63y000 | Read | Cerebral infarct due to thrombosis of precerebral arteries | diagnostic | Stroke | |||
| G63y100 | Read | Cerebral infarction due to embolism of precerebral arteries | diagnostic | Stroke | |||
| G64..00 | Read | Cerebral arterial occlusion | diagnostic | Stroke | |||
| G640.00 | Read | Cerebral thrombosis | diagnostic | Stroke | |||
| G640000 | Read | Cerebral infarction due to thrombosis of cerebral arteries | diagnostic | Stroke | |||
| G641.00 | Read | Cerebral embolism | diagnostic | Stroke | |||
| G641000 | Read | Cerebral infarction due to embolism of cerebral arteries | diagnostic | Stroke | |||
| G64..11 | Read | CVA - cerebral artery occlusion | diagnostic | Stroke | |||
| G641.11 | Read | Cerebral embolus | diagnostic | Stroke | |||
| G64..12 | Read | Infarction - cerebral | diagnostic | Stroke | |||
| G64..13 | Read | Stroke due to cerebral arterial occlusion | diagnostic | Stroke | |||
| G64z.00 | Read | Cerebral infarction NOS | diagnostic | Stroke | |||
| G64z000 | Read | Brainstem infarction | diagnostic | Stroke | |||
| G64z100 | Read | Wallenberg syndrome | diagnostic | Stroke | |||
| G64z.11 | Read | Brainstem infarction NOS | diagnostic | Stroke | |||
| G64z111 | Read | Lateral medullary syndrome | diagnostic | Stroke | |||
| G64z.12 | Read | Cerebellar infarction | diagnostic | Stroke | |||
| G64z200 | Read | Left sided cerebral infarction | diagnostic | Stroke | |||
| G64z300 | Read | Right sided cerebral infarction | diagnostic | Stroke | |||
| G64z400 | Read | Infarction of basal ganglia | diagnostic | Stroke | |||
| G65..00 | Read | Transient cerebral ischaemia | diagnostic | Stroke | |||
| G650.00 | Read | Basilar artery syndrome | diagnostic | Stroke | |||
| G650.11 | Read | Insufficiency - basilar artery | diagnostic | Stroke | |||
| G651.00 | Read | Vertebral artery syndrome | diagnostic | Stroke | |||
| G651000 | Read | Vertebro-basilar artery syndrome | diagnostic | Stroke | |||
| G65..11 | Read | Drop attack | diagnostic | Stroke | |||
| G65..12 | Read | Transient ischaemic attack | diagnostic | Stroke | |||
| G65..13 | Read | Vertebro-basilar insufficiency | diagnostic | Stroke | |||
| G652.00 | Read | Subclavian steal syndrome | diagnostic | Stroke | |||
| G653.00 | Read | Carotid artery syndrome hemispheric | diagnostic | Stroke | |||
| G654.00 | Read | Multiple and bilateral precerebral artery syndromes | diagnostic | Stroke | |||
| G656.00 | Read | Vertebrobasilar insufficiency | diagnostic | Stroke | |||
| G65y.00 | Read | Other transient cerebral ischaemia | diagnostic | Stroke | |||
| G65z.00 | Read | Transient cerebral ischaemia NOS | diagnostic | Stroke | |||
| G65z000 | Read | Impending cerebral ischaemia | diagnostic | Stroke | |||
| G65z100 | Read | Intermittent cerebral ischaemia | diagnostic | Stroke | |||
| G65zz00 | Read | Transient cerebral ischaemia NOS | diagnostic | Stroke | |||
| G66..00 | Read | Stroke and cerebrovascular accident unspecified | diagnostic | Stroke | |||
| G660.00 | Read | Middle cerebral artery syndrome | diagnostic | Stroke | |||
| G661.00 | Read | Anterior cerebral artery syndrome | diagnostic | Stroke | |||
| G66..11 | Read | CVA unspecified | diagnostic | Stroke | |||
| G66..12 | Read | Stroke unspecified | diagnostic | Stroke | |||
| G66..13 | Read | CVA - Cerebrovascular accident unspecified | diagnostic | Stroke | |||
| G662.00 | Read | Posterior cerebral artery syndrome | diagnostic | Stroke | |||
| G663.00 | Read | Brain stem stroke syndrome | diagnostic | Stroke | |||
| G664.00 | Read | Cerebellar stroke syndrome | diagnostic | Stroke | |||
| G665.00 | Read | Pure motor lacunar syndrome | diagnostic | Stroke | |||
| G666.00 | Read | Pure sensory lacunar syndrome | diagnostic | Stroke | |||
| G667.00 | Read | Left sided CVA | diagnostic | Stroke | |||
| G668.00 | Read | Right sided CVA | diagnostic | Stroke | |||
| G6W..00 | Read | Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | Stroke | |||
| G6X..00 | Read | Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | Stroke | |||
| Gyu6200 | Read | [X]Other intracerebral haemorrhage | diagnostic | Stroke | |||
| Gyu6300 | Read | [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | Stroke | |||
| Gyu6400 | Read | [X]Other cerebral infarction | diagnostic | Stroke | |||
| Gyu6500 | Read | [X]Occlusion and stenosis of other precerebral arteries | diagnostic | Stroke | |||
| Gyu6600 | Read | [X]Occlusion and stenosis of other cerebral arteries | diagnostic | Stroke | |||
| Gyu6G00 | Read | [X]Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | Stroke | |||
| L440.11 | Read | CVA - cerebrovascular accident in the puerperium | diagnostic | Stroke | |||
| L440.12 | Read | Stroke in the puerperium | diagnostic | Stroke | |||
| 4350AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS WITH HYPERTE | diagnostic | Stroke | |||
| 4359AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS | diagnostic | Stroke | |||
| 4360A | OXMIS | CEREBROVASCULAR ACCIDENT WITH HYPERTENSI | diagnostic | Stroke | |||
| 4360B | OXMIS | STROKE WITH HYPERTENSION | diagnostic | Stroke | |||
| 4369A | OXMIS | CVA (CEREBROVASCULAR ACCIDENT) | diagnostic | Stroke | |||
| 4369AL | OXMIS | CEREBROVASCULAR ACCIDENT LEFT | diagnostic | Stroke | |||
| 4369AR | OXMIS | CEREBROVASCULAR ACCIDENT RIGHT | diagnostic | Stroke | |||
| 4369B | OXMIS | STROKE | diagnostic | Stroke | |||
| 4369BN | OXMIS | SYNDROME STROKE | diagnostic | Stroke |
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The ClinicalCodes project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR)
Codes used to identify Stroke patients. Stroke treated as a chronic condition. Patients with any codes from this list prior to the end of a given QOF year are included for that year.