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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: Type 2 Diabetes
102 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 66Ao.00 | Read | Diabetes type 2 review | diagnostic | Type 2 Diabetes | |||
| 66At100 | Read | Type II diabetic dietary review | diagnostic | Type 2 Diabetes | |||
| 66At111 | Read | Type 2 diabetic dietary review | diagnostic | Type 2 Diabetes | |||
| C100112 | Read | Non-insulin dependent diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109.00 | Read | Non-insulin dependent diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109000 | Read | Non-insulin-dependent diabetes mellitus with renal comps | diagnostic | Type 2 Diabetes | |||
| C109011 | Read | Type II diabetes mellitus with renal complications | diagnostic | Type 2 Diabetes | |||
| C109012 | Read | Type 2 diabetes mellitus with renal complications | diagnostic | Type 2 Diabetes | |||
| C109100 | Read | Non-insulin-dependent diabetes mellitus with ophthalm comps | diagnostic | Type 2 Diabetes | |||
| C109.11 | Read | NIDDM - Non-insulin dependent diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109111 | Read | Type II diabetes mellitus with ophthalmic complications | diagnostic | Type 2 Diabetes | |||
| C109112 | Read | Type 2 diabetes mellitus with ophthalmic complications | diagnostic | Type 2 Diabetes | |||
| C109.12 | Read | Type 2 diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109.13 | Read | Type II diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109200 | Read | Non-insulin-dependent diabetes mellitus with neuro comps | diagnostic | Type 2 Diabetes | |||
| C109211 | Read | Type II diabetes mellitus with neurological complications | diagnostic | Type 2 Diabetes | |||
| C109212 | Read | Type 2 diabetes mellitus with neurological complications | diagnostic | Type 2 Diabetes | |||
| C109300 | Read | Non-insulin-dependent diabetes mellitus with multiple comps | diagnostic | Type 2 Diabetes | |||
| C109400 | Read | Non-insulin dependent diabetes mellitus with ulcer | diagnostic | Type 2 Diabetes | |||
| C109411 | Read | Type II diabetes mellitus with ulcer | diagnostic | Type 2 Diabetes | |||
| C109412 | Read | Type 2 diabetes mellitus with ulcer | diagnostic | Type 2 Diabetes | |||
| C109500 | Read | Non-insulin dependent diabetes mellitus with gangrene | diagnostic | Type 2 Diabetes | |||
| C109511 | Read | Type II diabetes mellitus with gangrene | diagnostic | Type 2 Diabetes | |||
| C109512 | Read | Type 2 diabetes mellitus with gangrene | diagnostic | Type 2 Diabetes | |||
| C109600 | Read | Non-insulin-dependent diabetes mellitus with retinopathy | diagnostic | Type 2 Diabetes | |||
| C109611 | Read | Type II diabetes mellitus with retinopathy | diagnostic | Type 2 Diabetes | |||
| C109612 | Read | Type 2 diabetes mellitus with retinopathy | diagnostic | Type 2 Diabetes | |||
| C109700 | Read | Non-insulin dependent diabetes mellitus - poor control | diagnostic | Type 2 Diabetes | |||
| C109711 | Read | Type II diabetes mellitus - poor control | diagnostic | Type 2 Diabetes | |||
| C109712 | Read | Type 2 diabetes mellitus - poor control | diagnostic | Type 2 Diabetes | |||
| C109900 | Read | Non-insulin-dependent diabetes mellitus without complication | diagnostic | Type 2 Diabetes | |||
| C109A00 | Read | Non-insulin dependent diabetes mellitus with mononeuropathy | diagnostic | Type 2 Diabetes | |||
| C109A11 | Read | Type II diabetes mellitus with mononeuropathy | diagnostic | Type 2 Diabetes | |||
| C109B00 | Read | Non-insulin dependent diabetes mellitus with polyneuropathy | diagnostic | Type 2 Diabetes | |||
| C109B11 | Read | Type II diabetes mellitus with polyneuropathy | diagnostic | Type 2 Diabetes | |||
| C109C00 | Read | Non-insulin dependent diabetes mellitus with nephropathy | diagnostic | Type 2 Diabetes | |||
| C109C11 | Read | Type II diabetes mellitus with nephropathy | diagnostic | Type 2 Diabetes | |||
| C109C12 | Read | Type 2 diabetes mellitus with nephropathy | diagnostic | Type 2 Diabetes | |||
| C109D00 | Read | Non-insulin dependent diabetes mellitus with hypoglyca coma | diagnostic | Type 2 Diabetes | |||
| C109D11 | Read | Type II diabetes mellitus with hypoglycaemic coma | diagnostic | Type 2 Diabetes | |||
| C109D12 | Read | Type 2 diabetes mellitus with hypoglycaemic coma | diagnostic | Type 2 Diabetes | |||
| C109E00 | Read | Non-insulin depend diabetes mellitus with diabetic cataract | diagnostic | Type 2 Diabetes | |||
| C109E11 | Read | Type II diabetes mellitus with diabetic cataract | diagnostic | Type 2 Diabetes | |||
| C109E12 | Read | Type 2 diabetes mellitus with diabetic cataract | diagnostic | Type 2 Diabetes | |||
| C109F11 | Read | Type II diabetes mellitus with peripheral angiopathy | diagnostic | Type 2 Diabetes | |||
| C109F12 | Read | Type 2 diabetes mellitus with peripheral angiopathy | diagnostic | Type 2 Diabetes | |||
| C109G00 | Read | Non-insulin dependent diabetes mellitus with arthropathy | diagnostic | Type 2 Diabetes | |||
| C109G11 | Read | Type II diabetes mellitus with arthropathy | diagnostic | Type 2 Diabetes | |||
| C109G12 | Read | Type 2 diabetes mellitus with arthropathy | diagnostic | Type 2 Diabetes | |||
| C109H11 | Read | Type II diabetes mellitus with neuropathic arthropathy | diagnostic | Type 2 Diabetes | |||
| C109H12 | Read | Type 2 diabetes mellitus with neuropathic arthropathy | diagnostic | Type 2 Diabetes | |||
| C109J00 | Read | Insulin treated Type 2 diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109J11 | Read | Insulin treated non-insulin dependent diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109J12 | Read | Insulin treated Type II diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C109K00 | Read | Hyperosmolar non-ketotic state in type 2 diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C10D.00 | Read | Diabetes mellitus autosomal dominant type 2 | diagnostic | Type 2 Diabetes | |||
| C10F.00 | Read | Type 2 diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C10F000 | Read | Type 2 diabetes mellitus with renal complications | diagnostic | Type 2 Diabetes | |||
| C10F011 | Read | Type II diabetes mellitus with renal complications | diagnostic | Type 2 Diabetes | |||
| C10F100 | Read | Type 2 diabetes mellitus with ophthalmic complications | diagnostic | Type 2 Diabetes | |||
| C10F.11 | Read | Type II diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C10F111 | Read | Type II diabetes mellitus with ophthalmic complications | diagnostic | Type 2 Diabetes | |||
| C10F200 | Read | Type 2 diabetes mellitus with neurological complications | diagnostic | Type 2 Diabetes | |||
| C10F211 | Read | Type II diabetes mellitus with neurological complications | diagnostic | Type 2 Diabetes | |||
| C10F300 | Read | Type 2 diabetes mellitus with multiple complications | diagnostic | Type 2 Diabetes | |||
| C10F311 | Read | Type II diabetes mellitus with multiple complications | diagnostic | Type 2 Diabetes | |||
| C10F400 | Read | Type 2 diabetes mellitus with ulcer | diagnostic | Type 2 Diabetes | |||
| C10F411 | Read | Type II diabetes mellitus with ulcer | diagnostic | Type 2 Diabetes | |||
| C10F500 | Read | Type 2 diabetes mellitus with gangrene | diagnostic | Type 2 Diabetes | |||
| C10F511 | Read | Type II diabetes mellitus with gangrene | diagnostic | Type 2 Diabetes | |||
| C10F600 | Read | Type 2 diabetes mellitus with retinopathy | diagnostic | Type 2 Diabetes | |||
| C10F611 | Read | Type II diabetes mellitus with retinopathy | diagnostic | Type 2 Diabetes | |||
| C10F700 | Read | Type 2 diabetes mellitus - poor control | diagnostic | Type 2 Diabetes | |||
| C10F711 | Read | Type II diabetes mellitus - poor control | diagnostic | Type 2 Diabetes | |||
| C10F900 | Read | Type 2 diabetes mellitus without complication | diagnostic | Type 2 Diabetes | |||
| C10F911 | Read | Type II diabetes mellitus without complication | diagnostic | Type 2 Diabetes | |||
| C10FA00 | Read | Type 2 diabetes mellitus with mononeuropathy | diagnostic | Type 2 Diabetes | |||
| C10FA11 | Read | Type II diabetes mellitus with mononeuropathy | diagnostic | Type 2 Diabetes | |||
| C10FB00 | Read | Type 2 diabetes mellitus with polyneuropathy | diagnostic | Type 2 Diabetes | |||
| C10FB11 | Read | Type II diabetes mellitus with polyneuropathy | diagnostic | Type 2 Diabetes | |||
| C10FC00 | Read | Type 2 diabetes mellitus with nephropathy | diagnostic | Type 2 Diabetes | |||
| C10FC11 | Read | Type II diabetes mellitus with nephropathy | diagnostic | Type 2 Diabetes | |||
| C10FD00 | Read | Type 2 diabetes mellitus with hypoglycaemic coma | diagnostic | Type 2 Diabetes | |||
| C10FD11 | Read | Type II diabetes mellitus with hypoglycaemic coma | diagnostic | Type 2 Diabetes | |||
| C10FE00 | Read | Type 2 diabetes mellitus with diabetic cataract | diagnostic | Type 2 Diabetes | |||
| C10FE11 | Read | Type II diabetes mellitus with diabetic cataract | diagnostic | Type 2 Diabetes | |||
| C10FF00 | Read | Type 2 diabetes mellitus with peripheral angiopathy | diagnostic | Type 2 Diabetes | |||
| C10FG00 | Read | Type 2 diabetes mellitus with arthropathy | diagnostic | Type 2 Diabetes | |||
| C10FG11 | Read | Type II diabetes mellitus with arthropathy | diagnostic | Type 2 Diabetes | |||
| C10FH00 | Read | Type 2 diabetes mellitus with neuropathic arthropathy | diagnostic | Type 2 Diabetes | |||
| C10FJ00 | Read | Insulin treated Type 2 diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C10FJ11 | Read | Insulin treated Type II diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C10FK00 | Read | Hyperosmolar non-ketotic state in type 2 diabetes mellitus | diagnostic | Type 2 Diabetes | |||
| C10FL00 | Read | Type 2 diabetes mellitus with persistent proteinuria | diagnostic | Type 2 Diabetes | |||
| C10FL11 | Read | Type II diabetes mellitus with persistent proteinuria | diagnostic | Type 2 Diabetes | |||
| C10FM00 | Read | Type 2 diabetes mellitus with persistent microalbuminuria | diagnostic | Type 2 Diabetes | |||
| C10FM11 | Read | Type II diabetes mellitus with persistent microalbuminuria | diagnostic | Type 2 Diabetes | |||
| C10FN00 | Read | Type 2 diabetes mellitus with ketoacidosis | diagnostic | Type 2 Diabetes | |||
| C10FP00 | Read | Type 2 diabetes mellitus with ketoacidotic coma | diagnostic | Type 2 Diabetes | |||
| C10FQ00 | Read | Type 2 diabetes mellitus with exudative maculopathy | diagnostic | Type 2 Diabetes | |||
| C10FR00 | Read | Type 2 diabetes mellitus with gastroparesis | diagnostic | Type 2 Diabetes | |||
| ZC2CA00 | Read | Dietary advice for type II diabetes | diagnostic | Type 2 Diabetes |
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