Our aim was to understand characteristics of patients with type 2 diabetes mellitus (T2DM) who develop macrovascular complications. This was a retrospective observational study using administrative claims from a large national health plan. We identified patients with T2DM between January 2010 and June 2012; date of the first claim for T2DM was set as the index date. Patients 18-89 years of age enrolled in a health plan for at least one year prior (baseline) and post-index, with at least one HbA1c value during pre-index, were identified. Patients were categorized into incident and prevalent cohorts of T2DM based on absence/presence of claims during the baseline period. Patients with cerebrovascular and cardiovascular complications (CV complications), as defined by the diabetes complications severity index, were evaluated. Descriptive analyses were used to evaluate characteristics of patients with and without CV complications. Landmark dynamic risk modeling was used to identify factors predicting CV complications for those with no history of CV complications during the baseline period. We identified 111,205 patients with T2DM; 61,101 (54.6%) had no history of CV complications at baseline. During the five years post-index, 13,059 (21.4%) and 31,472 (51.5%) had a cerebrovascular or cardiovascular complication, respectively. Proportions were slightly higher in the prevalent T2DM cohort, especially for cerebrovascular complications (22.3% vs. 20.2%, P<0.001). For patients with no history of CV complications, landmark dynamic risk modeling identified smoking (HR 1.26), obesity/overweight (HR 1.14), hypertension (HR 1.27), dyslipidemia (HR 1.11) and peripheral vascular disease (HR 1.19) increased risk of CV complications (P<0.001). Identifying modifiable variables that change over time, and the presence of chronic comorbidities, can aide development of specific interventions to evaluate and treat patients with T2DM, while addressing risk of CV complications.
T.G. Prewitt: None. D. Manner: Employee; Self; Eli Lilly and Company. R.W. DeClue: Employee; Self; Humana. R. Nair: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., GlaxoSmithKline plc. S.K. Bajpai: Employee; Self; Eli Lilly and Company. S. Wong-Jacobson: None. R. Juneja: Employee; Self; Eli Lilly and Company. X. Peng: None.
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