Microvascular complications (MC) affect CV risk and mortality in T2D. We explored the association of cumulative burden of retinopathy, nephropathy and peripheral neuropathy with mortality, CV events and ESRD in a single-centre, observational study involving 986 T2D over a 12.9±2.7 yrs follow-up. Vital status and rates of outcomes were censored on December 2017. The cohort included 491 (49.8%), 318 (32.3%), 135 (13.7%) and 42 (4.3%) people with no, 1, 2 or 3 MC. All-cause mortality (23.3%) increased from no-MC (15.3%) to 1 MC (23.3%, HR 1.60; 95%CI 1.16-2.20), 2 MC (41.5%, 3.19; 2.25-4.51) and 3 MC (59.5%, 5.32; 3.38-8.36; p<0.0001). After adjustments, HRs were: 1 MC, 1.21 (0.87-1.69); 2 MC, 1.72 (1.15-2.56) and 3 MC, 3.17 (1.89-5.33, p<0.0001). Irrespective of number of baseline CV risk factors not at target (HbA1c ≥7%, LDL ≥100 mg/dl, BP ≥140/90 mmHg), age and sex adjusted HRs raised with MC (p<0.0001). CV events occurred in 276 T2D (28.4%). Incidence raised with MC: no-MC, 20.8%; 1 MC, 31.3% (HR 1.65; 1-25-2.18); 2 MC, 42.7% (2.77; 2.00-3.85); 3 MC, 50.0% (3.78; 2.36-6.05, p<0.0001). After adjustments, HRs for CV events were: 1 MC, 1.37 (1.03-1.82); 2 MC, 1.61 (1.12-2.30) and 3 MC, 2.42 (1.48-3.99, p<0.0001). Rate of heart failure hospitalization (hHF) was 3.3% in no-MC, 11.5% in 1 MC (HR 3.19; 1.83-5.56), 17.6% in 2 MC (5.68; 3.09-10.45) and 14.3% (5.00; 2.00-12.54) in 3 MC (p<0.0001). After adjustments, rate of hHF raised in 1 MC (2.28; 1.30-4.01), 2 MC (3.38; 1.79-6.40) and 3 MC (3.02; 1.19-7.65). Also ESRD raised with MC: no-MC, 4.9%; 1 MC, 6.7% (HR 1.44; 0.80-2.59); 2 MC, 11.5% (2.76; 1.45-5.27); 3 MC, 26.2% (7.67; 3.75-15.70; p<0.0001). After adjustments, ESRD raised with 2 MC (HR 2.34; 1.21-4.53) and 3 MC (6.41; 3.19-13.16, p<0.0001). Incidence of CV events, hHF, and ESRD raised with number of MC after stratification for risk factors not at target (p<0.0001). In T2D, the cumulative burden of MC predicts mortality, CV events, hHF and ESRD, offering an accessible tool for improving risk prediction.

Disclosure

M. Garofolo: None. E. Gualdani: None. R. Giannarelli: None. D. Lucchesi: None. R. Miccoli: None. P. Francesconi: None. S. Del Prato: Advisory Panel; Self; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Takeda Pharmaceutical Company Limited. G. Penno: None.

© 2020 by the American Diabetes Association
2020
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