Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes

Sophia Zoungas, Mark Woodward, Qiang Li, Mark E. Cooper, Pavel Hamet, Stephen Harrap, Simon Heller, Michel Marre, Anushka Patel, Neil Poulter, Bryan Williams, John Chalmers, ADVANCE Collaborative Group

Research output: Contribution to journalArticlepeer-review

138 Citations (Scopus)

Abstract

Aims/hypothesis Data are inconsistent regarding the associations between age, age at diagnosis of diabetes, diabetes duration and subsequent vascular complications. Methods The associations between age (or age at diagnosis), diabetes duration and major macrovascular events, all-cause death and major microvascular events were examined in 11,140 patients with type 2 diabetes randomly allocated to intensive or standard glucose control in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Rates were calculated by 5 year baseline age (or age at diagnosis) and diabetes duration strata. Risks were estimated using Cox models adjusted for treatment assignment and HbA1c. Results The mean age (±SD) was 65.8±6.4 years, age at diagnosis was 57.8±8.7 years and diabetes duration was 7.9±6.4 years. Diabetes duration was associated with the risk of macrovascular events (HR 1.13 [95% CI 1.08, 1.17]), microvascular events (1.28 [1.23, 1.33]) and death (1.15 [1.10, 1.20]) whereas age (or age at diagnosis) was only associated with the risk of macrovascular events (1.33 [1.27, 1.39]) and death (1.56 [1.48, 1.64]). No interaction was observed between diabetes duration, age and the risk of macrovascular events or death (both p>0.4). However, an interaction was observed between diabetes duration, age and the risk of microvascular events (p=0.002), such that the effects of increasing diabetes duration were greatest at younger rather than older age. Conclusions/interpretation In patients with type 2 diabetes, age or age at diagnosis and diabetes duration are independently associated with macrovascular events and death whereas only diabetes duration is independently associated with microvascular events and this effect is greater in the youngest patients.

Original languageEnglish
Pages (from-to)2465-2474
Number of pages10
JournalDiabetologia
Volume57
DOIs
Publication statusPublished - 17 Sep 2014
Externally publishedYes

Keywords

  • Age
  • Age at diagnosis of diabetes
  • Duration of diabetes
  • Macrovascular complications
  • Microvascular complications
  • Mortality
  • Type 2 diabetes

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