Glycemic Control and Long-Term Macrovascular Outcomes in People With Type 2 Diabetes in China: A Retrospective Study

Speaker(s)

Zhang M1, Pan Q2, Sun F3, Shen P4, Sun Y4, Lin H4, Zhan S5, Guo L2
1Peking University, Beijing, 11, China, 2Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 3Peking University, Beijing, China, 4Yinzhou District Center for Disease Control and Prevention, Ningbo, China, 5Peking University, Beijing, Beijing, China

Presentation Documents

OBJECTIVES: The effect of glycemic control on microvascular outcomes in people with Type 2 Diabetes (T2D) has been well-studied, but its impact on macrovascular outcomes is relatively uncertain, and long-term evidence from the real world is particularly scarce. We aim to examine the association between glycemic control and long-term macrovascular outcomes in T2D patients in China.

METHODS: Data were retrospectively extracted from a regional data platform (2006/1/1-2021/10/31) in Yinzhou, Ningbo, China. People aged ≥ 18 years with ≥ 1 T2D diagnosis and ≥ 1 hemoglobin A1c (HbA1c) record from 2007/01/01-2016/10/31 were included so that ≥ 5 years of follow-up was available. Index date was defined as the first HbA1c record date occurring ≥ 90 days after the first T2D diagnosis. Exposure was defined as attaining the glycemic target (HbA1c < 7.0%) at index ("index glycemic control") or at every measurement during follow-up ("sustained glycemic control"). Outcome was 3-point major adverse cardiovascular event (3P-MACE) including myocardial infarction, stroke, and cardiovascular death during follow-up, identified using clinical diagnoses and death records. Cox proportional hazard model was used to examine the association between glycemic control and the risk of 3P-MACE, with demographic and clinical characteristics adjusted.

RESULTS: A total of 7,049 individuals (mean age 61.4±11.4 years, 3,751 [53.7%] female) were analyzed. During a median follow-up of 6.7 years (interquartile range: 5.5–7.9), 3P-MACE occurred in 1565 (22.2%) patients at an incidence rate of 3.4 per 100 person-years. Index and sustained glycemic control were significantly associated with risk reduction in 3P-MACE (adjusted hazard ratio [95% confidence interval]: 0.86 [0.78-0.96] and 0.75 [0.65-0.87], respectively, both p<0.05).

CONCLUSIONS: Glycemic control at HbA1c < 7% is associated with significant risk reduction in long-term macrovascular outcomes in Chinese people with T2D. Diabetes treatments with better glycemic control may have value on the long-term cardio-cerebrovascular outcomes in T2D patients.

Code

CO152

Topic

Clinical Outcomes

Topic Subcategory

Relating Intermediate to Long-term Outcomes

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)