Clinical Profile of Long-Term Survivors and Nonsurvivors With Type 2 Diabetes
- Viswanathan Mohan, MD, FRCP, PHD, DSc⇑,
- Coimbatore Subramanian Shanthi Rani, PHD,
- Amutha Anandakumar, MSC, RD,
- Sravan Dhulipala, BS,
- Ranjit Mohan Anjana, MD, DIPDIAB (UK),
- Balasubramanian Parathasarathy, MD and
- Ranjit Unnikrishnan, MD, DIPDIAB (UK)
- Madras Diabetes Research Foundation, Madras, India
- Dr. Mohan’s Diabetes Specialities Centre, Gopalapuram, Chennai, India
- World Health Organization Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre for Education, Chennai, India
- Corresponding author: Viswanathan Mohan,
OBJECTIVE To compare clinical profile of long-term survivors and nonsurvivors with type 2 diabetes (T2DM).
RESEARCH DESIGN AND METHODS After conducting a retrospective survey of >200,000 case records, we identified T2DM survivors (>40 years of duration) and age at diagnosis and sex-matched T2DM nonsurvivors. Prevalence of complications and causes of death were analyzed. Retinopathy was diagnosed by retinal photography. Microalbuminuria and macroalbuminuria, peripheral vascular disease based on ankle-brachial index <0.9, coronary artery disease, based on history of myocardial infarction or coronary revascularization, and neuropathy, based on vibration perception threshold >20 V, were compared in both groups.
RESULTS The mean duration of diabetes of survivors (n = 238) was 43.7 ± 3.9 years and that of the nonsurvivors (n = 307), at time of death, was 22.4 ± 11.0 years (P < 0.001). Nonsurvivors had significantly higher systolic and diastolic blood pressures, plasma glucose, HbA1c, serum cholesterol, LDL cholesterol, triglycerides, and lower HDL cholesterol compared with long-term survivors (P < 0.001 for all parameters except systolic blood pressure, which was P = 0.027). Myocardial infarction (46.4%) and renal failure (16.6%) were the most common causes of death. Prevalence of most complications were higher among survivors because of longer duration and older age, as follows, for survivors versus nonsurvivors: retinopathy, 76 vs. 62%; microalbuminuria, 39.1 vs. 27.3%; macroalbuminuria, 8.4 vs. 23.7%; neuropathy, 86.5 vs. 63.5%; peripheral vascular disease, 23.1 vs. 11.4%; and coronary artery disease, 44.5 vs. 40.7%.
CONCLUSIONS Long-term survivors with T2DM had better glycemic and blood pressure control and more favorable lipid profiles.
- Received June 21, 2012.
- Accepted January 15, 2013.
- © 2013 by the American Diabetes Association.
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