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Abstract
Background
We examined the relationships between components of metabolic syndrome at the time of diagnosis of type 2 diabetes, and the development of chronic complications in Korean patients with type 2 diabetes.
Methods
The medical records of patients with type 2 diabetes who had undergone treatment for at least five years prior were collected from 10 general hospitals in Korea. Among a total of 1,418 patients reviewed for possible inclusion in this study, 603 patients were selected, and the occurrence of complications among these patients was evaluated.
Results
Among the 603 patients (male, 253; female, 350), 154 males (60.8%) and 266 females (76.0%) were diagnosed with metabolic syndrome at the time of initial diagnosis of type 2 diabetes. The incidence of chronic complications (average follow-up 15.2 ± 4.9 years) included 60 cases of coronary artery disease (CAD), 57 cases of cerebrovascular accident (CVA), 268 cases of diabetic retinopathy (DR), 254 cases of diabetic nephropathy (DN), and 238 cases of diabetic peripheral neuropathy (DPN). As compared to patients without metabolic syndrome, the adjusted relative risks (95% CI) of incidental diabetic complications in patients with metabolic syndrome were 3.28 (1.40~7.71) for CAD, 2.04 (0.86~4.82) for CVA, 1.53 (1.10~2.14) for DR, 1.90 (1.29~2.80) for DN, and 1.51, (1.06~2.14) for DPN. With the addition of just one constituent of metabolic syndrome, the relative risk of developing CAD, CVD, DR, DN, and DPN increased by 2.08 (95% CI, 1.27~3.40), 1.16 (0.80~1.66), 1.09 (0.93~1.26), 1.29 (1.06~1.57) and 1.06 (0.87~1.26), respectively.
Figures and Tables
Fig. 1
Estimated cumulative hazard ratio of Macrovascular complications in diabetic patients with and without metabolic syndrome. A. Coronary artery disease (P < 0.01). B. Cerebrovascular accident (P = 0.02).
Fig. 2
Estimated cumulative hazard ratio of Microvascular complications in diabetic patients with and without metabolic syndrome. A. Diabetic retinopathy (P < 0.01). B. Diabetic nephropathy (P < 0.01). C. Microalbuminuria (P < 0.01). D. Overt nephropathy (P = 0.15). E. Diabetic neuropathy (P < 0.01).
Table 2
Occurence of chronic complications
*P < 0.05. aRR, adjusted relative risk (adjusted for age at T2DM diagnosis, sex, smoking, alcohol, physical activity & diet control); CAD, coronary artery disease; cRR, crude relative risk; CVA, cerebro-vascular accident; DN, diabetic nephropathy; DPN, diabetic peripheral neuropathy; DR, diabetic retinopathy; MetS, metabolic syndrome; micro, microalbuminuria; overt, overt nephropathy.
Table 3
The relative risk for chronic diabetic complications by the presence of each component of metabolic syndrome
*P < 0.05. ( ) 95% C.I.. aRR, adjusted relative risk (adjusted for age at T2DM diagnosis, sex, smoking, alcohol, physical activity & diet control); CAD, coronary artery disease; cRR, crude relative risk; CVA, cerebro-vascular accident; DN, diabetic nephropathy; DPN, diabetic peripheral neuropathy; DR, diabetic retinopathy; HDLC, high density lipoprotein cholesterol; micro, microalbuminuria; overt, overt nephropathy.
Table 4
The relative risk of developing complication of diabetes with the addition of one constituent of metabolic syndrome
*P < 0.05. aRR, adjusted relative risk (adjusted for age at T2DM diagnosis, sex, smoking, alcohol, physical activity & diet control); CAD, coronary artery disease; cRR, crude relative risk; CVA, cerebro-vascular accident; DN, diabetic nephropathy; DPN, diabetic peripheral neuropathy; DR, diabetic retinopathy; HDLC, high density lipoprotein cholesterol; micro, microalbuminuria; overt, overt nephropathy.
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