Abstract
BackgroundPrevious studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM.MethodsWe conducted a nested case–control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995 and 2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders.ResultsWe identified 2′653 VTE cases and 10′612 controls (53.1% females). We found no association between the HbA1c level and the risk of VTE in our analyses. However, when the most recent HbA1c value was recorded within 90 days before the index date, women with HbA1c levels > 7.0% had a 36–55% increased relative risk of VTE when compared to women with HbA1c > 6.5–7.0%.ConclusionsOur study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c levels > 6.5–7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.
Highlights
Diabetes mellitus (DM) is a chronic disease with a high global prevalence, affecting some 450 million (8.8%) patients worldwide and causing approximately 5 million deaths per year [1]
Patients exposed to insulin had an increased risk of venous thromboembolism (VTE) compared to never-users of insulin, independently of Glycated hemoglobin A1c (HbA1c) levels
We found no effect modification by Body Mass Index (BMI) on the association between HbA1c level and the risk of VTE
Summary
Diabetes mellitus (DM) is a chronic disease with a high global prevalence, affecting some 450 million (8.8%) patients worldwide and causing approximately 5 million deaths per year [1]. While it has been shown that T2DM patients have a higher risk for arterial thrombosis, the association between T2DM and the risk of venous thromboembolism (VTE) has been studied less. Especially at older ages (> 60 years), men have an approximately 20%–25% higher incidence rate of VTE than women [7, 11]. The term unprovoked is used in accordance with the definition provided by the NICE (National Institute for Health and Care Excellence) guideline on PE and DVT, meaning that—similar to the term idiopathic—no recent known major risk factors were present prior to the VTE [5]. Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM
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