IDF21-0174 Prevalence and Risk Factors of Vascular Complications in Type 2 Diabetes: DISCOVER Study-Middle East and Africa Cohort

Abstract

Background: Vascular complications predominantly contribute to the burden in people with type 2 diabetes mellitus (T2DM), with nearly a third of adults worldwide affected with cardiovascular disease (CVD). Therefore the assessment of CVD and risk factors is key in T2DM management. Aim: To evaluate the prevalence of vascular complications and associated risk factors in people with T2DM initiating second-line glucose-lowering therapy in Middle East and Africa (MEA) cohort of the global DISCOVER study (NCT02322762; NCT02226822), a 3-year prospective observational study involving 15 992 patients in 38 countries. Method: Baseline cross-sectional analysis of MEA cohort (Algeria, Bahrain, Egypt, Jordan, Kuwait, Lebanon, Oman, Saudi Arabia, South Africa, Tunisia, Turkey and United Arab Emirates), describing microvascular and macrovascular complications prevalence and associated factors in T2DM patients recruited from primary and specialist healthcare settings. Prevalence was assessed as crude and standardized for age and sex. Multivariable analysis assessed factors associated with these complications. Results: 3525 patients were enrolled, mean age was 54.3±10.8 years, 52.5% were males and mean time since T2DM diagnosis was 74.6±64.4 months. Clinical characteristics (mean±SD) revealed HbA1c 8.7±1.7%, BMI 31.1±5.9 kg/m2, total cholesterol 191.3±47.1 mg/dL, LDL-C 116.7±40.8 mg/dL, HDL-C 43.5±12.5 mg/dL and triglycerides 188.3±142.0 mg/dL. 43.2% and 40.1% had history of hypertension and hyperlipidemia, respectively. Metformin monotherapy was the first-line therapy in 56.5% of cases, and metformin + sulphonylurea dual in 20.3%. Concomitant therapies included statins (42.2%), acetylsalicylic acid (22.4%), angiotensin-converting enzyme inhibitors (33.6%), and beta-blockers (12.1%). Crude and standardized prevalence of microvascular diseases were 17.7% and 16.9% (95% confidence interval [CI] 16.8 - 17.0) and that of macrovascular complications were 10.7% and 8.7% (95% CI 8.6 - 8.8), respectively. Common vascular complications included coronary artery disease (8.5%), peripheral neuropathy (8.2%), erectile dysfunction (4.6%). Age, T2DM duration, male gender, history of hypertension and hyperlipidemia were significantly associated with microvascular and macrovascular complications (Table 1).Table 1Multivariate analysis for factors associated with microvascular and macrovascular complicationsFactorsMicrovascularMacrovascularOR (95% CI)P-valueOR (95% CI)P-valueAge (per 10-year increment)1.24 (1.12 – 1.39)<0.0011.58 (1.35 – 1.84)<0.001Sex (Male)1.33 (1.04 – 1.70)0.0211.71 (1.22 – 2.40)0.002Smoking StatusEx-smoker vs non-smoker1.27 (0.93 – 1.72)0.1352.50 (1.72 – 3.61)<0.001Current smoker vs non-smoker1.17 (0.87 – 1.56)0.3001.52 (1.01 – 2.26)0.042BMI (per 5 kg/m2 increment)1.03 (0.94 – 1.13)0.5141.12 (0.99 – 1.27)0.069HbA1C (per 1% increment)1.02 (0.96 – 1.09)0.4651.04 (0.95 – 1.13)0.372T2DM duration (per 1-year increment)1.00 (1.00 – 1.01)<0.0011.00 (1.00 – 1.01)<0.001Hyperlipidemia (Yes vs No)1.33 (1.07 – 1.65)0.0101.96 (1.46 – 2.63)<0.001Hypertension (Yes vs No)1.75 (1.40 – 2.19)<0.0012.84 (2.07 – 3.92)<0.001*OR, odds ratio; CI, confidence interval. Open table in a new tab *OR, odds ratio; CI, confidence interval. Discussion: Despite an early stage of T2DM progression, there was a substantial vascular complications burden confirmed by causal association with prominent risk factors, in patients mainly treated with metformin and metformin + sulphonylurea. Early cardiovascular preventive decisions are important as reflected in the guidelines.