Abstract
Nationwide data on glycemic control, blood pressure (BP) control and lipid control in patients with newly diagnosed type 2 diabetes were vacant in China. The aim of this study was to assess the clinical outcomes for these patients. This is an observational prospective cohort study with 12 months of follow up. Patients with a diagnosis of type 2 diabetes less than 6 months were enrolled. Hemoglobin A1c (HbA1c) levels, BP levels and lipid levels were collected at baseline and the follow-ups. This study was registered at www.clinicaltrials.gov (NCT01525693). A total of 5770 participants from 79 hospitals across six geographic regions of China were recruited. After 12 months of treatment, 68.5% of these patients achieved HbA1c <7.0%; 83.7% reached BP <140/90 mmHg; 48.2% met low density lipoprotein cholesterol (LDL-c) <2.6 mmol/L; and 29.5% of patients reached the combined three therapeutic targets. Compared to those patients with baseline HbA1c <7.0%, patients with baseline HbA1c ≥7.0% had higher failure rate to reach glycemic control (relative risk (RR) = 2.04, p < 0.001), BP control (RR = 1.21, p < 0.001) and LDL-c control (RR = 1.11, p < 0.001). Obese patients had higher possibilities of failure in glucose control (RR = 1.05, p = 0.004), BP control (RR = 1.62, p < 0.001) and lipid control (RR = 1.09, p = 0.001) than patients with normal weight. The active smokers were more likely to fail in glycemic control than non-smokers (RR = 1.06, p = 0.002), and patients with physical activities were less likely to fail in lipid control than patients without exercises (RR = 0.93, p = 0.008). This study outlined the burdens of glycemic control, blood pressure control, lipid control in newly diagnosed type 2 diabetic patients in China, identified gaps in the quality of care and risk-factor control and revealed the factors influencing these gaps.
Highlights
Type 2 diabetes is characterized by hyperglycemia, insulin resistance, and relative insulin deficiency
The mean body mass index (BMI) of the patients was 25.0 ± 3.4 kg/m2. 37.3% of the patients had hypertension and 46.3% of them had dyslipidemia at baseline. 23.6%, 27.3% and 49.0% patients were from tier 1, tier 2 and tier 3 hospitals, respectively
In terms of health behavior, the active smokers were more likely to fail in glycemic control than non-smokers (RR = 1.06; P = 0.0021), and patients with physical activities were less likely to fail in lipid control than patients without exercises (RR = 0.93; P = 0.0078)
Summary
Type 2 diabetes is characterized by hyperglycemia, insulin resistance, and relative insulin deficiency It increases the risk of physical disability and life-threatening complications, including microvascular diseases and macrovascular diseases. Www.nature.com/scientificreports incidence of vascular diseases and mortality[5,6] It was suggested intensive glycemic control had a legacy effect which was a beneficial cardiovascular effect[7,8]. Despite good-quality evidence on the legacy benefits of multifactorial risk factor interventions, patients with type 2 diabetes could not reach recommended targets for glycemic level, blood pressure and lipid profile around the world. Some clinical characteristics and treatment patterns in Chinese type 2 diabetes were reported retrospectively[22,23,24,25], no data has been reported about the controls of multiple risk factors in newly diagnosed type 2 diabetic patients nationwide. We designed this prospective, nationwide multicenter, observational cohort study with 12-month follow-up, a study of China Cardiometabolic Registry for newly diagnosed type 2 diabetic patients (CCMR-NEW2D), with the aim of evaluating treatment patterns and their clinical outcomes for newly diagnosed type 2 diabetic patients in China
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