Abstract
BackgroundNationwide studies on contemporary trends in incidence of diabetes-related complications in Asia are lacking. We describe trends in incident coronary heart disease (CHD), stroke, heart failure, hyperglycaemic crisis, and lower-extremity amputation (LEA) in people with diabetes in Hong Kong between 2001 and 2016.MethodsThe Hong Kong Diabetes Surveillance Database (HKDSD) is a territory-wide diabetes cohort identified from Hong Kong Hospital Authority electronic medical record system. We identified events of CHD, stroke, heart failure and hyperglycaemic crisis using hospital principal diagnosis codes at discharge and that of LEA using inpatient procedure codes. We used Joinpoint regression analysis to describe incidence trends by age and sex.ResultsBetween 2001 and 2016, a total of 390,071 men and 380,007 women aged 20 years or older with diabetes were included in the HKDSD. Event rates of CHD, stroke, heart failure, hyperglycaemic crisis and LEA declined by 69.4% (average annual percent change: − 7.6, 95% CI − 10.2, − 5.0), 70.3% (− 8.7, 95% CI − 9.8, − 7.5), 63.6% (− 6.4, 95% CI − 8.0, − 4.7), 59.1% (− 6.6, 95% CI − 12.4, − 0.44), and 67.5% (− 5.8, 95% CI − 7.2, − 4.4), in men and by 77.5% (− 9.9, 95% CI − 11.8, − 7.9), 74.5% (− 9.0, 95% CI − 9.6, − 8.4), 65.8% (− 7.0, 95% CI − 8.0, − 6.0), 81.7% (− 8.5, 95% CI − 10.5, − 6.5), and 72.7% (− 9.1. 95% CI − 12.2, − 5.8) in women, respectively, over a 16-year period in people with diabetes in Hong Kong. Joinpoint analysis identified greater declines in event rates of the five diabetes-related complications in the earlier one-third of study period and slowed down but remained significant until 2016. Event rates decreased for all age groups above 45 years for both sexes. There was no significant change in event rates in the group aged 20–44 years except for decline in hyperglycaemic crisis.ConclusionsThe event rates of diabetes-related complications have declined substantially with no evidence of stabilization or increase in Hong Kong up to 2016. Improvements in outcome were observed for all age subgroups but not in young people with diabetes, calling for urgent action to improve quality of care to prevent complications in young people at risk.
Highlights
Nationwide studies on contemporary trends in incidence of diabetes-related complications in Asia are lacking
Diabetes was ascertained based on one or more of the following qualifying criteria: (1) recording of diagnostic code of diabetes based on International Classification of Diseases, Ninth Revision (ICD-9) code of 250.xx; (2) recording of diagnostic code of diabetes according to the Revised Edition of the International Classification of Primary Care, World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians code T89 or code T90; (3) glycated haemoglobin (HbA1c) ≥ 6.5% (48 mmol/mol) in any one available measurement; (4) fasting plasma glucose ≥ 7.0 mmol/L in any one available measurement; (5) ever prescribed glucose-lowering drugs; or (6) long-term prescription of insulin (≥ 28 days)
Between 2001 and 2016, there was an increase in mean age but a decrease in fasting glucose, Glycated haemoglobin (HbA1c) and low-density lipoprotein (LDL)-cholesterol level among people in the Hong Kong Diabetes Surveillance Database (HKDSD) (Additional file 1: Table S1)
Summary
Nationwide studies on contemporary trends in incidence of diabetes-related complications in Asia are lacking. We describe trends in incident coronary heart disease (CHD), stroke, heart failure, hyperglycaemic crisis, and lower-extremity amputation (LEA) in people with diabetes in Hong Kong between 2001 and 2016. Wu et al Cardiovasc Diabetol (2020) 19:60 and microvascular complications including atherosclerotic cardiovascular disease, heart failure, lower extremity amputations (LEA), end-stage kidney disease and blindness, which are major contributors to disability and mortality in people with diabetes [2,3,4]. High income countries from Europe and North America reported large reduction in rates of most diabetes complications over a two-decade period since the 1990s recent surveillance in the United States (U.S.) has identified a rebound in the incidence of LEA and hyperglycaemic crisis and stabilization of cardiovascular and kidney events in the last 5 years. Recent introduction of sodiumglucose co-transporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists which have been shown to prevent atherosclerotic cardiovascular diseases and hospitalisation for heart failure may affect the trends of some of these complications [9,10,11]
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