Association of type 2 diabetes remission and risk of cardiovascular disease in pre-defined subgroups

Conference:

SAPC ASM 2021 - virtual

Talk Code:

4D.6

Presenter:

Hilda Hounkpatin

Co-authors:

Beth Stuart, Andrew Farmer and Hajira Dambha-Miller

Author institutions:

2. Primary Care Research Centre, University of Southampton ;Nuffield Department of Primary Care, University of Oxford; Primary Care Research Centre, University of Southampton

Problem

Remission of type 2 diabetes has been shown to be achievable through lifestyle changes alone. The extent to which remission is associated with reduced cardiovascular disease (CVD) outcomes in key subgroups of people with type 2 diabetes has not previously been assessed. We aimed to quantify the association between type 2 diabetes remission and 5-year incidence of CVD outcomes, overall and in pre-defined subgroups.

Approach

A retrospective cohort analysis of 65,347 adults with type 2 diabetes from the Care and Health Information Analytics (CHIA) database. Multivariable Cox models were used to assess the association between biochemical remission within the first two years of follow-up and incidence of cardiovascular disease (CVD) outcomes including events, microvascular and macrovascular complications at 7-year follow-up. Effect modification by age, sex, diabetes duration, pre-existing CVD, baseline body mass index (BMI) and HbA1c level were assessed.

Findings

29,705 (46.0%) people achieved remission during the first two years of follow-up. Overall, remission was associated with lower risk of CVD outcomes. Remission was associated with reduced risk of CVD events and microvascular complications for younger age groups (aHR ranging from 0.51(0.38-0.69) to 0.85(0.76-0.96)) but not in those aged 85+ years (aHR: 0.74 (0.52-1.05) and aHR: 0.77 (0.60-1.00), respectively). People with no comorbidities had lowest risk of CVD events (aHR: 0.67(0.57-0.77), microvascular complications (aHR: 0.64(0.58-0.70)), macrovascular complications (aHR: 0.74(0.64-0.84)) compared to those with 1-2 or more than 3 comorbidities (aHR: 0.79 (0.67-0.93), aHR: 0.81(0.72-0.90), aHR: 0.83(0.73-0.95), respectively). There were no significant interactions in the remaining subgroups.

Consequences

Achieving remission of type 2 diabetes is associated with a lower risk of CVD outcomes, particularly for younger groups and those with few comorbidities. Targeted interventions that focus on promoting remission in these groups may reduce the impact of CVD and associated health costs.

Submitted by:

Hilda Hounkpatin

Funding acknowledgement:

HDM is a National Institute for Health Research funded Academic Clinical Lecturer and has received NIHR SPCR funding (SPCR2014-10043) for this project. AF is a NIHR Senior Investigator and receives support from NIHR Oxford BioMedical Research Centre.