Abstract 1395: Risk Predictors of First Microvascular Complications in Type 2 Diabetes Mellitus: The FIELD Study
Background: Type 2 diabetes mellitus carries a profound health and economic burden, with a significant contribution from microvascular complications.
Objective: We explored clinical and biochemical indicators among 6515 of 9795 patients with type 2 diabetes with no microvascular disease at study entry, of whom 1545 (24%) developed it (retinopathy 2%, nephropathy 18%, neuropathy 6%, amputation <1%) during the study.
Methods: Microvascular disease was defined as:
urinary albumin:creatinine ratio >2.5 mg/mmol (men), >3.5 mg/mmol (women);
history of new diabetic retinopathy or laser photocoagulation surgery;
abnormal monofilament testing for sensory neuropathy; or
minor amputation without known peripheral vascular disease in the same limb.
Statistical analyses used logistic regression stratified by treatment group and an exhaustive-search approach based on the likelihood score statistic.
Results: A total of 12 variables were significantly associated with any new first microvascular disease arising during the trial. Age, duration and control of diabetes (HbA1c), blood pressure, and prior cardiovascular disease (CVD) were strongly and independently associated with the development of microvascular disease. The on-study risk model for new disease over 5 years fitted relatively well, with a C-statistic of 0.652. No treatment-by-variable interactions were found. A simplified risk model developed for routine clinical practice maintained the predictive power.
Conclusions: Routinely measured clinical and biochemical variables can successfully identify most patients at high risk of developing microvascular disease. A simplified risk model may be usefully applied in clinical practice.