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Abstract
Objective In this study, we examined trends in severe diabetes-related complications (acute myocardial infarction, stroke, lower extremity amputation, and end-stage renal disease) and prevalence of multiple complications in a total population with diabetes in Finland during an 18-year period.
Research design and methods The total population with diabetes aged 30 years or older in 1994–2011 was obtained from several Finnish health registers. Only the first episode of each end point was included in the analysis. We examined trends in the prevalence of these end points using age-standardization and changes in these end points were analyzed using repeated-measures Poisson regression models.
Results The prevalence of single comorbidities decreased during the study period, especially for acute myocardial infarction and stroke. The age-adjusted and diabetes duration-adjusted risk of having one of these end points decreased throughout the study period among persons with type 2 diabetes. Among women, the risk ratio was 0.71 (0.63 to 0.79) in 2006–2011 compared to 1994–1999, and among men, the figure was 0.72 (0.66 to 0.78). In type 1 diabetes, the risk of multiple serious complications increased. We further found increased mortality risk among persons with any of these complications irrespective of diabetes type.
Conclusions Our results concerning the development of risk of complications suggest improvements in the management of diabetes. More attention needs to be paid to the prevention of complications among older persons and those with longer history of diabetes to prevent clustering of complications and to prevent the diabetes epidemic in the population to reduce the public health burden of diabetes.
- Complication(s)
- Health Service Research
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Footnotes
Preliminary results of the study have been presented in poster form in European Public Health Congress in Glasgow, Scotland, 19–22 November 2014.
Contributors EF contributed to the conception and design of the study, planning and executing of analyses, and drafted the manuscript. MA contributed to the conception and design of the study, the statistical analyses, and took part in the revision of the manuscript for important intellectual content. KM contributed to the conception of the study and interpretation of the results and took part in the revision of the manuscript for important intellectual content. IR contributed to the conception and design of the study, forming the data, and took part in the revision of the study. IK and RS contributed to the conception and design of the study, planning of analyses, and took part in the revision of the manuscript for important intellectual content. RS acts as a guarantor of the paper. All authors have read and approved the final manuscript.
Funding This work was supported by the Academy of Finland (projects number 277 939 and 254 121).
Disclaimer The Academy of Finland had no involvement in its design, data collection, findings, or decision to publish.
Competing interests None declared.
Ethics approval The Research Ethics Committee of THL.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement According to the Finnish data protection legislation, data including sensitive health information can only be used by named individuals who have signed the pledge of secrecy for specifically defined research purposes. Therefore, no additional data are available for data sharing purposes.