INCREMENTAL MORTALITY RISK FACTORS IN T2DM

T2DM is common in Malaysia and getting commoner. It maims and it kills. I saw a patient yesterday who had T2DM for more than 10 years, I put him through CABG for chest pains, 6 months ago he had two episodes of transient diplopia which got better with plavix, and saw me yesterday with left calf intermittent claudication. Since 6 months ago, he had gained 5 Kgms and he likes to eat. He is well educated too. This is a common problem. I felt so upset with him, because I know that he is staring at a stroke soon.
Can we risk stratify those diabetics who are going to get into trouble, especially those who have an increase risk of dying. Yes we can, says the Italians.
Dr Salvatore della Cromo from the Casa Sollievo della Sofferenza, San Giovanni, Italy and colleagues published a simple study in the May 1 issue of Diabetic Care. They looked into the Gargano Mortality Cohort of 679 T2DM patients on follow-up for 7.4 years, and picked up the risk factors that affected mortality, and applied it in the Foggia Mortality Trial of 936 T2DM patients on 4.5 years of follow-up, to see the risk factors that affect mortality in an average of 2 years. They risk quantify the mortality risks factors of Age, Urine:Creatinine ration, LDL-C, Insulin, Hypertension, HDL-C, BMI, Diastolic BP and Serum Triglyceride into risk scores from 0-1. The low risk category have scores less than 0.67, the high risk category has scores of >0.8 and the medium risk category have scores from 0.69-0.79. Those at the high risk score category had a 24x increase mortality in 2 years compared to those in the low risk category. Those in the medium risk score category had a 7x increase mortality compared to those in the low risk category.
They found that Age >70, Rised Ur : Creatinine ratio, raised LDL-C, Insulin use and hypertension on treatment increase risk of dying, and high HDL-C, high BMI and diastolic hypertension, seemed to lower mortality risk. The last two is difficult to explain.
They however did made two caveats. 1 That this is not a pathophysiological study, so they are unable to explain everything. Just an observational study to produce a clinical model of risk stratification, and 2. That it is in Italians, challenging the rest of the world to repeat the study for their own population cohort.
Interesting.
The message that I take is that if I am diabetic with any of those risk factors, I wish to be very careful and try my best to lower my HbA1C and my other risk factors.