To investigate the impact of microvascular diseases on the risks of macrovascular complications in patients with type 2 diabetes, Taiwanese patients with type 2 diabetes diagnosed within one year were identified from the National Health Insurance Research Database between January 2008 and December 2019. Patients with microvascular diseases were categorized as having diabetic kidney disease, diabetic retinopathy, diabetic neuropathy, diabetic kidney disease and retinopathy, diabetic kidney disease and neuropathy, diabetic retinopathy and neuropathy and diabetic kidney disease, retinopathy, and neuropathy.

Results published in the journal Cardiovascular Diabetology showed that patient who had diabetic retinopathy or diabetic kidney disease or diabetic neuropathy were at higher risk of cardiovascular disease (CVD) (such as coronary artery disease, stroke, heart failure) and related mortality vs patients who did not have a microvascular disease.

Based on propensity-score matching, three pairs of patients were defined: patients with diabetic kidney disease and retinopathy, patients with diabetic kidney disease and neuropathy and patients with diabetic retinopathy and neuropathy.

The risk of incident coronary artery disease was higher among patients with diabetic neuropathy compared to those with diabetic kidney disease with adjusted hazard ratio (aHR) of 1.07. Patients with diabetic retinopathy were more likely to suffer a stroke vs those with diabetic kidney disease with aHR of 1.11. Compared to diabetic kidney disease and diabetic retinopathy, the risk of stroke was significantly higher with diabetic neuropathy with aHR of 1.17 and 1.12 respectively. The odds of new-onset heart failure were higher with diabetic retinopathy vs diabetic kidney disease (aHR 1.43), while the risk of incident heart failure was considerably lower with diabetic neuropathy vs diabetic retinopathy (aHR 0.79).

This study has demonstrated the higher risk of CVD and related mortality in type 2 diabetes patients with early development of microvascular disease. The risk was further enhanced among those who had more than one microvascular disease. While all the three microvascular diseases investigated in this study were associated with heart disease, the risk of stroke was significant with diabetic neuropathy, while diabetic retinopathy was linked to greater risk of heart failure. “Further research may be needed to elucidate whether there are causal relationships and plausible mechanisms between retinopathy and heart failure, neuropathy and stroke” concluded the authors.

Reference

1. Fu-Shun Yen, et al. Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: a nationwide population-based cohort study. Cardiovasc Diabetol. 2023 May 9;22(1):109. doi: 10.1186/s12933-023-01821-8.