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Variability of body weight, pulse pressure and glycaemia strongly predict total mortality in elderly type 2 diabetic patients. The Verona Diabetes Study
Author(s) -
Zoppini Giacomo,
Verlato Giuseppe,
Targher Giovanni,
Bonora Enzo,
Trombetta Maddalena,
Muggeo Michele
Publication year - 2008
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.897
Subject(s) - medicine , hazard ratio , pulse pressure , body mass index , diabetes mellitus , type 2 diabetes , blood pressure , confidence interval , cohort , cohort study , cardiology , endocrinology
Background Ageing is characterized by a decreased functional reserve, a concept defined as homeostenosis. We assessed the impact of long‐term exposure to the average value (mean) or to the variability (coefficient of variation) of fasting glycaemia, body mass index (BMI) and pulse pressure on total mortality in a cohort of type 2 diabetic patients. Methods Fasting glycaemia, BMI and pulse pressure values were collected over a period of 3 years in 1 319 type 2 diabetic patients who were subsequently followed up for 10 years. For each patient, the means and the coefficients of variation of fasting glycaemia, BMI and pulse pressure were computed. The adverse impact of these risk factors on total mortality was assessed in patients aged < 65 years ( n = 565) and in those aged ≥ 65 years ( n = 754), separately. Results During the 10 years of follow‐up, 438 patients died. In younger diabetic patients, the means of fasting glycaemia [hazard ratio (HR) of III tertile versus I tertile = 2.11, 95% confidence interval (CI): 1.22–3.64], BMI (HR = 1.88, 1.12–3.14) and pulse pressure (HR = 2.36, 1.34–4.16) were independently associated with total mortality, while in older patients they were not. In contrast, the coefficients of variation of glycaemia (HR = 1.56, 1.17–2.08), BMI (HR = 1.34, 1.03–1.75) and pulse pressure (HR = 1.34, 1.03–1.74) independently predicted total mortality only in older patients. Conclusions Our findings suggest that the variability of fasting glycaemia, body weight and blood pressure (BP) is independently associated with an increased risk of all‐cause mortality in older type 2 diabetic patients. Future studies are required to confirm the reproducibility of our findings. Copyright © 2008 John Wiley & Sons, Ltd.