Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013)

Cardiovascular Diabetology, Jan 2017

Background Representative data on the secular trends in cardiovascular disease (CVD) are limited in Asian populations with diabetes. We aimed to estimate the temporal trends in cardiovascular complications using Korean nationwide whole population-based claims data in subjects with and without diabetes. Methods Type 2 diabetes was defined as a current medication history of anti-diabetic drugs and the presence of International Classification of Diseases (ICD)-10 codes (E11–E14) as diagnosis. We compared the 8-year rates of six cardiovascular complications [i.e., ischemic heart disease, acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG)] in Korean adults aged 30 years and older using data from four consecutive nationwide databases (2006–2007, 2008–2009, 2010–2011, and 2012–2013) of Korean national health insurance service. Results A total of 1,645,348, 1,971,559, 2,291,247, and 2,562,612 subjects with type 2 diabetes were found in the year of 2006–2007, 2008–2009, 2010–2011, and 2012–2013, respectively. Age and gender standardized rates of the six predefined cardiovascular complications decreased in Korean adults with type 2 diabetes during the study period. The greatest relative reductions were observed for hospitalization due to AMI (−37.28%), followed by hospitalizations due to ischemic stroke (−36.98%). In the overall population without type 2 diabetes, the greatest relative reductions were observed for hospitalization for hemorrhagic stroke (−29.47%), followed by hospitalization due to ischemic stroke (−28.92%). Relative decreases in all six predefined cardiovascular complications were generally more profound in adults with diabetes than in those without diabetes, which led to significant decrease in the relative risks of all six cardiovascular complications in subjects with diabetes over the past 8 years. However, people with diabetes still had a two- to sixfold higher risk of hospitalization for major CVD events and interventions than people without diabetes. Conclusions Our findings suggest a significant reduction in the rate of people affected by CVD within the diabetic population. However, as the number of people with diabetes rises, the absolute burden of CVD will still be high in Korea.

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Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013)

Jung et al. Cardiovasc Diabetol Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006- 2013) Chang Hee Jung 0 4 Jin Ook Chung 3 Kyungdo Han 2 Seung‑Hyun Ko 6 Kyung Soo Ko 1 5 JoongY‑eol Park 0 4 on Behalf of the Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes Association 0 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic‐ro 43‐gil, Seoul, Songpa‐gu 05505 , South Korea 1 Depatment of Internal Medicine, Cardiovascular and Metabolic Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine , 1342 Dongil‐ro, Seoul, Nowon‐gu 139‐707 , South Korea 2 Department of Biostatics, The Catholic University of Korea , Seoul , South Korea 3 Department of Internal Medicine, Chonnam National University Medi‐ cal School , Kwangju , South Korea 4 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic‐ro 43‐gil, Seoul, Songpa‐gu 05505 , South Korea 5 Depatment of Internal Medicine, Cardiovascular and Metabolic Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine , 1342 Dongil‐ro, Seoul, Nowon‐gu 139‐707 , South Korea 6 Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea , Suwon , South Korea Background: Representative data on the secular trends in cardiovascular disease (CVD) are limited in Asian populations with diabetes. We aimed to estimate the temporal trends in cardiovascular complications using Korean nationwide whole population‑ based claims data in subjects with and without diabetes. Methods: Type 2 diabetes was defined as a current medication history of anti‑ diabetic drugs and the presence of International Classification of Diseases (ICD)‑ 10 codes (E11-E14) as diagnosis. We compared the 8‑ year rates of six cardiovascular complications [i.e., ischemic heart disease, acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG)] in Korean adults aged 30 years and older using data from four consecutive nationwide databases (2006-2007, 2008-2009, 2010-2011, and 2012-2013) of Korean national health insurance service. Results: A total of 1,645,348, 1,971,559, 2,291,247, and 2,562,612 subjects with type 2 diabetes were found in the year of 2006-2007, 2008-2009, 2010-2011, and 2012-2013, respectively. Age and gender standardized rates of the six predefined cardiovascular complications decreased in Korean adults with type 2 diabetes during the study period. The greatest relative reductions were observed for hospitalization due to AMI (−37.28%), followed by hospitalizations due to ischemic stroke (−36.98%). In the overall population without type 2 diabetes, the greatest relative reductions were observed for hospitalization for hemorrhagic stroke (−29.47%), followed by hospitalization due to ischemic stroke (−28.92%). Relative decreases in all six predefined cardiovascular complications were generally more profound in adults with diabetes than in those without diabetes, which led to significant decrease in the relative risks of all six cardiovascular complications in subjects with diabetes over the past 8 years. However, people with diabetes still had a two‑ to sixfold higher risk of hospitalization for major CVD events and interventions than people without diabetes. Conclusions: Our findings suggest a significant reduction in the rate of people affected by CVD within the diabetic population. However, as the number of people with diabetes rises, the absolute burden of CVD will still be high in Korea. Background Diabetes is one of the most common metabolic disorders in the world and its prevalence in adults has been increasing in recent decades [1]. It has been estimated that the number of people in the United States with diagnosed diabetes will increase by 165% from 2000 to 2050, from 11 million to 29 million [2]. However, there are considerable variations in the burden of diabetes across regions, with developing countries disproportionately affected [1]. Diabetes is a well-known risk factor for cardiovascular disease (CVD) and is associated with a two- to fourfold increase in the risk of coronary artery disease development [3–5]. Fortunately, intensive glycemic control implemented in the early stage of diabetes as well as multifactorial risk management that includes better control of high blood pressure and dyslipidemia show beneficial effects on macrovascular complications and related mortality in subjects with diabetes [6, 7]. These studies were followed by a steady improvement in diabetes care and risk factor control [8–10]. Indeed, recent studies have reported decreases in cardiovascular complications in patients with diabetes, which have been attributed to better risk factor management [11–14]. For instance, Booth et al. [13] de (...truncated)


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Chang Jung, Jin Chung, Kyungdo Han, Seung-Hyun Ko, Kyung Ko, Joong-Yeol Park, . Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013), Cardiovascular Diabetology, 2017, pp. 1, 16, DOI: 10.1186/s12933-016-0482-6