Abstract
The role of diabetic macrovascular complications of the heart, brain and lower extremities on the prognosis and cause of death were investigated in 1, 122 type-2 diabetes patients enroled in the Okamoto Diabetes Study. Using noninvasive examinations and the same diagnostic criteria, ischemic heart disease (IHD), cerebral infarction (CI) and arteriosclerosis obliterans (ASO) were evaluated upon enrollment in this study. The number of macroangiopathies present (MA score) was used as a marker of generalized atherosclerosis. Life prognosis and cause of death were analyzed as of Jun, 2001. Of the 1, 122 subjects, 129 subjects died within a mean observation period of 5.2 years. Cardiovascular disease (28.7%), cancer (26.4%) and infection (11.6%) were the three major causes of death. Using the Cox regression model, adjusted for age and duration of diabetes, each macroangiopathy was found to be an independent determinant of life prognosis. The prognosis was poor, especially in subjects associated with IHD and/or ASO. The MA score was also closely correlated with cardiovascular-related death. The mortality rate per 1, 000 person-years in subjects with all three macroangiopathies was 23-fold higher than that of macroangiopathy-free cases. In addition, the contribution of both HbA1c levels and gender patient prognosis was suggested. Macroangiopathy complications were a predictor of patient outcome in type-2 diabetes. These results indicate glycemic control, risk factor control and the evaluation of systemic macroangiopathy using noninvasive techniques is important for the initial management of diabetes to reduce the risk of death from cardiovasclular disease.
