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Observational Study
. 2022 Mar;5(2):e00321.
doi: 10.1002/edm2.321. Epub 2022 Jan 14.

Impact of micro- and macrovascular complications of type 2 diabetes on quality of life: Insights from the DISCOVER prospective cohort study

Suzanne V Arnold  1   2 , Kamlesh Khunti  3 , Fengming Tang  1 , Hungta Chen  4 , Antonio Nicolucci  5 , Marilia B Gomes  6 , Linong Ji  7 , Marina V Shestakova  8 , Hirotaka Watada  9 , Andrew Cooper  10 , Peter Fenici  10 , Niklas Hammar  11   12 , Jesús Medina  13 , Mikhail Kosiborod  1   2   14 ; DISCOVER investigators
Affiliations
Observational Study

Impact of micro- and macrovascular complications of type 2 diabetes on quality of life: Insights from the DISCOVER prospective cohort study

Suzanne V Arnold et al. Endocrinol Diabetes Metab. 2022 Mar.

Abstract

Background: The key goals of management in patients with type 2 diabetes (T2D) are to prolong life and improve quality of life. Micro- and macrovascular complications of T2D not only increase the risk of morbidity and mortality, but cross-sectional studies indicate they may also worsen quality of life. We prospectively examined the association of complications that developed during the follow-up with concurrent changes in quality of life.

Materials and methods: DISCOVER is a multinational, prospective, observational cohort study of T2D patients enrolled at initiation of second-line glucose-lowering therapy. Quality of life was assessed with the SF-36 Physical (PCS) and Mental Components Summary (MCS) scores at baseline, 6 months, and 1, 2 and 3 years. Hierarchical repeated measures regression models for PCS and MCS were constructed with complications included as time-dependent covariates; first each complication was modelled alone and then second including all interval complications (to account for different complications occurring in the same patient).

Results: Among 7830 patients with T2D from 30 countries (mean age 56.6 years, 47.6% women, mean duration of T2D 5.6 years), baseline mean SF-36 PCS was 48.0 ± 7.8 and SF-36 MCS was 45.5 ± 10.4. At baseline, 1422 (18.2%) patients had a known microvascular complication, and 966 (12.3%) had a macrovascular complication. Over the 3 years of the study, 641 (12.0%) developed a new microvascular complication (most commonly neuropathy) and 372 (5.8%) developed a new macrovascular complication (most commonly coronary disease). New diagnoses of coronary disease, peripheral artery disease, heart failure and neuropathy were each associated with subsequent moderate reductions in SF-36 PCS (range 0.7 to 1.6 points) and new cerebrovascular disease was associated with a reduction in SF-36 MCS (2.6 points). Results were consistent when all interval complications were considered in the same model.

Conclusion: In a prospective, multinational study of patients with T2D, the development of macrovascular complications and neuropathy was associated with decreases in both physical and mental quality of life. Our results provide additional support for clinicians to focus on the prevention, detection and management of the complications of T2D.

Keywords: quality of life; type 2 diabetes; vascular disease.

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Conflict of interest statement

SVA and FT: Employees of Saint Luke's Mid America Heart Institute, which received funding from AstraZeneca. KK: Investigator‐initiated studies for Astra Zeneca, Novartis, Novo Nordisk, Sanofi‐Aventis, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Bayer, Berlin‐Chemie AG/Menarini Group, Janssen and Napp. HC, PF, JM and AC: Employees of AstraZeneca. AN: Receive support from AstraZeneca to attend DISCOVER planning and update meetings; honoraria from AstraZeneca, Eli Lilly, Medtronic and Novo Nordisk; research support from Artsana, Dexcom, Novo Nordisk and Sanofi. MBG: Receive support from AstraZeneca to attend DISCOVER planning and update meetings; honoraria from Merck‐Serono. LJ: Receive support from AstraZeneca to attend DISCOVER planning and update meetings; honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Takeda, Sanofi and Roche, and research support from AstraZeneca, Bristol‐Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Roche and Sanofi. MVS: Receive support from AstraZeneca to attend DISCOVER planning and update meetings; honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk, Sanofi and Servier; research support from Novo Nordisk, Sanofi and Servier. HW: Receive support from AstraZeneca to attend DISCOVER planning and update meetings; honoraria from Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Sumitomo Dainippon Pharma, Eli Lilly, Kissei Pharmaceutical, Kowa Pharmaceuticals America Inc., Kyowa Hakko Kirin, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novartis, Novo Nordisk, Ono Pharmaceutical, Sanofi, Sanwa Kagaku Kenkyusho and Takeda; research support from Abbott, Astellas Pharma, AstraZeneca, Bayer, Benefit One Health Care, Boehringer Ingelheim, Bristol‐Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eli Lilly, Johnson & Johnson, Kissei Pharmaceutical, Kowa Pharmaceuticals America Inc., Kyowa Hakko Kirin, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nitto Boseki, Novartis, Novo Nordisk, Ono Pharmaceutical, Pfizer, Sanofi, Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical, Takeda and Terumo Corp. NH: former employee of AstraZeneca; owns company shares in AstraZeneca; consulting for Swedish Orphan Biovitrum. MK: Receive support from AstraZeneca to attend DISCOVER planning and update meetings; honoraria from Amgen, Applied Therapeutics AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Janssen, Merck (Diabetes), Novo Nordisk, Sanofi and Vifor Pharma.

Figures

FIGURE 1
FIGURE 1
Incidence of complications over 3 years of follow‐up
FIGURE 2
FIGURE 2
Short‐form 36 physical and mental components summary score over 3 years of follow‐up
See this image and copyright information in PMC

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