Diabetes Care, Vol 16, Issue 1 137-143, Copyright © 1993 by American Diabetes Association

ARTICLES

Development of macrovascular diseases in NIDDM patients in northern Taiwan. A 4-yr follow-up study

CC Fu, CJ Chang, CH Tseng, MS Chen, CS Kao, TJ Wu, HP Wu, LM Chuang, CJ Chen and TY Tai
Department of Family Medicine, Provincial Tao-Yuan Hospital, Taiwan, Republic of China.

OBJECTIVE--To assess the development of macrovascular diseases and explore major associative factors in NIDDM. RESEARCH DESIGN AND METHODS--A total of 479 NIDDM patients > or = 40 yr of age were recruited from four community primary care health centers of northern Taiwan in July 1986 for a cohort study with a 4-yr follow-up. No patient required insulin therapy within 1 yr of diagnosis nor had a history of diabetic ketoacidosis. All were able to participate independently in the activities of daily living. BP and ECG were measured, and a structured questionnaire was asked of each patient. Venous blood after overnight fasting was collected every year to measure cholesterol, HDL cholesterol, plasma glucose, and HbA1c. RESULTS--The duration of diabetes was associated with the development of stroke with a relative risk of 1.063 for every 1-yr increment (P = 0.07). As for HVDs, the significant risk factors were serum cholesterol and HbA1c. For every 1-mg/dl increase in mean total cholesterol level, the relative risk of developing HVD increased 1.016-fold (P = 0.04). For every 1% increase in HbA1c, the relative risk of developing HVD increased 1.170-fold (P = 0.01). With regard to leg VDs, sex and cigarette smoking were significant risk factors. Women diabetic subjects had a higher relative risk than men. Cigarette smoking was significantly associated with leg VD with a relative risk of 6.9 for smokers compared with nonsmokers. The most significant risk factor for LVD was the total cholesterol level. For every 1-mg/dl increase in mean serum cholesterol level, the relative risk of LVD increased 1.013-fold. CONCLUSIONS--In the prevention of macrovascular diseases, effective intervention of the nondiabetic cardiovascular risk factors may be as important as or even more important than the good control of diabetes.
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