Modifiable and Non-Modifiable Risk Factors and Vascular Damage Progression in Type 2 Diabetes: A Primary Care...

Background/Objectives: Type 2 diabetes mellitus (DM2) is characterized by the development of micro/macro-vascular complications over time. Factors influencing their course may present specific features in the primary care context. This study aims to identify predictive factors for the evolution of micro/macro-vascular pathology in DM2 patients and evaluate interventions implemented by general practitioners (GPs) in this context. Methods: From the medical records of 1169 DM2 patients from 13 Italian GPs, demographic, socio-environmental, and clinical data were recorded, along with the presence and degree of arterial hypertension and components of diabetic micro/macroangiopathy at the time of study entry and 5 years prior. Laboratory parameters and therapies from the last three years were recorded. Results: Compared to 5 years prior, at the study entry, the number of patients presenting at least one micro- or macro-vascular complication increased from 192 (16.4%) to 344 (29.4%) and from 245 (21.0%) to 350 (29.9%). At the logistic regression, microalbuminuria determination appeared to be the strongest predictor of vascular damage progression, followed by decreasing LDL cholesterol values induced by lipid-lowering therapy. Male gender, age >75 years, and smoking history were associated with greater vascular damage progression in the ANOVA repeated measures test. Conclusions: Advanced age, male gender, and smoking history proved strongly associated with the presence and extent of damage progression. GPs appear to adopt a more aggressive approach in treating risk factors (particularly lipid profile) for damage progression in these patients. Microalbuminuria has proven to be by far the marker most strongly associated with vascular damage progression.