[Life prognosis and macrovascular complications 10 years after diagnosis of type 2 diabetes]

Diabetes mellitus which develops in middle age is a serious complication, although its impact is often underrated due to relatively few symptoms and independence on insulin. The authors decided therefore to evaluate in 132 men with recently detected type 2 diabetes serious complications, evaluate the prognostic power of indicators apparent at the time of development of diabetes on the general mortality and macrovascular complications which were manifested within 10 years after detection of diabetes.

From a group of men, mean age 50.6 +/- 8.5 years, who were examined in 1985-1986 at the Clinic of Diabetology and Experimental Therapy, IKEM, during this period 20 died (15%). The total mortality correlated with systolic blood pressure (154 +/- 26.2 mm Hg vs 140.5 +/- 16.5 mm Hg, p < 0.05), blood sugar level (8.8 +/- 3.0 mmol/l vs 7.4 +/- 2.7 mmol/l, p < 0.05), alpha 2 globulin levels (6.4 +/- 1.2 vs 5.2 +/- 1.1 g/l, p < 0.01, family history of infarction (p < 0.01) and ischaemic changes on the ECG tracing (p < 0.05). In multiple logistic regression the role of systolic pressure, blood sugar level, family history of infarction and also HDL cholesterol in relation to the status after 10 years was confirmed (r = 0.5378). Clinically confirmed macrovascular complications were evaluated after 10 years in 91 of 112 living subjects. Signs of macroangiopathies (43%) were associated with a higher mean age (54.1 +/- 6.9 years vs 48.0 +/- 8.0 years, p < 0.001), elevated triacylglycerol levels (3.7 +/- 2.7 mmol/l vs 2.35 +/- 1.7 mmol/l, p < 0.01), reduced levels of HDL cholesterol (1.04 +/- 0.27 mmol/l vs 1.15 +/- 0.24 mmol/l, p < 0.05) and elevated Apo B levels (1.27 +/- 0.44 g/l vs 1.06 +/- 0.31 g/l vs p < 0.01). Only a group of 13 men which at the time when diabetes was detected had a history of cardiovascular complications the levels of C peptide were significantly elevated 120 min, after stimulation (2.57 +/- 0.74 pmol/ml vs 1.63 +/- 0.96 pmol/ml, p < 0.05).

Components of the metabolic syndrome conditioned by insulin resistance of tissues are among factors which have an impact on the general mortality as well as on clinical symptoms of macroangiopathies.