Diabetes increases the likelihood of major cardiovascular events and death, but the increased risk is variable across patients depending on age at diabetes onset, duration of diabetes, glucose control, blood pressure control, lipid control, tobacco control, renal function, microvascular complication status, and other factors. The association of diabetes and increased mortality can be attenuated by cardiovascular risk factor control. A HbA1c of 6% to 6.9% (42 mmol/mol to 52 mmol/mol) is associated with the lowest mortality. Trends in data for complications in people with diabetes show a declining risk of cardiovascular disease (CVD) and CVD-associated mortality, particularly in high-income countries. When type 2 diabetes is diagnosed at age 40, men lose an average of 5.8 years of life, and women lose an average of 6.8 years of life. The overall excess mortality in those with type 2 diabetes is around 15% higher, but ranges from ≥60% higher in younger adults with poor glucose control and impaired renal function, to better than those without diabetes for those who are age 65 and over with good glucose control and no renal impairment.
Cumulative prevalence of vision-threatening diabetic retinopathy in the US is about 4.4% among adults with type 2 diabetes, and appears to be higher for non-Hispanic black people compared with non-Hispanic white people (9.3% vs. 3.2%, respectively). Prevalence of end-stage renal disease (ESRD) is about 1% in those with type 2 diabetes (cross-sectional data), but cumulative prevalence of nephropathy and/or chronic kidney disease is much higher. Incidence rates of ESRD attributed to diabetes are declining; however, continued intervention to detect and manage diabetic kidney disease is required to limit the development of ESRD. Effective treatment requires a motivated and informed patient who actively takes responsibility for the care of his or her diabetes, and a clinical team willing to frequently adjust medications to support comprehensive disease management over a long period of time.
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