JMIR Publications

ABSTRACT

Background:

Type 2 diabetes (T2D) is a major non-communicable disease that can progress to multiple complications that lead to significant burden at both individual and population levels. Understanding disease progression and transition between complication states will inform appropriate treatment and management strategy planning. This T2D cohort was ascertained to estimate the transition probabilities of diabetic complications.

Objective:

The aim of this study is to construct the T2D cohort profile and estimate the transition probabilities.

Methods:

This T2D cohort was based on routine clinical practice data collected from Ramathibodi Hospital, Bangkok, Thailand from 2010 to 2019. Adults with newly diagnosed T2D were considered eligible for inclusion if they were followed up on at least two occasions. Outcomes of interest included diabetic retinopathy (DR), chronic kidney disease (CKD), cardiovascular disease (CVD), peripheral vascular disease (PVD) and mortality. These data were identified from multiple sources and combined with laboratory and medication prescribing data. Ten-year transition probabilities were calculated by Kaplan-Meier estimates.

Results:

Of 40,662 incident T2D cases, the incidence rate/100 patients/year (95% confidence intervals [CI]) for CKD, CVD, DR, PVD and death were 3.3 (3.1-3.3), 2.7 (2.6-2.8), 1.6 (1.5-1.63), 0.50 (0.49-0.56), and 0.58 (0.54-0.62), respectively. The transition probabilities from a baseline complication-free T2D state to these corresponding states at 10 years were 0.26 (0.21-0.33), 0.19 (0.15-0.23), 0.13 (0.11-0.15), 0.03 (0.03-0.04), and 0.03 (0.02-0.04), respectively.

Conclusions:

This well-characterized T2D cohort based on 10-year clinical practice data identified CKD as the most likely T2D complication, followed by CVD and DR. Further studies that consider prognostic factors, treatment safety and effectiveness, and economic evaluation will further guide treatment management and planning strategies in the Thai population.