Risk of Typical Diabetes-Associated Complications in Different Clusters of Diabetic Patients: Analysis of Nine Risk Factors
Michael Leutner, Nils Haug, Luise Bellach, Elma Dervić, Alexander Kautzky, Peter Klimek, Alexandra Kautzky‐Willer
Abstract
OBJECTIVES: Diabetic patients are often diagnosed with several comorbidities. The aim of the present study was to investigate the relationship between different combinations of risk factors and complications in diabetic patients. RESEARCH DESIGN AND METHODS: = 195,575) receiving a diagnosis of diabetes in the observation period from 2003-2014. We defined nine ICD-10-codes as risk factors and 16 ICD-10 codes as complications. Using a computational algorithm, cohort patients were assigned to clusters based on the risk factors they were diagnosed with. The clusters were defined so that the patients assigned to them developed similar complications. Complication risk was quantified in terms of relative risk (RR) compared with healthy control patients. RESULTS: We identified five clusters associated with an increased risk of complications. A combined diagnosis of arterial hypertension (aHTN) and dyslipidemia was shared by all clusters and expressed a baseline of increased risk. Additional diagnosis of (1) smoking, (2) depression, (3) liver disease, or (4) obesity made up the other four clusters and further increased the risk of complications. Cluster 9 (aHTN, dyslipidemia and depression) represented diabetic patients at high risk of angina pectoris "AP" (RR: 7.35, CI: 6.74-8.01), kidney disease (RR: 3.18, CI: 3.04-3.32), polyneuropathy (RR: 4.80, CI: 4.23-5.45), and stroke (RR: 4.32, CI: 3.95-4.71), whereas cluster 10 (aHTN, dyslipidemia and smoking) identified patients with the highest risk of AP (RR: 10.10, CI: 9.28-10.98), atherosclerosis (RR: 4.07, CI: 3.84-4.31), and loss of extremities (RR: 4.21, CI: 1.5-11.84) compared to the controls. CONCLUSIONS: A comorbidity of aHTN and dyslipidemia was shown to be associated with diabetic complications across all risk-clusters. This effect was amplified by a combination with either depression, smoking, obesity, or non-specific liver disease.