Mortality predictors in patients with type 2 diabetes

PhD ceremony: Mr. G.W.D. Landman, 14.30 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Mortality predictors in patients with type 2 diabetes

Promotor(s): prof. H.J.G. Bilo, prof. R.O.B. Gans

Faculty: Medical Sciences

This thesis deals with the relationship between specific risk factors and mortality in patients with type 2 diabetes mellitus (T2DM). The goals of the thesis were (1) to study factors which might be associated with total as well as cardiovascular mortality in a general and elderly group of patients with T2DM, and (2) to develop a risk calculator to calculate individual patient risk. All data were obtained from the ZODIAC cohort, a prospective observational study which was conducted in a primary health care setting.

Our studies show that classic risk factors for cardiovascular disease, including hypertension and hypercholesterolemia, have a different association in the elderly compared to younger patients. Besides the known beneficial effects of metformin on cardiovascular disease, we have shown that metformin may have a positive effect on cancer-related mortality. HRQOL and two SNPs appear to be associated with mortality, however in risk prediction they are of no additional value. Risk prediction for individual patients, as done with the UKPDS Risk Engine, has been insufficiently validated in the Dutch population and should not be used in the Netherlands. Renal dysfunction could play an important role in individual mortality risk prediction.