Risk Factors of Microvascular Complications Among Type 2 Diabetic Patients Using Cox Proportional Hazards Models: A Cohort Study in Tabuk Saudi Arabia

Abstract

Purpose

The burden of type 2 diabetes (T2D) is high in Saudi Arabia, but data related to its complications are limited. This study aimed to determine the incidence of microvascular complications caused by T2D and evaluate the impact of the associated risk factors.

Patients and Methods

This retrospective cohort study was conducted at two military hospitals in Tabuk, Saudi Arabia. Data on the socio-demographics, glycaemic profile, blood lipid indices, duration of T2D, and associated microvascular complications were collected from electronic health records and medical files. Descriptive statistics and Cox proportional hazards models were used for data analysis.

Results

This study included 1563 T2D patients. The incidence of microvascular complications was 34.3% (95% confidence interval [CI], 32.0–36.6). Retinopathy was the most common complication (incidence=20.0%; 95% CI, 18.0–22.0%), while nephropathy was the least common complication (incidence=12.2%; 95% CI, 10.6–13.8%). Advanced age (≥65 years) showed the highest risk of retinopathy (Hazard ratios [HR], 2.86; 95% CI, 2.56–3.21), neuropathy (HR, 2.70; 95% CI, 2.40–3.05), and nephropathy (HR, 2.37; 95% CI, 2.12–2.64) compared with their counterparts. After adjusting for potential confounders, the study found that the significant risk factors for microvascular complications were longer duration (≥10 years) of T2D (HR, 5.3; 95% CI, 5.1–5.6), uncontrolled hypertension (HR, 3.9; 95% CI, 3.3–4.2), poor glycaemic control (HR, 4.6; 95% CI, 4.3–5.1), obesity (HR, 2.3; 95% CI, 2.2–2.6), and dyslipidaemia (HR, 1.6; 95% CI, 1.2–2.0).

Conclusion

Given the high burden of microvascular complications in military healthcare facilities in Tabuk, Saudi Arabia, a context-specific accessible public health program focusing on the promotion of a healthy lifestyle, physical activity, and consumption of a healthy diet, as well as the early diagnosis and management of diabetes, needs to be developed and implemented.

Keywords:

• diabetes
• microvascular complications
• retinopathy
• peripheral neuropathy
• nephropathy
• Saudi Arabia

Abbreviations

T2D, type 2 diabetes; KSAFH, King Salman Armed Forces Hospital; KKMH, King Khalid Military Hospital; ICD, International Classification of Disease; HbA1c, haemoglobin A1c; BMI, body mass index; RBS, random blood glucose; FBS, fasting blood glucose; TG, triglycerides; TC, total cholesterol; LDL-c, low-density lipoprotein cholesterol; HDL-c, high-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; SD, standard deviation; HR, hazard ratio; CI, confidence interval; SPSS, Statistical Package for the Social Sciences; CHR, crude hazard ratio; AHR, adjusted hazard ratio.

Data Sharing Statement

The supporting data used in this study are available from King Salman Armed Forces Hospital and King Khalid Military Hospital, with some restrictions on their application due to the availability of these data. These data were used under license for the present study; hence, they are not publicly available. The data are however available from the research and ethics committee at King Salman Armed Forces Hospital (contact via email: [email protected] and telephone number: [phone]extensions:84571) for investigators who meet the criteria for the right to use confidential information.

Ethics Approval and Informed Consent

All ethical issues in King Salman Armed Forces Hospital and King Khalid Military Hospital were handled by a single research ethics committee. This study was reviewed and approved by the Research & Ethics Committee at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia (project no. KSAFH-REC-2022-436). The ethical committee waived the need for obtaining a written informed consent due to the retrospective nature of the study, which involved anonymised patient data. Patients’ identities were kept confidential. The research was carried out in accordance with the 1964 Declaration of Helsinki. All procedures were performed according to the ethical standards.

Acknowledgments

The authors would like to thank King Salman Armed Forces Hospital and King Khalid Military Hospital for their support. We would also like to acknowledge all the registry staff for their efforts in data management.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

Additional information

Funding

The study was fully funded by Research Department, King Salman Armed Forces Hospital Tabuk, Kingdom of Saudi Arabia.