To Örebro University

AIMS: To assess hospital-based care, work absence, associated costs, and mortality in type 2 diabetes with and without established cardiovascular disease (eCVD) compared to matched controls.

METHODS: In a population-based cohort study, we analysed individual-level data from national health, social insurance, and socio-economic registers for people with type 2 diabetes diagnosis<70 years and controls (5:1) in Sweden. Regression analysis attributed costs and days absent to eCVD. Mortality was analysed using Cox proportional hazard regression stratified for birthyear and adjusted for sex and education.

RESULTS: Thirty percent (n=136 135 of 454 983) of people with type 2 diabetes had ≥1 person-year with eCVD (women 24%; men 34%). The mean annual costs of hospital-based care for diabetes complications were EUR 2 629 (95% confidence interval [CI] 2 601 to 2 657) of which EUR 2 337 (95% CI 2 309 to 2 365) were attributed to eCVD (89%). The highest-costing person-years (10^th percentile) were observed in a broad subgroup, 42% of people with type 2 diabetes and eCVD. People with type 2 diabetes had on average 146 days absent (95% CI 145-147) per year of which 68 days (47%; 95% CI 67-70) were attributed to eCVD. Mortality was increased in type 2 diabetes: eCVD hazard rate [HR] 4.63 (95% CI 4.58-4.68), no eCVD HR 1.86 (95% CI 1.84-1.88).

CONCLUSIONS: The sizable burden of eCVD, on the individual with type 2 diabetes and the society, calls for efficient management for reducing the risks for those living with eCVD and postponing its onset. This article is protected by copyright. All rights reserved.