Chronic complications of type 2 diabetes mellitus. Clinical course after 5 years of follow-up

To evaluate the modifications in the prevalence of complications and the incidence of end-points in diabetic patients observed for five years, and the effectiveness of a diabetes care protocol on the process indicators. Prospective observational study between 1991 and 1996. Primary care centre. Diabetic patients monitored between 1991 and 1996. Social and demographic variables, DM epidemiology variables, cardiovascular risk factors, complications and end-points were measured. 318 of the 352 patients selected in 1991 were followed. Average age was 68.6 (SD 11.2) and 39% were male. Mean observance was for 53 months (SD 10). There was an increase of insulin use (19%) and self-analysis (34.7%) both in men (chi 2 = 14.7, p < 0.001) and in women (chi 2 = 40.5, p < 0.001), independently of age (chi 2 = 37.77, p < 0.001). Complications increased: microvascular ones from 33.4% to 42.1%, macrovascular ones from 22.3% to 37.2%. The most common end-points were CVA (7.8%) and angor (3.6%). 22 patients died (6.9%), with ischaemic cardiopathy (30%) and neoplasm (30%) the most common causes. Hypertension increased from 51.6% to 59.8% and hypercholesterolaemia from 42.6% to 47%. Obesity (42%) and tobacco dependency (28%) remained stable. Systolic blood pressure went down by 4.7 mmHg and diastolic pressure by 3.76 mmHg, and in women, over-65s and those who had had the illness longest (> 10 years). 6.5% (CI 1-12.9%) of patients improved their blood pressure (< 135/85 mmHg). HbA1c worsened independently of sex, age or years of evolution of diabetes.