The files of 3,131 patients – 20 percent from Austria, 39 percent from Hungary, 27 percent from the Netherlands and 14 percent from Scotland – with type 2 diabetes were used. The study thus provides an insight into the medical care quality of diabetics.
Patients have been followed for years
The mean age of the people examined was 65 years, most of the patients had been diabetic at the beginning for around eight years. The observation period was between four and five years, depending on the country/region.
The scientists focused in particular on the frequency of the occurrence or significant deterioration of chronic kidney disease and cardiovascular disease. Both are the most dangerous and common long-term complications of diabetes. Chronic and progressive kidney damage can end with the need for dialysis, acute heart disease also represents a high risk of death.
Increased risk of death from cardiovascular disease
“40 percent of patients with type 2 diabetes develop diabetic nephropathy as a negative microvascular complication that usually becomes apparent 10 to 20 years after the onset of the disease and is often present at the time the diabetes is diagnosed. In the past 30 years, diabetic kidney disease has become the leading cause of kidney failure and the need for renal replacement therapy (…),” the scientists wrote.
This also leads to an increased risk of death as a result of acute cardiovascular diseases. The experts therefore used parameters for a significant deterioration in kidney function (e.g. decrease in the filtration rate by at least 40 percent, increase in protein excretion), kidney failure and deaths as well as cardiovascular mortality and the frequency of non-fatal heart attacks and strokes – each in Combination.
study of scientists
The scientific study by Stefanie Thönie from the University Clinic for Internal Medicine IV in Innsbruck (nephrology and high blood pressure) and her co-authors appeared a few days ago in „Kidney Blood Pressure Research“.
Austria performs poorly in the study
After an average observation period, Austria performed poorly in terms of kidney complications and cardiovascular diseases. Overall, the incidence of renal complications was 21.1 times per 1,000 patient-years. Austria was significantly higher (23.3 per 1,000 patient years and Hungary/26.7). The Netherlands (15.5 such events per 1,000 patient-years) and Scotland (15.1) performed significantly better.
In the case of cardiovascular diseases or complications, the overall frequency was 15.5 per 1,000 patient-years. Scotland (24.3) and Austria (19.6) were the highest. The Netherlands (9.3) and Hungary (8.3) were significantly better here.
Lowest mortality in the Netherlands
For all-cause mortality (13 deaths per 1,000 patient-years for all countries/regions compared), the Netherlands performed best (5.8 deaths per 1,000 patient-years). At the top were Scotland (19.2), Hungary (12.1) and Austria (11.5).
In any case, the results do not paint a very good picture for Austria: While the average systolic blood pressure found in the diabetics was 135 mmHg for all groups when they were included in the study, it was 140 mmHg in Austria, i.e. on average at the recommended limit (e.g. Hungary as lowest average value: 130 mmHg).
In the case of the “bad” LDL cholesterol, the Austrian diabetics also had the highest level of 114 milligrams per deciliter of blood (overall average: 174 milligrams per deciliter) at the beginning of all comparison groups (Scotland, for example: 85.8 milligrams/deciliter as the lowest value).
More frequent kidney disease despite shorter duration of diabetes
With an average duration of diabetes of seven years at the beginning of the study (average overall eight years; Hungary twelve years, Netherlands and Scotland six years each), the Austrian patients should have been in a more positive situation with their chronic and progressive disease.
“In Austria, despite a significantly shorter duration of diabetes, the participants had diabetic kidney disease more often than in Hungary (37 percent versus 33.6 percent). The systolic blood pressure values were higher in Austria than in any other country,” the scientists wrote. The blood pressure values turned out to be the most important risk factor for kidney damage in the scientific study.
Chronic heart failure widespread in Austria
On the other hand: With a proportion of 4.3 percent of patients who were already suffering from chronic cardiac insufficiency when they were included in the scientific study, Austria was also at the top (overall average: 2.4 percent).
The evaluation indicates that on average the care of Austrian diabetics is by no means optimal: Compared to the other countries, for example, the patients were least likely to receive low-dose acetylsalicylic acid to prevent heart attacks and strokes and least often cholesterol-lowering drugs. 80 percent of Hungarian diabetics received blood pressure medication from their doctors, which also protects the kidneys and prevents heart failure (renin-angiotensin inhibitors). In Austria it was only 61 percent of the study participants.