Baseline clinical profile and rapid progression to insulin treatment in newly diagnosed diabetic patients over 50 years of age

Cardiovascular disease is very common among newly diagnosed middle aged and elderly diabetic patients and causes substantial morbidity. Most of these patients will have type 2 diabetes. However type 1 diabetes can occur at all ages and insulin treatment can be inappropriately deferred in older newly diagnosed patients. We examined the records of all new diabetic patients between 1994 and 1997, aged over 50 years and within 6 months of diagnosis, to determine their presenting cardiovascular profile and baseline factors which might predict rapid progression to insulin treatment. We identified 455 patients and 371 had 2 year follow-up data. 71% had a blood pressure greater than 150 and/or 85 mm Hg, 70% had a cholesterol>5.0 mmol/L and 28% had diagnosed ischaemic heart disease. Within 2 years (8±2 months), 22 (6%) had progressed to insulin treatment. Predictive factors for insulin were presentation HbA1c (risk ratio 1.36, p<0.001), ketonuria (1.6, p<0.05) and the BMI/HbA1c ratio (0.23, p<0.0001) but not BMI alone. In conclusion, new diabetic patients aged over 50 years are at high cardiovascular risk. Progression to insulin treatment within 2 years of first clinic contact is uncommon. However, presenting HbA1c and especially the BMI/HbA1c ratio are strong predictors. Copyright © 2001 John Wiley & Sons, Ltd.