Macrovascular and microvascular complications in US Medicare enrollees with type 2 diabetes with and without atherosclerotic cardiovascular disease.

Aims: To assess the incidence of macrovascular and microvascular complications in US Medicare enrollees diagnosed with T2D with and without established ASCVD.

Materials and methods: We conducted a retrospective cohort study using Medicare fee-for-service claims data from 1 January 2006, through 31 December 2021. Baseline demographic and clinical characteristics were assessed in the 1-year prior to indexing. Cumulative incidences of various diabetes complications were assessed until the first microvascular or macrovascular complication of interest, the end of the study period or death.

Results: A total of 2 326 726 patients and 640 666 patients met study inclusion/exclusion criteria for the T2D cohort and T2D + ASCVD sub-cohort, respectively. The incidence rate of any macrovascular event was 483.34 per 10 000 person-years in the T2D cohort. Overall, the 1-year cumulative incidence rate of any macrovascular event was 3.90%. Coronary heart disease (T2D, 3.24%; T2D + ASCVD, 8.10%) and peripheral artery disease (T2D, 1.97%; T2D + ASCVD, 7.33%) were the macrovascular events with the greatest 1-year cumulative incidence. Patients developed microvascular complications at a rate of 1569.28 per 10 000 person-years in the T2D cohort and 1859.80 per 10 000 person-years in the T2D + ASCVD sub-cohort. The 1-year cumulative incidence of any microvascular event was 16.88% in the T2D cohort and 21.16% in the T2D + ASCVD sub-cohort. Neuropathy and nephropathy were the microvascular events with the greatest 1-year cumulative incidence in both cohorts: T2D, 8.34% and 7.02%; T2D + ASCVD, 10.65% and 9.12%, respectively.

Conclusions: The frequencies of macrovascular and microvascular complications highlight the importance of annual cardiovascular risk assessment in patients with T2D, especially those with established ASCVD.