Type 2 Diabetes in a Defined Population The Skaraborg Hypertension and Diabetes Project

To examine cardiovascular risk factors, glycaemic control and survival in patients with type 2 diabetes mellitus (T2DM) treated in primary care, patients with T2DM and a randomised age-stratified sample of men and women aged ≥40 years living in the same community were surveyed 1992-1994. ß–Cell function and insulin resistance were estimated using the Homeostasis Model Assessment (HOMA). Vital status was ascertained until year 2000. In men without hypertension and diabetes, cigarette-smoking was independently associated with impaired ß–cell function (p=0.003). Patients with both T2DM and hypertension (n=204, 51%) had higher BMI, higher serum triglycerides, higher LDL/HDL cholesterol ratio, higher fasting serum insulin, but better ß–cell function (p<0.001) and lower HbA1c (6.4% vs 6.8%, p=0.009) than patients with T2DM alone. HbA1c ≥6.5% was associated with a longer diabetes duration and impaired ß–cell function (p<0.001). In both genders together, all-cause mortality was predicted by HbA1c, dyslipidaemia, prevalent hypertension (RR = 1.72; 95% CI 1.21 - 2.44), microalbuminuria (RR = 1.87; 95% CI 1.27 – 2.76) and previous cardiovascular disease. The common Pro12Ala polymorphism in Peroxisome Proliferator-Activated Receptor-g was associated with lower diastolic blood pressure (D = 4.4; 95% CI 1.3 - 7.4) in men with T2DM. Patients with both T2DM and hypertension are characterised by an atherogenic risk factor profile related to the insulin resistance syndrome while those without hypertension are distinguished by an impaired ß–cell function. Both life-style and genetic factors contribute to the outcome in patients with T2DM.