Development of diabetic complications and influencing factors among 32653 type 2 diabetes patients: retrospective cohort study using a multi-state Markov model.

Background: Patients with type 2 diabetes are at high risk for developing multiple chronic complications. However, there is a lack of studies of the cumulative number of diabetic complications in China. Methods: A retrospective cohort study was performed from 2009 to 2021. Type 2 diabetes patients who were first diagnosed after the age of 35 years between January 1, 2009, and December 31, 2017, were included. Five states were defined according to the number of chronic complications: no (S0), one (S1), two (S2), three (S3), and four or more complications (S4). A multi-state Markov model was constructed to estimate transition probability, transition intensity, mean sojourn time, and the possible factors for each state. Results: The study included 32653 type 2 diabetes patients (mean age, 59.59 years; 15929 (48.8%) male), and mean follow-up time of 7.75 years. In all, 4375 transitions were observed. The 12-year transition probability of from state S0 to S1 was the lowest at 16.4%, while that from S2 to S3 was the highest, at 45.6%. Higher fasting blood glucose, lower high-density lipoprotein cholesterol, higher total cholesterol, and an unhealthy diet were associated with higher risk of progression from S0 to S1. Being female, less than 60 years old, weekly physical activity, and vegetarian diet decreased this risk. Being female and less than 60 years old reduced the likelihood of transition from S1 to S2, whereas lower high-density lipoprotein cholesterol increased this likelihood. Conclusions: Following the occurrence of two complications in type 2 diabetes patients, the risk for accumulating a third complication within a short time is significantly increased. It is important to take advantage of the stable window period when patients have fewer than two complications, strengthen the monitoring of blood glucose and blood lipids, and encourage patients to maintain good living habits to prevent further deterioration. [ABSTRACT FROM AUTHOR]