Evidence map›Paper›PMID 30110583›Full record

Observational studyThe New England journal of medicine2018

Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes.

Aidin Rawshani, Araz Rawshani, Stefan Franzén, Naveed Sattar, Björn Eliasson, Ann-Marie Svensson, Björn Zethelius, Mervete Miftaraj, Darren K McGuire, Annika Rosengren and 1 more

Registry-linked trialOpen access · bronzeAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in The New England journal of medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06108388 (Functional Investigation of Endothelial Function and Regenerative Cell Exhaustion in Type 2 Diabetes), which is not on this map. Cited by 684 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
684citing papers in PubMed, 8 pooled it
99.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06108388 unknown statusnot on this mapstarted 2023, after this paper: background citation

Functional Investigation of Endothelial Function and Regenerative Cell Exhaustion in Type 2 Diabetes

TypeobservationalSponsorCanadian Medical and Surgical Knowledge Translation Research GroupRan2023 to 2026Enrolled90ConditionsDiabetes Mellitus, Type 2
3 · Its place in the literature

Who cites it

684 citing papers in PubMed, 8 syntheses or guidelines pooled it, 1,396 citations in OpenAlex.

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624 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 3 countries.

Aidin RawshaniFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Araz RawshaniFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Stefan FranzénFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Naveed SattarFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Björn EliassonFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Ann-Marie SvenssonFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Björn ZetheliusFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Mervete MiftarajFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Darren K McGuireFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Annika RosengrenFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Soffia GudbjörnsdottirFrom the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.).
Centre of Registers Vastra Gotaland · SEMedical Products Agency · SEThe University of Texas Southwestern Medical Center · USUniversity of Glasgow · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients with diabetes are at higher risk for death and cardiovascular outcomes than the general population. We investigated whether the excess risk of death and cardiovascular events among patients with type 2 diabetes could be reduced or eliminated.

methodsIn a cohort study, we included 271,174 patients with type 2 diabetes who were registered in the Swedish National Diabetes Register and matched them with 1,355,870 controls on the basis of age, sex, and county. We assessed patients with diabetes according to age categories and according to the presence of five risk factors (elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure). Cox regression was used to study the excess risk of outcomes (death, acute myocardial infarction, stroke, and hospitalization for heart failure) associated with smoking and the number of variables outside target ranges. We also examined the relationship between various risk factors and cardiovascular outcomes.

resultsThe median follow-up among all the study participants was 5.7 years, during which 175,345 deaths occurred. Among patients with type 2 diabetes, the excess risk of outcomes decreased stepwise for each risk-factor variable within the target range. Among patients with diabetes who had all five variables within target ranges, the hazard ratio for death from any cause, as compared with controls, was 1.06 (95% confidence interval [CI], 1.00 to 1.12), the hazard ratio for acute myocardial infarction was 0.84 (95% CI, 0.75 to 0.93), and the hazard ratio for stroke was 0.95 (95% CI, 0.84 to 1.07). The risk of hospitalization for heart failure was consistently higher among patients with diabetes than among controls (hazard ratio, 1.45; 95% CI, 1.34 to 1.57). In patients with type 2 diabetes, a glycated hemoglobin level outside the target range was the strongest predictor of stroke and acute myocardial infarction; smoking was the strongest predictor of death.

conclusionsPatients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. (Funded by the Swedish Association of Local Authorities and Regions and others.).

Indexed as

AdultAlbuminuriaBody Mass IndexCardiovascular DiseasesCohort StudiesDiabetes Mellitus, Type 2FemaleGlycated HemoglobinHumansHypercholesterolemiaHypertensionMaleMiddle AgedMyocardial InfarctionRisk FactorsSmokingGlycated Hemoglobin

Identifiers

PMID30110583
OpenAlexW2887185538

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.