Risk Factors of Microvascular Complications Among Type 2 Diabetic Patients Using Cox Proportional Hazards Models: A Cohort Study in Tabuk Saudi Arabia

Abstract

Purpose: The burden of type 2 diabetes (T2D) is high in Saudi Arabia, but data related to its complications are limited. This study aimed to determine the incidence of microvascular complications caused by T2D and evaluate the impact of the associated risk factors. Patients and Methods: This retrospective cohort study was conducted at two military hospitals in Tabuk, Saudi Arabia. Data on the socio-demographics, glycaemic profile, blood lipid indices, duration of T2D, and associated microvascular complications were collected from electronic health records and medical files. Descriptive statistics and Cox proportional hazards models were used for data analysis. Results: This study included 1563 T2D patients. The incidence of microvascular complications was 34.3% (95% confidence interval [CI], 32.0–36.6). Retinopathy was the most common complication (incidence=20.0%; 95% CI, 18.0–22.0%), while nephropathy was the least common complication (incidence=12.2%; 95% CI, 10.6–13.8%). Advanced age (≥65 years) showed the highest risk of retinopathy (Hazard ratios [HR], 2.86; 95% CI, 2.56–3.21), neuropathy (HR, 2.70; 95% CI, 2.40–3.05), and nephropathy (HR, 2.37; 95% CI, 2.12–2.64) compared with their counterparts. After adjusting for potential confounders, the study found that the significant risk factors for microvascular complications were longer duration (≥10 years) of T2D (HR, 5.3; 95% CI, 5.1–5.6), uncontrolled hypertension (HR, 3.9; 95% CI, 3.3–4.2), poor glycaemic control (HR, 4.6; 95% CI, 4.3–5.1), obesity (HR, 2.3; 95% CI, 2.2–2.6), and dyslipidaemia (HR, 1.6; 95% CI, 1.2–2.0). Conclusion: Given the high burden of microvascular complications in military healthcare facilities in Tabuk, Saudi Arabia, a contextspecific accessible public health program focusing on the promotion of a healthy lifestyle, physical activity, and consumption of a healthy diet, as well as the early diagnosis and management of diabetes, needs to be developed and implemented.