Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2025; 16(7): 107647
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.107647
Impact of longer diabetes duration and lower estimated glomerular filtration rate on cardiovascular complications and mortality: A nationwide population-based study
Hong Sang Choi, Bongseong Kim, Kyung-Do Han, Sang Heon Suh, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim
Hong Sang Choi, Sang Heon Suh, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea
Bongseong Kim, Kyung-Do Han, Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, South Korea
Author contributions: Choi HS, Suh SH, Kim CS, Bae EH, Ma SK, Kim SW contributed to conceptualization; Han KD and Kim B contributed to data curation, formal analysis; Choi HS contributed to writing–original draft; Choi HS, Suh SH, Kim B, Han KD, Kim CS, Bae EH, Ma SK, and Kim SW contributed to writing-review and editing; Kim SW contributed to supervision; Choi HS and Kim SW contributed to funding acquisition.
Supported by the National Research Foundation of Korea grant funded by the Korea government, No. RS-2023-00217317; and the Korea Health Technology R and D Project through the Korea Health Industry Development Institute funded by the Ministry of Health and Welfare, Republic of Korea, No. RS-2024-00439029.
Institutional review board statement: The study was approved by the Institutional Review Board of Chonnam National University Hospital (CNUH-EXP-2024-136).
Informed consent statement: The Institutional Review Board of Chonnam National University Hospital (No. CNUH-EXP-2024-136) waived the ethical approval and informed consent requirements for this study. Hence, consent was not obtained because the participants’ records and information were anonymized and de-identified before analysis.
Conflict-of-interest statement: No potential conflict of interest relevant to this article was reported.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Anonymized data are publicly available from the National Health Insurance Sharing Service (https://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Soo Wan Kim, MD, PhD, Professor, Department of Internal Medicine, Chonnam National University Medical School, Jebongro 42, Gwangju 61469, South Korea. skimw@chonnam.ac.kr
Received: March 27, 2025
Revised: April 18, 2025
Accepted: June 3, 2025
Published online: July 15, 2025
Processing time: 110 Days and 10 Hours
Abstract
BACKGROUND

Decreased renal function is a well-known risk factor for cardiovascular diseases (CVD) and death. However, the impact of diabetes duration and the glomerular filtration rate (GFR) on cardiovascular complications in patients with type 2 diabetes has not been well studied.

AIM

To investigate the complex impact of longer diabetes duration and GFR on CVD and mortality.

METHODS

Subjects with diabetes age ≥ 20 years, who underwent health check-ups from 2015 to 2016 were identified in the Korean National Health Insurance Service database. Based on diabetes duration, subjects were grouped into new-onset, < 5 years, 5–9 years, or ≥ 10 years. The new-onset diabetes group [estimated GFR (eGFR): ≥ 90 mL/min/1.73 m2] was the reference group. A Cox proportional hazards model adjusted for potential confounders was used to estimate the risk for myocardial infarction (MI), ischemic stroke (IS), and mortality.

RESULTS

During a 3.9-year follow-up of 2105228 patients, 36003 (1.7%) MIs, 46496 (2.2%) ISs, and 73549 (3.5%) deaths were documented. Both longer diabetes duration and lower eGFR were independently associated with higher risks of MI, IS, and mortality, which were further amplified when these factors coexisted. Even patients with new-onset diabetes had elevated MI and IS risk at mildly reduced eGFR (60–90 mL/min/1.73 m²). Mortality risk rose appreciably once eGFR declined below 60 mL/min/1.73 m², particularly in those with longer diabetes duration. eGFR ≥ 90 mL/min/1.73 m2 subgroups had higher death risk than eGFR 60–90 mL/min/1.73 m2 subgroups regardless of diabetic duration.

CONCLUSION

Increasing diabetes duration and decreasing eGFR are associated with increased risk of MI, IS, and mortality. For cardiovascular risk estimation, diabetes duration should be considered an important risk factor.

Keywords: Diabetes mellitus; Duration; Cardiovascular disease; Myocardial infarction; Stroke; Mortality

Core Tip: This study investigated the complex impact of longer diabetes duration and glomerular filtration rate (GFR) on cardiovascular diseases and mortality. We reveal an association between longer diabetes duration and an increased risk of myocardial infarction and ischemic stroke, even when the GFR is within the normal range. With increasing diabetes duration, mortality increased in subjects with GFR < 60 mL/min/1.73 m2. These findings highlight that for cardiovascular risk estimation, diabetes duration should be considered an important risk factor.