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Aim: To describe the association between socio‐economic status and prevalence of key cardiovascular risk factors in people with type 2 diabetes in Scotland. Methods: A cross‐sectional study of 264 011 people with type 2 diabetes in Scotland in 2016 identified from the population‐based diabetes register. Socio‐economic status was defined using quintiles of the area‐based Scottish Index of Multiple Deprivation (SIMD) with quintile (Q)1 and Q5 used to identify the most‐ and least‐deprived fifths of the population, respectively. Logistic regression models adjusted for age, sex, health board, history of cardiovascular disease and duration of diabetes were used to estimate odds ratios (ORs) for Q1 compared with Q5 for each risk factor. Results: The mean (sd) age of the study population was 66.7 (12.8) years, 56% were men, 24% were in Q1 and 15% were in Q5. Crude prevalence in Q1/Q5 was 24%/8.8% for smoking, 62%/49% for BMI ≥ 30 kg/m2, 44%/40% for HbA1c ≥ 58 mmol/mol (7.5%), 31%/31% for systolic blood pressure (SBP) ≥ 140 mmHg, and 24%/25% for total cholesterol ≥ 5 mmol/l, respectively. ORs [95% confidence intervals (CI)] were 3.08 (2.95–3.21) for current smoking, 1.48 (1.44–1.52) for BMI ≥ 30 kg/m2, 1.11 (1.08–1.15) for HbA1c ≥ 58 mmol/mol (7.5%), 1.03 (1.00–1.06) for SBP ≥ 140 mmHg and 0.87 (0.84–0.90) for total cholesterol ≥ 5 mmol/l. Conclusions: Socio‐economic deprivation is associated with higher prevalence of smoking, BMI ≥ 30 kg/m2 and HbA1c ≥ 58 mmol/mol (7.5%), and lower prevalence of total cholesterol ≥ 5 mmol/l among people with type 2 diabetes in Scotland. Effective approaches to reducing inequalities are required as well as reducing risk factor prevalence across the whole population. What's new?: Socio‐economic deprivation is associated with increased risk of cardiovascular disease in people with diabetes.This study, using a national database of quarter of a million people, found that socio‐economic deprivation is strongly positively associated with smoking and obesity, modestly positively associated with above‐target HbA1c, and modestly negatively associated with above‐target cholesterol, with no evidence of an association with above‐target blood pressure.Inequalities appear to have widened over time.Our findings may enable more effective interventions to reduce these inequalities by targeted approaches in subgroups of the population. [ABSTRACT FROM AUTHOR]

Aims: To describe the prevalence of major cardiovascular disease (CVD) and risk factor control in a contemporary population with Type 2 diabetes. Methods: We used data from the national registry in Scotland, Scottish Care Information‐Diabetes, linked to hospital admissions. Using descriptive statistics and logistic regression we described associations of risk factors with CVD. CVD was defined based on diagnostic codes in primary or secondary care data for ischaemic heart disease, cerebrovascular disease peripheral arterial disease, heart failure, cardiac arrhythmia, hypertensive heart disease and revascularization procedures. Results: Among 248 400 people with Type 2 diabetes with a median age of 67.5 years (IQR 58.2, 76.1) and median diabetes duration of 7.8 years (3.8, 13.0), 32% had prior CVD (35% of men, 29% of women). Median HbA1c overall was 55 mmol/mol (7.2%), median SBP was 132 mmHg, median total cholesterol was 4.1 mmol/l and mean BMI was 32 kg/m2. Overall two‐thirds (65% of men, 68% of women) have two or more of the following CVD risk factor thresholds: HbA1c ≥ 53 mmol/mol (7%), SBP > 130 mmHg or DBP > 80 mmHg, total cholesterol ≥ 5 mmol/l or BMI ≥ 30 kg/m2, or were currently smoking. Overall 84% were taking anti‐hypertensives and 75% a statin. Use of metformin was common at 58%, but other diabetes drugs that reduce CVD were rarely used. Conclusions: There continues to be a high prevalence of CVD among people with Type 2 diabetes and a high level of unmet need for risk factor control. This implies substantial scope for reducing the excess risk of CVD in diabetes through improved management of known risk factors. What's new?: There have been substantial advances in the management and prevention of cardiovascular disease in diabetes. To understand where unmet needs lie, it is important to understand the current burden of cardiovascular disease and the levels of treated and untreated risk factors.In this paper, we show that there continues to be a high prevalence of cardiovascular disease among people with Type 2 diabetes and a high level of unmet need for risk factor control. This implies substantial scope for reducing the excess risk of cardiovascular disease in diabetes through improved management of known risk factors. [ABSTRACT FROM AUTHOR]

Aim To describe trends in first ischaemic stroke incidence and case fatality in adults with and without a diagnosis of Type 2 diabetes prior to their ischaemic stroke event in Scotland between 2004 and 2013. Methods Using population-wide hospital admission, death and diabetes datasets, we conducted a retrospective cohort study. Negative binomial and logistic regression models were used to calculate year-specific incidence and case-fatality rates for people with Type 2 diabetes and for people without diabetes. Results During 41.0 million person-years of follow-up there were 69 757 ischaemic stroke events. Type 2 diabetes prevalence among patients who experienced ischaemic stroke increased from 13.5% to 20.3% between 2004 and 2013. Stroke incidence rates declined by 2.7% (95% CI 2.4, 3.0) annually for people with and without diabetes [diabetes/year interaction: rate ratio 0.99 (95% CI 0.98, 1.01)]. Type 2 diabetes was associated with an increased risk of ischaemic stroke in men [rate ratio 1.23 (95% CI 1.17, 1.30)] and women [rate ratio 1.41 (95% CI 1.35, 1.48)]. Case-fatality rates were 14.2% and 12.7% in people with Type 2 diabetes and without diabetes, respectively. Case fatality declined by 3.5% (95% CI 2.7, 4.5) annually [diabetes/year interaction: odds ratio 1.01 (95% CI 0.98, 1.02)]. Conclusions Ischaemic stroke incidence declined no faster in people with a diagnosis of Type 2 diabetes than in people without diabetes. Increasing prevalence of Type 2 diabetes among stroke patients may mean that declines in case fatality over time will be less marked in the future. [ABSTRACT FROM AUTHOR]