Joint Modeling of Fasting Blood Sugar Changes and Cardiovascular Disease Progression in Type-2 Diabetes Mellitus Patients: A Retrospective Cohort Study.

Background: Type II diabetes mellitus is one of the major public health concerns causing a two- to four fold increased risk of developing cardiovascular disease (CVD) among patients in developing countries. The primary objective of this study was to assess how the rate of change in fasting blood sugar (FBS) determines CVD progression and to identify risk factors. Methods: The hospital-based retrospective cohort study data of 344 type-II diabetic mellitus patients under follow-up at Dessie Referral Hospital in the Amhara region, Northern Ethiopia, were used in the study. The linear mixed effects model was used to estimate the rate of change in FBS over time, and the time-to-event model was used to estimate time to CVD progression. We measure the relationship between temporal changes in FBS levels and time to CVD progression using a joint modeling approach. Results: From total of the study participants, 51.2% were female, and 48.8% were male; of these, 52.6% were rural residents, and 47.4% were from urban areas. 51.16% of patients experienced CVD during the study period. Time to CVD progression had an inverse relation with the rate of change in FBS level ( Conclusion: Accelerated rate of change in FBS, old age (80+), increased pulse rate, and a raised cholesterol level were the major risk factors of CVD progression. A slow rate of change in FBS elongates time to CVD progression.