The DM rate was greater at 5 years for A2 patients with DM as the first sign of failure versus patients with other A2 failures ( 87.3 % vs 11.7 % , P < .001 ) , and this also correlated with worse OS at 5 years : 81.1 % for A2 failure without DM and 52.8 % with DM ( P < .001 ) .