Differential dyslipidemia associated with albuminuria in type 2 diabetic patients in Taiwan

BACKGROUND

This study evaluated the lipid abnormalities associated with different stages of albuminuria in type 2 diabetic patients.

METHODS AND RESULTS

A total of 549 patients (245 men and 304 women) with mean age of 63.4 were studied. Normoalbuminuria (n=251), microalbuminuria (n=242) and macroalbuminuria (n=56) were defined as albumin-to-creatinine ratio of < 30, 30-299 and > or = 300 microg/mg, respectively. Lipid parameters included total cholesterol, triglyceride (TG), high- and low-density lipoprotein (LDL) cholesterol, apolipoproteins A1 and B (ApoB), and lipoprotein(a) [Lp(a)]. Results showed that ApoB differed significantly (p<0.05) between normoalbuminuria and microalbuminuria/macroalbuminuria and Ln[Lp(a)] differed between normoalbuminuria/microalbuminuria and macroalbuminuria. Ln(TG) increased progressively with increasing albuminuria. In multivariate logistic regression analyses, only ApoB showed significant odds ratio (95% confidence interval) for microalbuminuria: 1.013 (1.004-1.022); and both ln(TG) and ln[Lp(a)] were significant for macroalbuminuria [respective odds ratios: 1.995 (1.010-3.938) and 1.708 (1.200-2.430)].

CONCLUSIONS

A differential dyslipidemia is observed for microalbuminuria and macroalbuminuria. Apo(B) and Lp(a) increase at the stages of microalbuminuria and macroalbuminuria, respectively. However, TG increases significantly throughout the three stages of albuminuria.

Age-related risk of mortality from bladder cancer in diabetic patients: a 12-year follow-up of a national cohort in Taiwan

BACKGROUND

To compare bladder cancer mortality between diabetic patients and the general population.

MATERIALS AND METHODS

Yearly sex-specific mortality rates for age 25-64, 65-74, and > or =75 years in Taiwanese general population for 1995-2006 were calculated; 113,347 diabetic men and 131,573 diabetic women aged > or =25 years recruited in 1995-1998 were followed prospectively.

RESULTS

In the general population, 4,943 men and 2,291 women died of bladder cancer, and aging was associated with increased risk. Although the trend of crude mortality was increasing in either sex, the trend of age-standardized rates had been steady. The average crude and age-standardized mortality rates were 5.35 and 5.98 (per 100,000 population), respectively, for men; and were 2.63 and 3.02 for women. A total of 224 diabetic men and 126 diabetic women died of bladder cancer with crude mortality of 26.0 and 11.9 per 100,000 person-years, respectively. The relative risk of bladder cancer mortality (95% confidence interval) for diabetic patients was 2.18 (1.75-2.72), 2.50 (2.06-3.04), and 5.95 (4.57-7.74), in men, and 1.34 (0.96-1.89), 2.48 (1.92-3.19), and 7.44 (5.46-10.15), in women, for ages > or =75, 65-74, and 25-64 years, respectively.

CONCLUSIONS

Diabetic patients had a higher risk of bladder cancer mortality, which is more remarkable in the younger population.

A review on environmental factors regulating arsenic methylation in humans

Subjects exposed to arsenic show significant inter-individual variation in urinary patterns of arsenic metabolites but insignificant day-to-day intra-individual variation. The inter-individual variation in arsenic methylation can be partly responsible for the variation in susceptibility to arsenic toxicity. Wide inter-ethnic variation and family correlation in urinary arsenic profile suggest a genetic effect on arsenic metabolism. In this paper the environmental factors affecting arsenic metabolism are reviewed. Methylation capacity might reduce with increasing dosage of arsenic exposure. Furthermore, women, especially at pregnancy, have better methylation capacity than their men counterparts, probably due to the effect of estrogen. Children might have better methylation capacity than adults and age shows inconsistent relevance in adults. Smoking and alcohol consumption might be associated with a poorer methylation capacity. Nutritional status is important in the methylation capacity and folate may facilitate the methylation and excretion of arsenic. Besides, general health conditions and medications might influence the arsenic methylation capacity; and technical problems can cause biased estimates. The consumption of seafood, seaweed, rice and other food with high arsenic contents and the extent of cooking and arsenic-containing water used in food preparation may also interfere with the presentation of the urinary arsenic profile. Future studies are necessary to clarify the effects of the various arsenic metabolites including the trivalent methylated forms on the development of arsenic-induced human diseases with the consideration of the effects of confounding factors and the interactions with other effect modifiers.

Waist-to-height ratio and coronary artery disease in Taiwanese type 2 diabetic patients

Waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHeiR), and BMI are indicators for obesity. This study examined the usefulness of these indicators for coronary artery disease (CAD) in Taiwanese type 2 diabetic patients. A total of 1,345 (646 men and 699 women) patients aged 63.3 +/- 11.5 years were studied. CAD was defined by history or Minnesota-coded electrocardiogram. The relative importance was evaluated by the magnitude of adjusted odds ratio per 1-s.d. increment, the decrease in -2 log likelihood after adding the index to the logistic model, the c-index, and the Akaiki's information criterion (AIC). Results showed that the four indices were highly intercorrelated and except BMI for men, all indices differed significantly between patients with and without CAD in either sex. In logistic regressions, the respective adjusted odds ratios for WC, WHR, WHeiR, and BMI for every 1-s.d. increment were 1.209 (1.010-1.448), 1.109 (0.935-1.316), 1.231 (1.027-1.474), and 1.207 (0.997-1.461) for men; and were 1.176 (0.995-1.390), 1.105 (0.923-1.322), 1.280 (1.079-1.518), and 1.277 (1.083-1.507) for women. Only WHeiR was significant for both sexes and it also showed the greatest decrease in -2 log likelihood, the largest magnitude of odds ratio, and the smallest AIC while compared with the other indices in either sex. It is concluded that WHeiR has the superiority of independent association with CAD and the highest magnitude of association than WC, WHR, and BMI in both sexes. The usefulness of WHeiR should not be neglected in clinical practice.

Parental diabetes in Taiwanese diabetic women with and without previous gestational diabetes

Background Gestational diabetes mellitus (GDM) is reported to be associated with maternal but not paternal diabetes. This study examined the relative contribution of maternal and paternal diabetes among type 2 diabetic women with and without a GDM history. Materials and methods A total of 48 502 type 2 diabetic women from a national sample were interviewed by telephone. Among them, 510 reported a GDM history. Parental diabetes was compared between patients with and without a GDM history considering the confounding effects of age, body mass index, smoking, hypertension, duration of diabetes and insulin use. Results Patients with a GDM history were younger in age, had younger age of onset, longer duration of diabetes, slightly lower body mass index, higher prevalence of insulin use and lower prevalence of hypertension, but smoking rates were similar. The percentages of parental diabetes of nil, mother only, father only and both father and mother for those without a GDM history were 76.2, 15.2, 5.8 and 2.8%, respectively; and were 47.8, 26.8, 17.5 and 7.9%, respectively, for those with a GDM history (P < 0.001). The adjusted odds ratios for patients with versus without a GDM history for parental diabetes of nil, mother only, father only, and both father and mother were 1.000, 1.210 (0.948-1.544), 1.783 (1.341-2.371) and 2.094 (1.440-3.045), respectively. Conclusions Although maternal diabetes is more commonly seen, the disproportionately higher paternal diabetes in patients with a GDM history suggests an important role for paternal diabetes on the development of GDM into type 2 diabetes mellitus.

Betel nut chewing is associated with hypertension in Taiwanese type 2 diabetic patients

Betel nut chewing is associated with oral cancers and diabetes. This study investigated whether betel nut chewing could be associated with hypertension in Taiwanese patients with type 2 diabetes mellitus (T2DM). The data of a total of 81,226 (37,226 men and 44,000 women) patients with T2DM obtained from a cross-sectional telephone survey in a national sample of diabetic patients in Taiwan were analyzed. Hypertension was defined by a positive history or reported systolic blood pressure>or=140 mmHg and/or diastolic blood pressure>or=90 mmHg. Analyses were performed in separate sexes with consideration paid to the potential confounding effects of age, diabetic duration, body mass index and smoking. The prevalences of betel nut chewing in men and women were 20.4% and 1.1%, respectively. Betel nut chewing was more common in the younger age groups of the male sex. The multivariate-adjusted odds ratios for hypertension in chewers vs. non-chewers were 1.067 (1.007-1.131) and 1.897 (1.534-2.346) for men and women, respectively. In multiple linear regression, although no adjustment was made for the use of antihypertensive agents, betel nut chewing was significantly associated with blood pressure, with regression coefficients of 0.958+/-0.163 (SEM) for systolic and 0.441+/-0.108 for diastolic blood pressure in men; and the respective values for women were 1.805+/-0.618 and 1.198+/-0.393. In conclusion, betel nut chewing was significantly associated with hypertension in Taiwanese patients with T2DM and the association was stronger in women.

Body mass index and blood pressure in adult type 2 diabetic patients in Taiwan

BACKGROUND

The correlation between body mass index (BMI)/obesity and blood pressure/hypertension has not been confirmed in diabetic patients. This study analyzed the association in Taiwanese adult patients with type 2 diabetes mellitus (T2DM).

METHODS AND RESULTS

The National Health Insurance data of 89,857 adult patients (41,398 men and 48,459 women; aged >or=18 years with mean +/- SD of 62.2+/-11.3 years) interviewed by questionnaire were analyzed, taking into account the potential confounding of age, sex, diabetic duration, smoking and parental hypertension. Prevalence of obesity (BMI >or=25 kg/m2) was 39.3% and 41.7% in the diabetic men and women, respectively; and hypertension was 54.5% in both sexes. Hypertension increased significantly with increasing age and BMI. The adjusted odds ratio (OR) for hypertension for every 1 kg/m(2) increment of BMI was 1.16 (1.15-1.17) and 1.13 (1.12-1.14) for men and women, respectively. The correlation between BMI and hypertension/blood pressure extended throughout BMI levels to the nonobese range. For men, adjusted OR for BMI <18.5, 18.5-22.9, 23.0-24.9, 25.0-29.9 and >or=30.0 kg/m2 were 1.00, 1.23 (1.07-1.41), 1.78 (1.55-2.05), 3.06 (2.66-3.53) and 6.59 (5.56-7.82), respectively; and were 1.00, 1.09 (0.97-1.22), 1.49 (1.32-1.68), 2.32 (2.06-2.60), 4.40 (3.84-5.05), respectively, for women. For every 1 unit BMI increase in patients without a hypertension history, the systolic and diastolic blood pressures significantly increased by 0.618 and 0.447 mmHg for men; and by 0.637 and 0.462 mmHg, respectively, for women.

CONCLUSIONS

BMI/obesity is significantly linked to blood pressure/hypertension throughout the range of BMI in diabetic patients in either sex regardless of a previous hypertension history.

The association between urinary albumin excretion and ankle-brachial index in elderly Taiwanese patients with type 2 diabetes mellitus

OBJECTIVE

this study examined the association between urinary albumin/creatinine ratio (ACR) and ankle-brachial index (ABI), or peripheral arterial disease (PAD), in elderly patients with type 2 diabetes mellitus (T2DM).

METHODS

a total of 290 (108 men, 182 women) T2DM, aged > or =65 (71.6 +/- 4.9) years were recruited. PAD was diagnosed by ABI<0.9, and ACR was divided into normoalbuminuria (<30.0 microg/mg), microalbuminuria (30.0-299.9 microg/mg), and macroalbuminuria (> or = 300.0 microg/mg).

RESULTS

patients with PAD (n = 45) had higher ln(ACR) than patients without: 4.48 +/- 1.48 versus 3.73 +/- 1.39 (P<0.01). For normoalbuminuria (n = 112), microalbuminuria (n = 152), and macroalbuminuria (n = 26), respective PAD prevalence was 8.0, 17.1 and 38.5% (P<0.001). The proportion of normoalbuminuria, microalbuminuria and macroalbuminuria in patients with PAD was 20.0, 57.8 and 22.2%, respectively; and 42.0, 51.4 and 6.5%, respectively, in patients without (P<0.001). Ln(ACR) was inversely correlated with ABI in all patients (gamma = -0.198, P<0.01) and in separate sexes (gamma = -0.211 for men and gamma = -0.181 for women). The multivariate-adjusted odds ratios for PAD for every 1 unit increment of ln(ACR) was 1.66 (1.17-2.34); and for microalbuminuria versus normoalbuminuria and macroalbuminuria versus normoalbuminuria were 2.54 (1.05-6.17) and 5.86 (1.76-19.52), respectively.

CONCLUSIONS

urinary ACR is not only associated with PAD, it is also significantly correlated with ABI in an inverse pattern in elderly Taiwanese with T2DM.

Effect of parental hypertension and/or parental diabetes on hypertension in Taiwanese diabetic patients

BACKGROUND

Both type 2 diabetes mellitus (T2DM) and hypertension aggregate in families. It is a common thought that diabetic patients with parental diabetes and/or parental hypertension are more likely to develop hypertension. This study evaluated the separate and joint effects of parental hypertension and parental diabetes on the prevalence of hypertension in patients with T2DM.

MATERIALS AND METHODS

A total of 89 956 patients from a national cohort were interviewed by telephone. Information about age, sex, onset age of diabetes, body height, body weight, systolic (SBP) and diastolic blood pressure (DBP), smoking, hypertension, and paternal and maternal history of diabetes and hypertension were obtained. Hypertension was defined in two ways: (1) a positive history; or (2) a positive history or a reported SBP > or = 140 mmHg and/or DBP > or = 90 mmHg in patients without a hypertension history.

RESULTS

While analysed separately in logistic models, both parental diabetes and parental hypertension were positively associated with hypertension. However, when both were analysed together, only parental hypertension was positively associated with hypertension, with paternal and maternal hypertension exerting a similar effect of an approximately 2.5-fold higher risk. While considering the effect of parental hypertension, both paternal and maternal diabetes was significantly associated with a lower risk of hypertension with odds ratios of approximately 0.8. Parental hypertension was also significantly associated with increased SBP and DBP; and parental diabetes with lower values in multiple linear regression.

CONCLUSIONS

Parental hypertension is strongly associated with hypertension. However, parental diabetes may be protective if the effect of parental hypertension is considered.

Arsenic and diabetes and hypertension in human populations: A review

Long-term exposure to ingested arsenic from drinking water has been well documented to be associated with an increased risk of diabetes mellitus and hypertension in a dose-response relationship among residents of arseniasis-endemic areas in southwestern Taiwan and Bangladesh. An increased risk of self-reported hypertension but not diabetes was reported in a community-based study of residents who consumed drinking water with a low level of arsenic. Increased glycosylated hemoglobin level and systolic blood pressure were observed in workers occupationally exposed to arsenic. Inconsistent findings of arsenic and diabetes in occupational studies may result from the healthy worker effect and the variation in exposure measurement, age composition, number of patients, accuracy in diagnosis and classification of underlying causes of death, competing causes of death, and method to detect diabetes. The dose-response relationship and toxicological mechanisms of arsenic-induced diabetes and hypertension need further elucidation.

Angiotensin-converting enzyme gene polymorphism and stroke in type 2 diabetic patients in Taiwan

BACKGROUND

The effect of traditional risk factors on the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and stroke was rarely studied previously. We investigated such effect in Taiwanese type 2 diabetic patients.

MATERIALS AND METHODS

A total of 872 (422 men and 450 women) patients aged 63.5 (SD: 11.6) years were recruited. Among them, 92 cases (48 men and 44 women) had stroke. Polymerase chain reaction was used to classify the genotypes as II, ID and DD. Analyses were performed in separate sexes.

RESULTS

The adjusted odds ratios for stroke for ID vs. II and DD vs. II were 0.837 (0.413-1.697) and 1.778 (0.596-5.300), respectively, for men; but were 1.700 (0.824-3.505) and 3.706 (1.375-9.985), respectively, for women. In models assuming recessive (DD vs. II + ID), dominant (DD + ID vs. II) and additive (II = 0, ID = 1 and DD = 2) transmission, none of the odds ratios was significant for men; but were all significant for women: 2.784 (1.137-6.818), 1.996 (1.006-3.962) and 1.877 (1.155-3.050), respectively. In models using patients without risk factors (hypertension, obesity, smoking or dyslipidaemia ) as a referent group and comparing them to patients with the risk factor and with ID/II, and with DD genotypes, all models (except for smoking) favoured an increasing trend of risk with patients having the risk factor and DD genotype at the highest risk in women. Similar trends for hypertension and dyslipidaemia were also observed in men.

CONCLUSION

Traditional risk factors play an important role in the association between the ACE genotypes and stroke. Patients with DD genotype and having traditional risk factors are at the highest risk.

Metabolism of inorganic arsenic and non-cancerous health hazards associated with chronic exposure in humans

Humans can be exposed to arsenic from a variety of environmental, occupational and medicinal sources. Exposure from drinking water is the most common source nowadays. Inorganic arsenic is metabolized by two main biochemical reactions: reduction and oxidative methylation. Recent studies have confirmed a reactivation of the toxic effects of arsenic associated with such methylation process, because the methylated metabolites, especially the trivalent forms, are more toxic than the inorganic arsenicals. Chronic exposure to arsenic can cause a variety of cancerous and noncancerous health hazards in humans. The main non-cancerous health hazards include cardiovascular disease, skin lesions, neurological problems, diabetes mellitus and hypertension.

Mortality, causes of death and associated risk factors in a cohort of diabetic patients after lower-extremity amputation: a 6.5-year follow-up study in Taiwan

BACKGROUND

To determine the mortality, causes of death and associated risk factors in Taiwanese diabetic patients after lower-extremity amputation (LEA).

METHODS

A total of 358 diabetic patients (191 men and 167 women, aged 66.6+/-10.3 years) after LEA from the Taiwanese cohort of 778 cases previously recruited in the multinational Global Lower Extremity Amputation Study were followed. Risk factors included age, sex, smoking, body mass index (BMI), hypertension, systolic (SBP) and diastolic blood pressure (DBP), and LEA level. Mortality was ascertained from the National Death Registry.

RESULTS

With a follow-up period of up to 6.5 (median: 4.0) years and 1239.17 patient-years, 214 patients died. Crude mortality rate was 172.7 per 1000 patient-years and median survival time 4.1 years. The underlying cause of death was recorded as diabetes mellitus in 57.9% of those who died and none to disease of arteries, arterioles and capillaries. After adjustment for age and sex, smoking, SBP as a continuous variable, SBP >or=140 mm Hg and BMI <18.5 kg/m(2) (underweight) were predictors for mortality with respective odds ratios (95% confidence intervals) of 1.580 (1.030-2.425), 1.011 (1.000-1.022), 1.363 (1.007-1.845) and 1.889 (1.203-2.968); but hypertension, DBP as a continuous variable and DBP >or=90 mm Hg, BMI as a continuous variable and LEA level were not.

CONCLUSIONS

Mortality after LEA in Taiwanese diabetic patients is high. The most common cause of death was recorded as diabetes mellitus. After adjustment for age and sex, smoking, SBP and underweight are predictive for mortality; while LEA level is not.

Higher risk of hypertension in indigenous type 2 diabetic patients in Taiwan

BACKGROUND

This study compared the risk of hypertension between indigenous and Han adults with type 2 diabetes mellitus (T2DM) in Taiwan.

METHODS

The data of 89,857 (747 indigenous and 89,110 Han people) T2DM patients aged > or =18 years were extracted from an established cohort of 93 484 diabetic patients using the National Health Insurance system of Taiwan. The prevalence of hypertension before diabetes diagnosis and at the time of survey, and the incidence of hypertension after diabetes diagnosis were compared between the two ethnicities.

RESULTS

The indigenous people had a higher prevalence of hypertension before diabetes diagnosis (39.0% versus 29.4%, P < 0.001) and at the time of survey (66.9% versus 54.4%, P < 0.001); and showed poorer blood pressure control, with systolic pressure > or = 140 mmHg (38.4% versus 30.3%, P < 0.001) and diastolic pressure > or = 90 mmHg (20.4% versus 15.5%, P < 0.001). Logistic and Cox's regression models showed an adjusted risk of hypertension of about twofold in indigenous people compared to the Han people.

CONCLUSIONS

The indigenous diabetics are more prone to develop hypertension than their Han counterparts in Taiwan.

Sex Difference in the Distribution of Atherosclerotic Risk Factors and Their Association With Peripheral Arterial Disease in Taiwanese Type 2 Diabetic Patients

BACKGROUND

There appear to be sex differences in the risk factors for peripheral arterial disease (PAD) in type 2 diabetic patients, but studies in Taiwanese patients have not been conducted.

METHODS AND RESULTS

A total of 610 (268 men, 342 women) Taiwanese patients aged 63.3+/-10.8 years were evaluated. PAD was diagnosed by an ankle - brachial index <0.9. Risk factors included age, sex, body mass index (BMI), waist circumference (WC), smoking, menopause, diabetes duration, hypertension, insulin therapy, systolic and diastolic blood pressures, fasting glucose, total cholesterol (TC), triglyceride (TG), high- (HDL-C) and low-density lipoprotein-cholesterol (LDL-C), apolipoproteins A1 (ApoA1) and B (ApoB) and uric acid (UA). When compared with the men, the women were significantly older and had longer duration, smaller WC, higher levels of systolic blood pressure, TC, TG, HDL-C, LDL-C, ApoA1 and ApoB, lower levels of UA, fewer smokers and more insulin users. Stepwise logistic regression showed age, BMI (inverse association) and systolic blood pressure as independent risk factors for men [respective odds ratios (OR): 1.080 (1.024-1.139), 0.832 (0.713-0.971) and 1.028 (1.005-1.051)]; and for women they were age, UA and insulin therapy [respective OR: 1.113 (1.056-1.173), 1.340 (1.101-1.630) and 4.173 (1.974-8.824).

CONCLUSIONS

PAD risk factors differ significantly between the sexes.

Arsenic methylation capability and hypertension risk in subjects living in arseniasis-hyperendemic areas in southwestern Taiwan

BACKGROUND

Cumulative arsenic exposure (CAE) from drinking water has been shown to be associated with hypertension in a dose-response pattern. This study further explored the association between arsenic methylation capability and hypertension risk among residents of arseniasis-hyperendemic areas in Taiwan considering the effect of CAE and other potential confounders.

METHOD

There were 871 subjects (488 women and 383 men) and among them 372 were diagnosed as having hypertension based on a positive history or measured systolic blood pressure >or=140 mm Hg and/or diastolic blood pressure >or=90 mm Hg. Urinary arsenic species were determined by high-performance liquid chromatography-hydride generator and atomic absorption spectrometry. Primary arsenic methylation index [PMI, defined as monomethylarsonic acid (MMA(V)) divided by (As(III)+As(V))] and secondary arsenic methylation index (SMI, defined as dimethylarsinic acid divided by MMA(V)) were used as indicators for arsenic methylation capability.

RESULTS

The level of urinary arsenic was still significantly correlated with cumulative arsenic exposure (CAE) calculated from a questionnaire interview (p=0.02) even after the residents stopped drinking the artesian well water for 2-3 decades. Hypertensive subjects had higher percentages of MMA(V) and lower SMI than subjects without hypertension. However, subjects having CAE >0 mg/L-year had higher hypertension risk than those who had CAE=0 mg/L-year disregard a high or low methylation index.

CONCLUSION

Inefficient arsenic methylation ability may be related with hypertension risk.

Arsenic methylation, urinary arsenic metabolites and human diseases: current perspective

Arsenic can cause cancerous and non-cancerous human diseases. Inorganic arsenic from drinking water is the most common source of human exposure. Pentavalent arsenate can be reduced to trivalent arsenite in the blood, which is taken up mainly in the liver and metabolized by a sequence of reduction and oxidative methylation. A proportion of the inorganic arsenicals together with methylated metabolites are excreted in urine. Analyses of the urinary arsenic profile can give a hint to the methylation capacity of exposed individuals. All studies evaluating the association between urinary arsenic profiles and human diseases nowadays measure mainly the inorganic arsenate and arsenite and the two organic forms of methylated metabolites: the pentavalent form of monomethylarsonic acid (MMAV) and dimethylarsinic acid (DMAV). A review of the current literature suggests that reduced methylation capacity with increased MMAV percentage, decreased DMAV percentage, or decreased DMAV/MMAV is associated with skin lesions, skin cancer, bladder cancer, peripheral vascular disease, muscle cramps and structural chromosome aberrations in peripheral lymphocytes obtained from exposed subjects. The detection of the recently identified more toxic trivalent forms of methylated metabolites in urine awaits further confirmation.

Exogenous Insulin Use and Hypertension in Adult Patients With Type 2 Diabetes Mellitus

BACKGROUND

Endogenous hyperinsulinemia, along with insulin resistance, is associated with hypertension. This study investigated the link between exogenous insulin use and hypertension in patients with type 2 diabetes mellitus.

METHODS

Using national health insurance records in Taiwan, data from 87,850 adult patients with type 2 diabetes mellitus were collected cross-sectionally with retrospective recall for onset of events. Data were analyzed to evaluate the strength of association, consistency, dose-response relationship, and temporality between exogenous insulin use and hypertension.

RESULTS

There were 5927 insulin users, who were characterized by being 1 year older in age, female preponderance, longer duration of diabetes, slightly lower body mass index, and less smoking but higher prevalence of hypertension with higher blood pressure. After adjustment for age, sex, body mass index, duration of diabetes, smoking, and parental hypertension, the odds ratios (95% confidence interval [CI]) for hypertension for patients using insulin for less than 5 years, 5 to 9 years, and 10 years or more were 1.14 (95% CI, 1.06-1.23), 1.35 (95% CI, 1.18-1.54), and 1.46 (95% CI, 1.24-1.74), respectively, compared with nonusers. In insulin users who did not have hypertension at the start of insulin use, the respective odds ratios for those using insulin for 5 to 9 years and 10 years or more were 1.5 (95% CI, 1.25-1.80) and 2.15 (95% CI, 1.72-2.70), respectively, compared with those using insulin for less than 5 years.

CONCLUSIONS

In patients with type 2 diabetes mellitus, insulin users are at higher risk for development of hypertension. These observational data suggest the need for further study of the relationship between exogenous insulin use and hypertension.