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Berezin AE. New Trends in Stem Cell Transplantation in Diabetes Mellitus Type I and Type II. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/978-3-319-55687-1_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Li SJ, Wang ZQ, Li YJ, Fan J, Zhang WB, Che GW, Liu LX, Chen LQ. Diabetes mellitus and risk of anastomotic leakage after esophagectomy: a systematic review and meta-analysis. Dis Esophagus 2017; 30:1-12. [PMID: 28475743 DOI: 10.1093/dote/dox006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/20/2017] [Indexed: 02/05/2023]
Abstract
Diabetes mellitus has the probability to impair the anastomotic healing and cause postesophagectomy anastomotic leakages but previous studies showed controversial results. This review aims to summary the impact of diabetes mellitus on the risk of anastomotic leakage after esophagectomy. We searched the PubMed and EMBASE databases to recognize English articles that met our eligibility criteria. Odds ratio with 95% confidence interval serves as the appropriate summarized statistic. Sensitivity analysis, meta-regression analysis, and publication bias tests were also performed to perceive potential bias risks. Finally, 16 observational studies with 12359 surgical patients were included. An overall analysis identified that diabetes mellitus was significantly associated with the risk of anastomotic leakage after esophagectomy (odds ratio = 1.63; 95% confidence interval = 1.25-2.12; P < 0.001). Further subgroup analysis showed a significant impact of diabetes mellitus in surgical populations from the Europe and America (odds ratio = 1.42; 95% confidence interval = 1.22-1.65; P < 0.001) but not in the Asian populations (odds ratio = 2.27; 95% confidence interval = 0.86-6.05; P = 0.1). The robustness of these estimates was confirmed by meta-regression analysis and sensitivity analysis. No significant publication bias exists between studies. In conclusion, this systematic review demonstrates that diabetes mellitus can be a significant risk factor of anastomotic leakage for patients undergoing esophagectomy. Our findings need to be further confirmed and modified by more well-designed worldwide multivariable analyses in the future.
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Affiliation(s)
- S-J Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Z-Q Wang
- Department of Thoracic Surgery, Chongqing Cancer Hospital and Institute, Chongqing, China
| | - Y-J Li
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - J Fan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - W-B Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - G-W Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - L-X Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - L-Q Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Choi SE, Seligman H, Basu S. Cost Effectiveness of Subsidizing Fruit and Vegetable Purchases Through the Supplemental Nutrition Assistance Program. Am J Prev Med 2017; 52:e147-e155. [PMID: 28153648 PMCID: PMC5401647 DOI: 10.1016/j.amepre.2016.12.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/31/2016] [Accepted: 12/12/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION A diet high in fruits and vegetables (FV) is associated with reduced risk of chronic disease. One strategy to incentivize FV consumption among low-income households is to make them more affordable through the Supplemental Nutrition Assistance Program (SNAP). This study aims to identify the cost effectiveness of subsidizing FV purchases among the one in seven Americans who participate in SNAP. METHODS A cost-effectiveness analysis was conducted from a societal perspective to estimate lifetime costs and health gains associated with subsidizing FV purchases. A stochastic microsimulation model of obesity, type 2 diabetes, myocardial infarction, and stroke in the 2015 U.S. population was used. Model parameters were based on nationally representative SNAP participation and dietary consumption data from the National Health and Nutrition Examination Survey (2003-2012), and data from a randomized trial of FV subsidies among SNAP users. RESULTS Despite cycling of participants in and out of SNAP, expanding an FV subsidy nationwide through SNAP would be expected to reduce incidence of type 2 diabetes by 1.7% (95% CI=1.2, 2.2), myocardial infarction by 1.4% (95% CI=0.9, 1.9), stroke by 1.2% (95% CI=0.8, 1.6), and obesity by 0.2% (95% CI=0.1, 0.3), and be cost saving from a societal perspective. The saved costs would be largely attributable to long-term reductions in type 2 diabetes and cardiovascular diseases. CONCLUSIONS The model suggests nationwide SNAP FV subsidies would reduce chronic disease morbidity, mortality, and costs over long time horizons that are unlikely to be observed in short-term community-based trials.
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Affiliation(s)
- Sung Eun Choi
- Department of Management Science and Engineering, Stanford University, Stanford, California.
| | - Hilary Seligman
- Department of General Internal Medicine, University of California San Francisco, San Francisco, California; Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Sanjay Basu
- Department of Medicine, Institute for Economic Policy Research, and Center on Poverty and Inequality, Stanford University, Stanford, California;; Center for Primary Care, Harvard Medical School, Boston, Massachusetts
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54
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Cardiovascular inflammation is reduced with methotrexate in diabetes. Mol Cell Biochem 2017; 432:159-167. [PMID: 28303409 DOI: 10.1007/s11010-017-3006-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/04/2017] [Indexed: 02/06/2023]
Abstract
Diabetes increases the risk of vascular events and mortality. While earlier type 2 diabetes trials demonstrated that intensive glucose lowering reduces microvascular complications, it is only recently that treatment with some of the newer antihyperglycemic agents has been associated with macrovascular benefits. We report herein that db/db mice concomitantly fed the Western diet and treated with the anti-inflammatory agent methotrexate display a less aggressive inflammatory (lower serum IL-1β, IL-6, SDF-1, and TNFα levels; higher circulating adiponectin, IL-12p70 and IL-10 concentrations; lower aortic VCAM-1 levels) profile than their saline-treated counterpart. Furthermore, acetylcholine-elicited endothelium-dependent vasodilatation was significantly greater in thoracic aortic segments from the former group. Collectively, the data lend support to the notion that alterations in the inflammatory system may be involved in the macrovascular benefits observed in type 2 diabetes trials and provide credence for the development of anti-inflammatory tools to lower CV risk and CV events in diabetes.
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55
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Shestakova MV, Dedov II. [Diabetes mellitus in the Russian Federation: Arguments and facts]. TERAPEVT ARKH 2017; 88:4-8. [PMID: 27801413 DOI: 10.17116/terarkh201688104-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diabetes mellitus (DM) is a fast-spreading non-communicable disease epidemic of the 21st century. According to the Russian State Register, in 2015 a total of 4.3 million patients were registered for seeking medical advice for DM. were registered in 2015. However, the first NATION epidemiological survey aimed to actively screen type 2 DM (T2DM) in the population of Russia has shown that the true prevalence of T2DM is twice as high as the registered one, accounting for 5.4%. The proportion of previously undiagnosed T2DM was 54%. The highest prevalence of T2DM was seen in individuals older than 45 years and in those with obesity or cardiovascular diseases. The prevalence of prediabetes was 19.3%. The main cause of death in DM patients is cardiovascular diseases. Nonmedical and indirect costs are more than a quarter of the economic burden. The medical costs of treatment for patients with DM and complications are thrice higher than those in uncomplicated DM subjects.
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Affiliation(s)
- M V Shestakova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - I I Dedov
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
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Wright AK, Kontopantelis E, Emsley R, Buchan I, Sattar N, Rutter MK, Ashcroft DM. Life Expectancy and Cause-Specific Mortality in Type 2 Diabetes: A Population-Based Cohort Study Quantifying Relationships in Ethnic Subgroups. Diabetes Care 2017; 40:338-345. [PMID: 27998911 DOI: 10.2337/dc16-1616] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/30/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study 1) investigated life expectancy and cause-specific mortality rates associated with type 2 diabetes and 2) quantified these relationships in ethnic subgroups. RESEARCH DESIGN AND METHODS This was a cohort study using Clinical Practice Research Datalink data from 383 general practices in England with linked hospitalization and mortality records. A total of 187,968 patients with incident type 2 diabetes from 1998 to 2015 were matched to 908,016 control subjects. Abridged life tables estimated years of life lost, and a competing risk survival model quantified cause-specific hazard ratios (HRs). RESULTS A total of 40,286 deaths occurred in patients with type 2 diabetes. At age 40, white men with diabetes lost 5 years of life and white women lost 6 years compared with those without diabetes. A loss of between 1 and 2 years was observed for South Asians and blacks with diabetes. At age older than 65 years, South Asians with diabetes had up to 1.1 years' longer life expectancy than South Asians without diabetes. Compared with whites with diabetes, South Asians with diabetes had lower adjusted risks for mortality from cardiovascular (HR 0.82; 95% CI 0.75, 0.89), cancer (HR 0.43; 95% CI 0.36, 0.51), and respiratory diseases (HR 0.60; 95% CI 0.48, 0.76). A similar pattern was observed in blacks with diabetes compared with whites with diabetes. CONCLUSIONS Type 2 diabetes was associated with more years of life lost among whites than among South Asians or blacks, with older South Asians experiencing longer life expectancy compared with South Asians without diabetes. The findings support optimized cardiovascular disease risk factor management, especially in whites with type 2 diabetes.
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Affiliation(s)
- Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - Evangelos Kontopantelis
- The Farr Institute of Health Informatics Research, Division of Informatics, Imaging & Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - Richard Emsley
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - Iain Buchan
- The Farr Institute of Health Informatics Research, Division of Informatics, Imaging & Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Martin K Rutter
- Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, U.K
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.
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Gagliardino JJ, Atanasov PK, Chan JCN, Mbanya JC, Shestakova MV, Leguet-Dinville P, Annemans L. Resource use associated with type 2 diabetes in Africa, the Middle East, South Asia, Eurasia and Turkey: results from the International Diabetes Management Practice Study (IDMPS). BMJ Open Diabetes Res Care 2017; 5:e000297. [PMID: 28123754 PMCID: PMC5253437 DOI: 10.1136/bmjdrc-2016-000297] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/01/2016] [Accepted: 12/03/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Type 2 diabetes (T2D) and its complications form a global healthcare burden but the exact impact in some geographical regions is still not well documented. We describe the healthcare resource usage (HRU) associated with T2D in Africa, the Middle East, South Asia, Eurasia and Turkey. RESEARCH DESIGN AND METHODS In the fifth wave of the International Diabetes Management Practices Study (IDMPS; 2011-2012), we collected self-reported and physician-reported cross-sectional data from 8156 patients from 18 countries across 5 regions, including different types of HRU in the previous 3-6 months. Negative binomial regression was used to identify parameters associated with HRU, using incidence rate ratios (IRRs) to express associations. RESULTS Patients in Africa (n=2220), the Middle East (n=2065), Eurasia (n=1843), South Asia (n=1195) and Turkey (n=842) experienced an annual hospitalization rate (mean±SD) of 0.6±1.9, 0.3±1.2, 1.7±4.1, 0.4±1.5 and 1.3±2.7, respectively. The annual number of diabetes-related inpatient days (mean±SD) was 4.7±22.7, 1.1±6.1, 16.0±30.0, 1.5±6.8 and 10.8±34.3, respectively. Despite some inter-regional heterogeneity, macrovascular complications (IRRs varying between 1.4 and 8.9), microvascular complications (IRRs varying between 3.4 and 4.3) and, to a large extent, inadequate glycemic control (IRRs varying between 1.89 and 10.1), were independent parameters associated with hospitalization in these respective regions. CONCLUSIONS In non-Western countries, macrovascular/microvascular complications and inadequate glycemic control were common and important parameters associated with increased HRU.
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Affiliation(s)
- Juan J Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET), La Plata, Argentina
| | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jean C Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Marina V Shestakova
- Endocrinology Research Centre, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
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Cookson R, Asaria M, Ali S, Ferguson B, Fleetcroft R, Goddard M, Goldblatt P, Laudicella M, Raine R. Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them.ObjectivesThe objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format.DesignLongitudinal whole-population study at the small-area level.SettingEngland from 2001/2 to 2011/12.ParticipantsA total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people.Main outcome measuresSlope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality.Data sourcesPractice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8).ResultsBetween 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark.LimitationsGeneral practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible.ConclusionsNHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any administrative geography comprising ≥ 100,000 people.Future workExploration of quality improvement lessons from local areas performing well and badly on health-care equity, improved methods including better measures of need and risk and measures of health-care inequality over the life-course, and monitoring of other dimensions of equity. These indicators can also be used to evaluate the health-care equity impacts of interventions and make international health-care equity comparisons.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Miqdad Asaria
- Centre for Health Economics, University of York, York, UK
| | - Shehzad Ali
- Centre for Health Economics, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Brian Ferguson
- Knowledge and Intelligence, Public Health England, York, UK
| | | | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Peter Goldblatt
- Institute of Health Equity, University College London, London, UK
| | | | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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Westlake K, Plihalova A, Pretl M, Lattova Z, Polak J. Screening for obstructive sleep apnea syndrome in patients with type 2 diabetes mellitus: a prospective study on sensitivity of Berlin and STOP-Bang questionnaires. Sleep Med 2016; 26:71-76. [PMID: 27613528 DOI: 10.1016/j.sleep.2016.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/06/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes mellitus representing an additional risk factor for already increased cardiovascular mortality. As cardiovascular diseases are the main cause of death in this population, there is a need to identify patients with moderate to severe OSA indicated for treatment. We aimed to evaluate the performance of the Berlin, STOP, and STOP-Bang screening questionnaires in a population of patients with Type 2 diabetes mellitus. METHODS 294 consecutive patients with Type 2 diabetes mellitus filled in the questionnaires and underwent overnight home sleep monitoring using a type IV sleep monitor. RESULTS Severe, moderate, and mild OSA was found in 31 (10%), 61 (21%), and 121 (41%) patients, respectively. The questionnaires showed a similar sensitivity and specificity for AHI ≥ 15: 0.69 and 0.50 for Berlin, 0.65 and 0.49 for STOP, and 0.59 and 0.68 for STOP-Bang. However, the performance of the STOP-Bang questionnaire was different in men vs. women, sensitivity being 0.74 vs. 0.29 (p < 0.05) and specificity 0.56 vs. 0.82 (p < 0.05). CONCLUSIONS Even the best-performing Berlin questionnaire failed to identify 31% of patients with moderate to severe OSA as being at high risk of OSA, thus preventing them from receiving a correct diagnosis and treatment. Considering that patients with Type 2 diabetes mellitus are at high risk of cardiovascular mortality and also have a high prevalence of moderate to severe OSA, we find screening based on the questionnaires suboptimal and suggest that OSA screening should be performed using home sleep monitoring devices.
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Affiliation(s)
- Katerina Westlake
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Diabetology Practice Diainmed s.r.o., Slunecna 2, Prague, Czech Republic
| | - Andrea Plihalova
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic
| | - Martin Pretl
- Neurology and Sleep Laboratory, INSPAMED s.r.o., Kubelikova 46, Prague, Czech Republic
| | - Zuzana Lattova
- Sleep Medicine Department, National Institute of Mental Health, Topolová 748, Klecany, Czech Republic
| | - Jan Polak
- 2nd Internal Medicine Department, Vinohrady Teaching Hospital, Srobarova 50, Prague, Czech Republic; Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Prague, Czech Republic.
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Wang Z, Liu M. Life years lost associated with diabetes: An individually matched cohort study using the U.S. National Health Interview Survey data. Diabetes Res Clin Pract 2016; 118:69-76. [PMID: 27348179 DOI: 10.1016/j.diabres.2016.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/27/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
AIM Previous estimates of life-years lost to diabetes are highly inconsistent. This study provided the updated estimates of life-years lost to diabetes in the United States. METHODS Each of a nationally representative sample of 21,829 adults with diabetes in the U.S. National Health Interview Survey 1997-2009 was individually matched to one without diabetes by age, sex, race, survey year, BMI, smoking status, pre-existing cardiovascular disease and pre-existing cancer. All-cause mortality from original surveys to 31 December 2011 and median survival ages were estimated for those with diabetes and their matched controls. RESULTS Overall median survival age for adults with diabetes was 10.5years shorter than that for matched controls without diabetes. Estimated life-years lost associated with diabetes decreased with increasing age at diagnosis from 20.0years for those diagnosed before age 20years to no difference for those diagnosed after 80years. Hazard ratios for mortality decreased from 3.03 (95% CI: 2.41, 3.80) for those with diabetes diagnosed before 20years to 1.04 (95% CI: 0.78, 1.39) for those diagnosed after 80years. The estimate of life-years lost associated with diabetes was much higher among those with pre-existing cardiovascular disease (20.3years) than among those without cardiovascular disease (8.5years). CONCLUSIONS The effect of diabetes on survival depends on age at first diagnosis of diabetes and the presence of pre-existing diseases. The life-years lost are higher for those with diabetes diagnosed at younger ages. This study provided the updated estimates of life-years lost associated with diabetes in the United States.
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Affiliation(s)
- Zhiqiang Wang
- The University of Queensland, School of Medicine, Herston, Queensland, Australia.
| | - Meina Liu
- Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, China.
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Li M, McDermott R. High absolute risk of severe infections among Indigenous adults in rural northern Australia is amplified by diabetes - A 7 year follow up study. J Diabetes Complications 2016; 30:1069-73. [PMID: 27179750 DOI: 10.1016/j.jdiacomp.2016.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 01/13/2023]
Abstract
AIMS To quantify the risk of hospitalization for infections in Indigenous Australian adults with diabetes in rural and remote communities. METHODS 2787 Indigenous adults including 396 with diabetes at baseline from 19 communities in North Queensland from 1998 to 2007 were included in the study. Main measures were weight, height, waist circumference, blood pressure, fasting glucose, lipids, self-reported tobacco smoking, alcohol intake and physical activity. Baseline data were linked to hospital separation data using probabilistic linkage. The association between diabetes and hospitalization for all causes and infections was investigated using generalized linear model (GLM) and adjusted for other baseline measurements. RESULTS During a median follow up of 7years, 461 participants were hospitalized with 762 episodes of infection. 277 patients with diabetes (70%) were hospitalized at least once. 40% (110 in 277) were for community acquired infections. Patients with diabetes were twice as likely to be hospitalized for infections as those without diabetes (adjusted risk ratio 2.1, 95% CI 1.6-2.8), especially for urinary tract infections, cellulitis, and septicaemia. Median length of stay was 6 (IQR 3-13) days for diabetes patients compared to 3.4days (IQR 2-6.4) for those without diabetes (P<0.001) CONCLUSIONS: In addition to an already high rate of hospitalizations for infections among Indigenous compared to non-Indigenous Australians, diabetes confers an additional risk for severe infections especially urinary tract infection, cellulitis and septicaemia. Recovery is also comparatively slower. Early recognition and management of these infections in the primary care setting may reduce this risk and better control of glycaemia and its risk factors may improve underlying immune dysfunction.
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Affiliation(s)
- Ming Li
- Centre of Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide SA, Australia 5001.
| | - Robyn McDermott
- Centre of Population Health Research, University of South Australia, IPC CWE-48, GPO Box 2471, Adelaide SA, Australia 5001.
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Hoogenveen RT, Boshuizen HC, Engelfriet PM, van Baal PHM. You Only Die Once: Accounting for Multi-Attributable Mortality Risks in Multi-Disease Models for Health-Economic Analyses. Med Decis Making 2016; 37:403-414. [DOI: 10.1177/0272989x16658661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Mortality rates in Markov models, as used in health economic studies, are often estimated from summary statistics that allow limited adjustment for confounders. If interventions are targeted at multiple diseases and/or risk factors, these mortality rates need to be combined in a single model. This requires them to be mutually adjusted to avoid ‘double counting’ of mortality. We present a mathematical modeling approach to describe the joint effect of mutually dependent risk factors and chronic diseases on mortality in a consistent manner. Most importantly, this approach explicitly allows the use of readily available external data sources. An additional advantage is that existing models can be smoothly expanded to encompass more diseases/risk factors. To illustrate the usefulness of this method and how it should be implemented, we present a health economic model that links risk factors for diseases to mortality from these diseases, and describe the causal chain running from these risk factors (e.g., obesity) through to the occurrence of disease (e.g., diabetes, CVD) and death. Our results suggest that these adjustment procedures may have a large impact on estimated mortality rates. An improper adjustment of the mortality rates could result in an underestimation of disease prevalence and, therefore, disease costs.
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Affiliation(s)
- Rudolf T. Hoogenveen
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
| | - Hendriek C. Boshuizen
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
| | - Peter M. Engelfriet
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
| | - Pieter H. M. van Baal
- National Institute of Public Health and the Environment, Expertise Center for Methodology and Information Services, Bilthoven, the Netherlands (RTH, HCB, PME)
- Erasmus University Rotterdam, institute of Health Policy & Management, Rotterdam, Netherlands (PHMV)
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Muñoz-Rivas N, Méndez-Bailón M, Hernández-Barrera V, de Miguel-Yanes JM, Jimenez-Garcia R, Esteban-Hernández J, Lopez-de-Andrés A. Type 2 Diabetes and Hemorrhagic Stroke: A Population-Based Study in Spain from 2003 to 2012. J Stroke Cerebrovasc Dis 2016; 25:1431-43. [PMID: 27017281 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/16/2016] [Accepted: 02/24/2016] [Indexed: 12/12/2022] Open
Abstract
AIM The objective of this study is to compare trends in outcomes for intracerebral hemorrhagic stroke in people with or without type 2 diabetes in Spain between 2003 and 2012. METHODS We selected all patients hospitalized for hemorrhagic stroke using national hospital discharge data. We evaluated annual incident rates stratified by diabetes status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, in-hospital mortality (IHM), length of hospital stay, and readmission rate in 1 month. RESULTS We identified a total of 173,979 discharges of patients admitted with hemorrhagic stroke (19.1% with diabetes). Incidences were higher among those with than those without diabetes in all the years studied. Diabetes was positively associated with stroke (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI] 1.35-1.40 for men; IRR = 1.31, 95% CI 1.29-1.34 for women). Length of stay decreased significantly and readmission rate remained stable for both groups (around 5%). We observed a significant increase in the use of decompressive craniectomy from 2002 to 2013. Mortality was positively associated with older age, with higher comorbidity and atrial fibrillation as risk factors. We found a negative association with the use of decompressive craniectomy. Mortality did not change over time among diabetic men and women. In those without diabetes, mortality decreased significantly over time. Suffering diabetes was not associated with higher mortality. CONCLUSIONS Type 2 diabetes is associated with higher incidence of hemorrhagic stroke but not with IHM. Incidence among diabetic people remained stable over time. In both groups, the use of decompressive craniectomy has increased and is associated with a decreased mortality.
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Affiliation(s)
- Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | | | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
| | - Jesus Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Ana Lopez-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
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Steinberg HO. Sodium-glucose cotransporter 2 inhibitors and cardiovascular outcomes. Postgrad Med 2016; 128:398-408. [PMID: 26999348 DOI: 10.1080/00325481.2016.1168687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an elevated risk of cardiovascular (CV) morbidity and mortality. Furthermore, many patients with T2DM have comorbidities that are risk factors for CV disease. While intensive glucose control reduces the risk of diabetic microvascular complications, its relationship to CV outcomes remains unclear. Consequently, the management of CV risk factors in patients with T2DM is complex, and factors other than blood glucose must be considered. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of oral glucose-lowering agents, are associated with reductions in blood pressure and body weight, in addition to decreasing hyperglycemia, and therefore have the potential to reduce CV risk in patients with T2DM. The clinical trial results of SGLT2 inhibitors regarding CV safety and outcomes are discussed, including data from the recently published EMPA-REG OUTCOME study. This trial was the first dedicated CV outcomes study to demonstrate that a glucose-lowering agent lowered CV mortality and all-cause mortality, and reduced hospitalization for heart failure in patients with T2DM at high risk of CV events.
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Affiliation(s)
- Helmut O Steinberg
- a Medicine-Endocrinology, Division of Endocrinology, Diabetes and Metabolism Faculty , University of Tennessee Health Science Center , Memphis , TN , USA
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65
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Jacob L, Waehlert L, Kostev K. Changes in Type 2 Diabetes Mellitus Patients in German Primary Care Prior to (2006) and After (2010, 2014) Launch of New Drugs. J Diabetes Sci Technol 2016; 10:414-20. [PMID: 26864513 PMCID: PMC4773963 DOI: 10.1177/1932296815607860] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The aim was to analyze the changes in a German type 2 diabetes population prior to (2006) and after (2010, 2014) launch of new drugs. METHODS Patients with T2DM in 2006, 2010, and 2014 were recruited for the study. Demographic data included age, gender, and health insurance type (private/statutory). Drug prescription, mean costs per patient, HbA1c levels, macrovascular complications, and time before first insulin prescription were analyzed. RESULTS In all, 64 098, 77 219, and 85 004 T2DM patients were included for 2006, 2010, and 2014, respectively. The mean age (65.9-66.9 years), proportion of men (50.8%-53.8%), and proportion of patients with private health insurance (6.6%-7.2%) differed significantly for each of the 3 years. There was a 1.25-fold increase in the total costs per patient, linked with an increase in the costs associated with the use of new drugs and a decrease in those associated with the use of old drugs, respectively. HbA1c levels were slightly better regulated in 2014 than in 2006 and 2010. The share of macrovascular complications decreased significantly over time, dropping from 27.4% in 2006 to 24.6% in 2014. The mean duration before first insulin treatment increased from 1225 days in 2006 to 1406 days in 2014. CONCLUSIONS The new drugs analyzed in this study had positive effects on HbA1c levels, macrovascular complications, and mean time before first insulin treatment.
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Affiliation(s)
- Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - Lilia Waehlert
- Fresenius University of Applied Sciences, Health Economics, Idstein, Germany
| | - Karel Kostev
- IMS Health, Real World Evidence, Epidemiology, Frankfurt, Germany
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66
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The prediction and monitoring of toxicity associated with long-term systemic glucocorticoid therapy. Curr Rheumatol Rep 2016; 17:513. [PMID: 25903665 DOI: 10.1007/s11926-015-0513-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Glucocorticoids are often required for adequate control of inflammation in many serious inflammatory diseases; common indications for long-term treatment include polymyalgia rheumatica, giant cell arteritis, asthma and chronic obstructive pulmonary disease. Long-term glucocorticoid therapy is, however, associated with many adverse effects involving skin, gastro-intestinal, eye, skeletal muscle, bone, adrenal, cardio-metabolic and neuropsychiatric systems. This balance between benefits and risks of glucocorticoids is important for clinical practice and glucocorticoid-related adverse effects can significantly impair health-related quality of life. Understanding the nature and mechanisms of glucocorticoid-related adverse effects may inform how patients are monitored for toxicity and identify those groups, such as older people, that may need closer monitoring. For clinical trials in diseases commonly treated with glucocorticoids, standardised measurement of glucocorticoid-related adverse effects would facilitate future evidence synthesis and meta-analysis.
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67
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Methi T, Thorsby PM. Insulinresistens – kroppens forsvar mot kaloriforgiftning? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1015-7. [DOI: 10.4045/tidsskr.16.0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Walker J, Halbesma N, Lone N, McAllister D, Weir CJ, Wild SH. Socioeconomic status, comorbidity and mortality in patients with type 2 diabetes mellitus in Scotland 2004-2011: a cohort study. J Epidemiol Community Health 2015; 70:596-601. [PMID: 26681293 PMCID: PMC4893140 DOI: 10.1136/jech-2015-206702] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/29/2015] [Indexed: 11/11/2022]
Abstract
Background Mortality in people with and without diabetes often exhibits marked social patterning, risk of death being greater in deprived groups. This may reflect deprivation-related differences in comorbid disease (conditions additional to diabetes itself). This study sought to determine whether the social patterning of mortality in a population with type 2 diabetes mellitus (T2DM) is explained by differential comorbidity. Methods Hospital records for 70 197 men and 56 451 women diagnosed with T2DM at 25 years of age and above in Scotland during the period 2004–2011 were used to construct comorbidity histories. Sex-specific logistic models were fitted to predict mortality at 1 year after diagnosis with T2DM, predicted initially by age and socioeconomic status (SES) then extended to incorporate in turn 5 representations of comorbidity (including the Charlson Index). The capacity of comorbidity to explain social mortality gradients was assessed by observing the change in regression coefficients for SES following the addition of comorbidity. Results After adjustment for age and Charlson Index, the OR for the contrast between the least deprived and most deprived quintiles of SES for men was 0.79 (95% CI 0.67 to 0.94). For women, the OR was 0.81 (0.67 to 0.97). Similar results were obtained for the 4 other comorbidity measures used. Conclusions The social patterning of mortality in people with T2DM is not fully explained by differing levels of comorbid disease additional to T2DM itself. Other dimensions of deprivation are implicated in the elevated death rates observed in deprived groups of people with T2DM.
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Affiliation(s)
- Jeremy Walker
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nynke Halbesma
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nazir Lone
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - David McAllister
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
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Singh J, Schupf N, Boudreau R, Matteini AM, Prasad T, Newman AB, Liu Y, Christensen K, Kammerer CM. Association of Aging-Related Endophenotypes With Mortality in 2 Cohort Studies: the Long Life Family Study and the Health, Aging and Body Composition Study. Am J Epidemiol 2015; 182:926-35. [PMID: 26582777 DOI: 10.1093/aje/kwv143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/28/2015] [Indexed: 11/13/2022] Open
Abstract
One method by which to identify fundamental biological processes that may contribute to age-related disease and disability, instead of disease-specific processes, is to construct endophenotypes comprising linear combinations of physiological measures. Applying factor analyses methods to phenotypic data (2006-2009) on 28 traits representing 5 domains (cognitive, cardiovascular, metabolic, physical, and pulmonary) from 4,472 US and Danish individuals in 574 pedigrees from the Long Life Family Study (United States and Denmark), we constructed endophenotypes and assessed their relationship with mortality. The most dominant endophenotype primarily reflected the physical activity and pulmonary domains, was heritable, was significantly associated with mortality, and attenuated the association of age with mortality by 24.1%. Using data (1997-1998) on 1,794 Health, Aging and Body Composition Study participants from Memphis, Tennessee, and Pittsburgh, Pennsylvania, we obtained strikingly similar endophenotypes and relationships to mortality. We also reproduced the endophenotype constructs, especially the dominant physical activity and pulmonary endophenotype, within demographic subpopulations of these 2 cohorts. Thus, this endophenotype construct may represent an underlying phenotype related to aging. Additional genetic studies of this endophenotype may help identify genetic variants or networks that contribute to the aging process.
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Luck T, Roehr S, Jessen F, Villringer A, Angermeyer MC, Riedel-Heller SG. Mortality in Individuals with Subjective Cognitive Decline: Results of the Leipzig Longitudinal Study of the Aged (LEILA75+). J Alzheimers Dis 2015; 48 Suppl 1:S33-42. [DOI: 10.3233/jad-150090] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
- LIFE – Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Day Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
| | - Matthias C. Angermeyer
- Center for Public Mental Health, Gösing a. W., Austria
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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71
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Kato M, Noda M, Mizoue T, Goto A, Takahashi Y, Matsushita Y, Nanri A, Iso H, Inoue M, Sawada N, Tsugane S. Diagnosed diabetes and premature death among middle-aged Japanese: results from a large-scale population-based cohort study in Japan (JPHC study). BMJ Open 2015; 5:e007736. [PMID: 25941187 PMCID: PMC4420968 DOI: 10.1136/bmjopen-2015-007736] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the association between diabetes and premature death for Japanese general people. DESIGN Prospective cohort study. SETTING The Japan Public Health Center-based prospective study (JPHC study), data collected between 1990 and 2010. POPULATION A total of 46,017 men and 53,567 women, aged 40-69 years at the beginning of baseline survey. MAIN OUTCOME MEASURES Overall and cause specific mortality. Cox proportional hazards models were used to calculate the HRs of all cause and cause specific mortality associated with diabetes. RESULTS The median follow-up period was 17.8 years. During the follow-up period, 8223 men and 4640 women have died. Diabetes was associated with increased risk of death (856 men and 345 women; HR 1.60, (95% CI 1.49 to 1.71) for men and 1.98 (95% CI 1.77 to 2.21) for women). As for the cause of death, diabetes was associated with increased risk of death by circulatory diseases (HR 1.76 (95% CI 1.53 to 2.02) for men and 2.49 (95% CI 2.06 to 3.01) for women) while its association with the risk of cancer death was moderate (HR 1.25 (95% CI 1.11 to 1.42) for men and 1.04 (95% CI 0.82 to 1.32) for women). Diabetes was also associated with increased risk of death for 'non-cancer, non-circulatory system disease' (HR 1.91 (95% CI 1.71 to 2.14) for men and 2.67 (95% CI 2.25 to 3.17) for women). CONCLUSIONS Diabetes was associated with increased risk of death, especially the risk of death by circulatory diseases.
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Affiliation(s)
- Masayuki Kato
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
- Fiore Kenshin Clinic, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Goto
- Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiko Takahashi
- Division of Diabetes and Metabolism, Iwate Medical University School of Medicine, Morioka, Japan
| | - Yumi Matsushita
- Department of Clinical Research, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akiko Nanri
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyasu Iso
- Department of Public Health, Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine, Osaka-fu, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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Kuo CC, Howard BV, Umans JG, Gribble MO, Best LG, Francesconi KA, Goessler W, Lee E, Guallar E, Navas-Acien A. Arsenic Exposure, Arsenic Metabolism, and Incident Diabetes in the Strong Heart Study. Diabetes Care 2015; 38:620-7. [PMID: 25583752 PMCID: PMC4370323 DOI: 10.2337/dc14-1641] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Little is known about arsenic metabolism in diabetes development. We investigated the prospective associations of low-moderate arsenic exposure and arsenic metabolism with diabetes incidence in the Strong Heart Study. RESEARCH DESIGN AND METHODS A total of 1,694 diabetes-free participants aged 45-75 years were recruited in 1989-1991 and followed through 1998-1999. We used the proportions of urine inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) over their sum (expressed as iAs%, MMA%, and DMA%) as the biomarkers of arsenic metabolism. Diabetes was defined as fasting glucose ≥ 126 mg/dL, 2-h glucose ≥ 200 mg/dL, self-reported diabetes history, or self-reported use of antidiabetic medications. RESULTS Over 11,263.2 person-years of follow-up, 396 participants developed diabetes. Using the leave-one-out approach to model the dynamics of arsenic metabolism, we found that lower MMA% was associated with higher diabetes incidence. The hazard ratios (95% CI) of diabetes incidence for a 5% increase in MMA% were 0.77 (0.63-0.93) and 0.82 (0.73-0.92) when iAs% and DMA%, respectively, were left out of the model. DMA% was associated with higher diabetes incidence only when MMA% decreased (left out of the model) but not when iAs% decreased. iAs% was also associated with higher diabetes incidence when MMA% decreased. The association between MMA% and diabetes incidence was similar by age, sex, study site, obesity, and urine iAs concentrations. CONCLUSIONS Arsenic metabolism, particularly lower MMA%, was prospectively associated with increased incidence of diabetes. Research is needed to evaluate whether arsenic metabolism is related to diabetes incidence per se or through its close connections with one-carbon metabolism.
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Affiliation(s)
- Chin-Chi Kuo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
| | | | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Timber Lake, SD
| | - Kevin A Francesconi
- Institute of Chemistry - Analytical Chemistry, Karl-Franzens University Graz, Graz, Austria
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, Karl-Franzens University Graz, Graz, Austria
| | - Elisa Lee
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Eliseo Guallar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ana Navas-Acien
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
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Helfand BKI, Maselli NJ, Lessard DM, Yarzebski J, Gore JM, McManus DD, Saczynski JS, Goldberg RJ. Elevated serum glucose levels and survival after acute heart failure: a population-based perspective. Diab Vasc Dis Res 2015; 12:119-25. [PMID: 25525077 DOI: 10.1177/1479164114559024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Limited data are available about the characteristics, treatment and survival in patients without diabetes mellitus (DM), previously diagnosed DM and patients with hyperglycaemia who present with acute decompensated heart failure (ADHF). Our objectives were to examine differences in these endpoints in patients hospitalized with ADHF. METHODS Patients hospitalized with ADHF during 1995, 2000, 2002 and 2004 comprised the study population. RESULTS A total of 5428 non-diabetic patients were hospitalized with ADHF, 3807 with diagnosed DM and 513 with admission hyperglycaemia. Patients with admission hyperglycaemia experienced the highest in-hospital death rates (9.9%) compared to those with diagnosed DM (6.5%) and non-diabetics (7.5%). Patients with diagnosed DM had the greatest risk of dying after hospital discharge. CONCLUSIONS Patients with elevated blood glucose levels at hospital admission are more likely to die acutely. After resolution of the acute illness, patients with previously diagnosed DM need careful monitoring and enhanced treatment.
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Affiliation(s)
- Benjamin K I Helfand
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nicholas J Maselli
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Darleen M Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Berezin AE. Diabetes mellitus and cellular replacement therapy: Expected clinical potential and perspectives. World J Diabetes 2014; 5:777-86. [PMID: 25512780 PMCID: PMC4265864 DOI: 10.4239/wjd.v5.i6.777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/16/2014] [Accepted: 09/23/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus (DM) is the most prevailing disease with progressive incidence worldwide. Despite contemporary treatment type one DM and type two DM are frequently associated with long-term major microvascular and macrovascular complications. Currently restoration of failing β-cell function, regulation of metabolic processes with stem cell transplantation is discussed as complements to contemporary DM therapy regimens. The present review is considered paradigm of the regenerative care and the possibly effects of cell therapy in DM. Reprogramming stem cells, bone marrow-derived mononuclear cells; lineage-specified progenitor cells are considered for regenerative strategy in DM. Finally, perspective component of stem cell replacement in DM is discussed.
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75
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Ulrichsen SP, Mor A, Svensson E, Larsen FB, Thomsen RW. Lifestyle factors associated with type 2 diabetes and use of different glucose-lowering drugs: cross-sectional study. PLoS One 2014; 9:e111849. [PMID: 25369331 PMCID: PMC4219789 DOI: 10.1371/journal.pone.0111849] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/08/2014] [Indexed: 01/28/2023] Open
Abstract
Aims To examine the lifestyle profile among persons with and without Type 2 diabetes mellitus (DM) and among users of different glucose-lowering drugs. Methods We used questionnaire data from a Danish health survey and identified presence of Type 2 DM and use of medications through medical databases. We calculated age- and gender-standardized prevalence ratios (PRs) of lifestyle factors according to Type 2 DM and different glucose-lowering drugs. Results Of 21,637 survey participants aged 25–79 years, 680 (3%) had Type 2 DM (median age 63 years) with a median diabetes duration of 5 years. Participants with Type 2 DM had a substantially higher prevalence of obesity (36% vs. 13%, PR: 3.1, 95% confidence interval (CI): 2.8–3.6), yet more reported to eat a very healthy diet (25% vs. 21%, PR: 1.2, 95% CI: 1.0–1.4) and to exercise regularly (67% vs. 53%, PR: 1.3, 95% CI: 1.2–1.4). Also, fewer were current smokers or had high alcohol intake. When compared with metformin users, obesity was substantially less prevalent in users of sulfonylurea (PR: 0.5, 95% CI: 0.4–0-8), and insulin and analogues (PR: 0.4, 95% CI: 0.3–0.7). Tobacco smoking was more prevalent in sulfonylurea users (PR: 1.4, 95% CI: 0.9–2.1) compared with metformin users. We found no material differences in physical exercise, diet or alcohol intake according to type of glucose-lowering drug. Conclusions Type 2 DM patients are substantially more obese than other individuals, but otherwise report to have a healthier lifestyle. Metformin use is strongly associated with obesity, whereas sulfonylurea use tends to be associated with tobacco smoking.
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Affiliation(s)
- Sinna P. Ulrichsen
- Department of Clinical Epidemiology, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark
| | - Anil Mor
- Department of Clinical Epidemiology, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Elisabeth Svensson
- Department of Clinical Epidemiology, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark
| | - Finn B. Larsen
- Centre for Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark
| | - Reimar W. Thomsen
- Department of Clinical Epidemiology, Faculty of Health, Aarhus University Hospital, Aarhus, Denmark
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Alonso-Morán E, Orueta JF, Fraile Esteban JI, Arteagoitia Axpe JM, Marqués González ML, Toro Polanco N, Ezkurra Loiola P, Gaztambide S, Nuño-Solinis R. The prevalence of diabetes-related complications and multimorbidity in the population with type 2 diabetes mellitus in the Basque Country. BMC Public Health 2014; 14:1059. [PMID: 25300610 PMCID: PMC4197247 DOI: 10.1186/1471-2458-14-1059] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus is associated with a diverse range of pathologies. The aim of the study was to determine the incidence of diabetes-related complications, the prevalence of coexistent chronic conditions and to report multimorbidity in people with type 2 diabetes living in the Basque Country. METHODS Administrative databases, in four cross sections (annually from 2007 to 2011) were consulted to analyse 149,015 individual records from patients aged ≥ 35 years with type 2 diabetes mellitus. The data observed were: age, sex, diabetes-related complications (annual rates of acute myocardial infarction, major amputations and avoidable hospitalisations), diabetes-related pathologies (prevalence of ischaemic heart disease, renal failure, stroke, heart failure, peripheral neuropathy, foot ulcers and diabetic retinopathy) and other unrelated pathologies (44 diseases). RESULTS The annual incidence for each condition progressively decreased during the four-year period: acute myocardial infarction (0.47 to 0.40%), major amputations (0.10 to 0.08%), and avoidable hospitalisations (5.85 to 5.5%). The prevalence for diabetes-related chronic pathologies was: ischaemic heart disease (11.5%), renal failure (8.4%), stroke (7.0%), heart failure (4.3%), peripheral neuropathy (1.3%), foot ulcers (2.0%) and diabetic retinopathy (7.2%). The prevalence of multimorbidity was 90.4%. The highest prevalence for other chronic conditions was 73.7% for hypertension, 13.8% for dyspepsia and 12.7% for anxiety. CONCLUSIONS In the type 2 diabetes mellitus population living in the Basque Country, incidence rates of diabetes complications are not as high as in other places. However, they present a high prevalence of diabetes related and unrelated diseases. Multimorbidity is very common in this group, and is a factor to be taken into account to ensure correct clinical management.
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Affiliation(s)
- Edurne Alonso-Morán
- O + berri, Basque Institute for Healthcare Innovation, Torre del BEC (Bilbao Exhibition Centre), Ronda de Azkue 1, 48902 Barakaldo, Spain.
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Marfella R, Rizzo MR, Capoluongo MC, Ambrosino M, Savinelli A, Cinone F, Martinelli G, Fava I, Petrella A, Barbieri M, Paolisso G. Cryptogenic stroke and diabetes: a probable link between silent atrial fibrillation episodes and cerebrovascular disease. Expert Rev Cardiovasc Ther 2014; 12:323-9. [DOI: 10.1586/14779072.2014.882230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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