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Cardiac Function is Preserved in Adolescents With Well-Controlled Type 1 Diabetes and a Normal Physical Fitness: A Cross-sectional Study. Can J Diabetes 2021; 45:718-724.e1. [PMID: 33773936 DOI: 10.1016/j.jcjd.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/07/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in T1DM adolescents, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated to the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity. METHODS Transthoracic echocardiography was performed in 19 T1DM adolescents (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO2peak). RESULTS VO2peak and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO2peak; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration. CONCLUSIONS Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young T1D patients may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and therefore, improve long-term cardiovascular health.
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Ichikawa K, Miyoshi T, Osawa K, Miki T, Toda H, Ejiri K, Yoshida M, Nanba Y, Yoshida M, Nakamura K, Morita H, Ito H. Prognostic value of non-alcoholic fatty liver disease for predicting cardiovascular events in patients with diabetes mellitus with suspected coronary artery disease: a prospective cohort study. Cardiovasc Diabetol 2021; 20:8. [PMID: 33413363 PMCID: PMC7791695 DOI: 10.1186/s12933-020-01192-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background Risk stratification of cardiovascular events in patients with type 2 diabetes mellitus (T2DM) has not been established. Coronary artery calcium score (CACS) and non-alcoholic fatty liver disease (NAFLD) are independently associated with cardiovascular events in T2DM patients. This study examined the incremental prognostic value of NAFLD assessed by non-enhanced computed tomography (CT) in addition to CACS and Framingham risk score (FRS) for cardiovascular events in T2DM patients. Methods This prospective pilot study included 529 T2DM outpatients with no history of cardiovascular disease who underwent CACS measurement because of suspected coronary artery disease. NAFLD was defined on CT images as a liver:spleen attenuation ratio < 1.0. Cardiovascular events were defined as cardiovascular death, nonfatal myocardial infarction, late coronary revascularization, nonfatal stroke, or hospitalization for heart failure. Results Among 529 patients (61% men, mean age 65 years), NAFLD was identified in 143 (27%). Forty-four cardiovascular events were documented during a median follow-up of 4.4 years. In multivariate Cox regression analysis, NAFLD, CACS, and FRS were associated with cardiovascular events (hazard ratios and 95% confidence intervals 5.43, 2.82–10.44, p < 0.001; 1.56, 1.32–1.86, p < 0.001; 1.23, 1.08–1.39, p = 0.001, respectively). The global χ2 score for predicting cardiovascular events increased significantly from 27.0 to 49.7 by adding NAFLD to CACS and FRS (p < 0.001). The addition of NAFLD to a model including CACS and FRS significantly increased the C-statistic from 0.71 to 0.80 (p = 0.005). The net reclassification achieved by adding CACS and FRS was 0.551 (p < 0.001). Conclusions NAFLD assessed by CT, in addition to CACS and FRS, could be useful for identifying T2DM patients at higher risk of cardiovascular events.
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Affiliation(s)
- Keishi Ichikawa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kazuhiro Osawa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Cardiovascular Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hironobu Toda
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masatoki Yoshida
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Nanba
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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53
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Robert AA, Al Dawish MA. Cardiovascular Disease among Patients with Diabetes: The Current Scenario in Saudi Arabia. Curr Diabetes Rev 2021; 17:180-185. [PMID: 32459609 DOI: 10.2174/1573399816666200527135512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
One of the well-recognized conditions linked to diabetes mellitus (DM) is cardiovascular disease (CVD). Those affected by DM face greater risk for early onset of CVD. Although huge strides have been made in cardiovascular therapy and prevention, with striking results in decreasing diabetesrelated coronary mortality in developed countries, the morbidity and mortality due to CVD continue to remain high among patients with diabetes. While there is an increasing incidence of cardiovascular event survivors with DM across the world, the number of DM patients with higher cardiovascular risk is predicted to soar, presenting a massive challenge for health care systems globally, including Saudi Arabia. A report of the Saudi Scientific Diabetes Society indicates that more than 50% of patients with DM die due to cardiovascular causes. In fact, Saudi Arabia globally ranks among the top 10 countries in the prevalence of diabetes. However, the incidence of CVD and its risk factors among patients with diabetes in Saudi Arabia have not yet been well documented. This review aims to present an overview of CVD among patients with DM in Saudi Arabia, through a comprehensive review of currently available published literature. The findings indicate that diabetes linked CVD burden in Saudi Arabia is expected to exponentially increase to a very high degree unless a wide-ranging epidemic control program is initiated. The findings emphasize the need for maintenance of a healthy diet accompanied by exercise, an active lifestyle and weight control measures among the population. It is essential that the health care system focus on raising awareness among the population, and implement appropriate measures for prevention, early detection and suitable management of CVD among patients with DM.
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Affiliation(s)
- Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed Abdulaziz Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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54
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Echouffo-Tcheugui JB, Niiranen TJ, McCabe EL, Henglin M, Jain M, Vasan RS, Larson MG, Cheng S. An Early-Onset Subgroup of Type 2 Diabetes: A Multigenerational, Prospective Analysis in the Framingham Heart Study. Diabetes Care 2020; 43:3086-3093. [PMID: 33033069 PMCID: PMC7770277 DOI: 10.2337/dc19-1758] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relation of type 2 diabetes occurring earlier (age <55 years) versus later in life to the risk of cardiovascular death and to diabetes in offspring. RESEARCH DESIGN AND METHODS In the Framingham Heart Study, a community-based prospective cohort study, glycemic status was ascertained at serial examinations over six decades among 5,571 first- and second-generation participants with mortality data and 2,123 second-generation participants who initially did not have diabetes with data on parental diabetes status. We assessed cause of death in a case (cardiovascular death)-control (noncardiovascular death) design and incident diabetes in offspring in relation to parental early-onset diabetes. RESULTS Among the participants in two generations (N = 5,571), there were 1,822 cardiovascular deaths (including 961 coronary deaths). The odds of cardiovascular versus noncardiovascular death increased with decreasing age of diabetes onset (P < 0.001 trend). Compared with never developing diabetes, early-onset diabetes conferred a 1.81-fold odds (95% CI 1.10-2.97, P = 0.02) of cardiovascular death and 1.75-fold odds (0.96-3.21, P = 0.07) of coronary death, whereas later-onset diabetes was not associated with greater risk for either (P = 0.09 for cardiovascular death; P = 0.51 for coronary death). In second-generation participants, having a parent with early-onset diabetes increased diabetes risk by 3.24-fold (1.73-6.07), whereas having one or both parents with late-onset diabetes increased diabetes risk by 2.19-fold (1.50-3.19). CONCLUSIONS Our findings provide evidence for a diabetes subgroup with an early onset, a stronger association with cardiovascular death, and higher transgenerational transmission.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Teemu J Niiranen
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Elizabeth L McCabe
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Mir Henglin
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mohit Jain
- Division of Cardiovascular Medicine, Department of Medicine, and Department of Pharmacology, University of California, San Diego, La Jolla, CA
| | - Ramachandran S Vasan
- Sections of Preventive Medicine and Cardiology, Department of Medicine, Boston University, School of Medicine, Boston, MA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Susan Cheng
- Institute for Research on Healthy Aging and Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
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Lassen MCH, Jensen MT, Biering-Sørensen T, Møgelvang R, Fritz-Hansen T, Vilsbøll T, Rossing P, Jørgensen PG. Prognostic value of ratio of transmitral early filling velocity to early diastolic strain rate in patients with Type 2 diabetes. Eur Heart J Cardiovasc Imaging 2020; 20:1171-1178. [PMID: 31329838 DOI: 10.1093/ehjci/jez075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/28/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS The ratio of early mitral inflow velocity to global diastolic strain rate (E/e'sr) has recently emerged as a novel measure of left ventricular filling pressure. E/e'sr has in previous studies demonstrated to have good prognostic value in various patient populations. The aim of this study is to investigate the prognostic value of E/e'sr in a large cohort of patients with Type 2 diabetes in relation to cardiovascular morbidity and mortality. METHODS AND RESULTS In this prospective study, 848 Type 2 diabetic patients (mean age 63.6 ± 10.3 years, 64.7% male) underwent comprehensive echocardiographic examination including 2D speckle tracking in which E/e'sr along with novel and conventional echocardiographic variables were obtained. During follow-up (median: 4.8 years, interquartile range: 4.0-5.3), 122 (14.1%) met the composite outcome of cardiovascular disease, hospitalization, and mortality. Both E/e'sr and E/e' were significantly associated with the outcome [E/e'sr: hazard ratio (HR) 1.07, 95% confidence interval (CI): 1.05-1.10; P < 0.001, per 0.10 m increase] and (E/e': HR 1.07, 95% CI: 1.05-1.10; P = 0.001, per 1 unit increase). E/e'sr remained an independent predictor after multivariable adjustment for demographical, clinical, and echocardiographic parameters (HR 1.06, 95% CI: 1.01-1.12; P = 0.032, per 10 cm increase). The same was true for E/e' (HR 1.09, 95% CI: 1.04-1.14; P < 0.001, per 1 unit increase). Additionally, E/e'sr provided incremental prognostic information beyond the UK 'Prospective Diabetes Study risk engine' 0.72 (0.68-0.77) vs. 0.74 (0.70-79), P = 0.040. CONCLUSION In patients with Type 2 diabetes, E/e'sr provides independent and incremental prognostic information regarding cardiovascular morbidity and mortality.
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Affiliation(s)
- Mats Christian Højbjerg Lassen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
| | - Tina Vilsbøll
- Steno Diabetes Center, Copenhagen, Niels Steensens vej 2, Gentofte, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, København N, Denmark
| | - Peter Rossing
- Steno Diabetes Center, Copenhagen, Niels Steensens vej 2, Gentofte, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, København N, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK Hellerup, Denmark
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56
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Khan N, Ahmad I, Noohu MM. Association of disease duration and sensorimotor function in type 2 diabetes mellitus: beyond diabetic peripheral neuropathy. Somatosens Mot Res 2020; 37:326-333. [PMID: 33028136 DOI: 10.1080/08990220.2020.1830757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of the study is to assess association of the duration of diabetes and vibration, proprioception, muscle strength, reaction time and balance measures in people with type 2 diabetes mellitus (DM) without peripheral neuropathy. METHODS Forty-seven type 2 diabetics without peripheral neuropathy and 23 healthy controls were recruited for the study. Patients with type 2 DM were further classified into 23 patients who suffered from diabetes for less than 5 years (<5yrDM) and 24 patients who had diabetes for 5 years and above (≥5yrDM). All participants were assessed for Michigan neuropathy screening instrument (MNSI), vibration perception threshold (VPT), proprioception, muscles strength, centre of pressure (COP) range, COP sway and reaction time. RESULTS ≥5yrDM patients were found to significantly differ from healthy control in MNSI score (p ≤ 0.013), VPT score (p ≤ 0.002), reaction time (p ≤ 0.018), COP range (p ≤ 0.005) and COP sway (p ≤ 0.027). A significant difference was found only in reaction time (p < 0.002) except in the back direction (p = 0.089), and COP range (p ≤ 0.016) except in the front (p = 0.101) and right direction (p = 0.085) between <5yrDM patients and healthy controls. CONCLUSIONS ≥5yrDM patients exhibit a subtle deterioration in VPT, reaction time, and balance measure while <5yr DM patients were impaired only in COP range and reaction time when compared with healthy control.
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Affiliation(s)
- Neha Khan
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
| | - Irshad Ahmad
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India.,Department of Physiotherapy, Manav Rachna International Institute of Research and Studies, Faridabad, India
| | - Majumi M Noohu
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia Central University, New Delhi, India
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57
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Bajaj HS, Raz I, Mosenzon O, Murphy SA, Rozenberg A, Yanuv I, Bhatt DL, Leiter LA, McGuire DK, Wilding JPH, Gause-Nilsson IAM, Sabatine MS, Wiviott SD, Cahn A. Cardiovascular and renal benefits of dapagliflozin in patients with short and long-standing type 2 diabetes: Analysis from the DECLARE-TIMI 58 trial. Diabetes Obes Metab 2020; 22:1122-1131. [PMID: 32090404 DOI: 10.1111/dom.14011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 01/07/2023]
Abstract
AIM To investigate whether the cardiovascular and renal benefits observed with dapagliflozin in the DECLARE-TIMI 58 trial are also observed in patients with short and long-standing diabetes. MATERIALS AND METHODS This post hoc analysis studied the dual primary efficacy endpoints, a composite of cardiovascular death or hospitalization for heart failure (CVD/HHF) and major adverse cardiovascular events (MACE; CVD, myocardial infarction [MI], ischaemic stroke) by diabetes duration. RESULTS Of the 17 160 patients, 3836 had diabetes duration of ≤5 years, 4731 >5-10 years, 3952 >10-15 years, 2433 >15-20 years and 2206 >20 years. Dapagliflozin reduced the risk of CVD/HHF by a similar amount across diabetes duration subgroups, ranging from HR 0.79 (0.58-1.06) in patients with diabetes duration of ≤5 years to 0.75 (0.55-1.03) in those patients with diabetes duration of >20 years (interaction trend P-value 0.76). Hazard ratios (HRs) for MACE ranged from 1.08 (0.87-1.35) in patients with diabetes duration of ≤5 years to 0.67 (0.52-0.86) in those patients with diabetes duration of >20 years (interaction trend P-value 0.004). This was driven by greater reductions in the risk of MI and ischaemic stroke with dapagliflozin in patients with long-standing diabetes (interaction trend P-values 0.019 and 0.015, respectively). The duration-based MACE heterogeneity was apparent in those with or without a history of prior MI and in those with multiple risk factors. The renal-specific outcome was reduced with dapagliflozin with HRs ranging from 0.79 (0.47-1.34) in patients with diabetes duration of ≤5 years to 0.42 (0.25-0.72) in those patients with diabetes duration of >20 years (interaction trend P-value 0.084). CONCLUSIONS Dapagliflozin reduced the risk of CVD/HHF consistently, regardless of diabetes duration, whereas the treatment effect for MACE differed by duration subgroups, with significant reductions with dapagliflozin in patients with long-standing diabetes.
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Affiliation(s)
- Harpreet S Bajaj
- LMC Diabetes and Endocrinology, Brampton, Ontario, Canada
- Leadership Sinai Center for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Itamar Raz
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sabina A Murphy
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aliza Rozenberg
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ilan Yanuv
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Deepak L Bhatt
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Darren K McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John P H Wilding
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | - Marc S Sabatine
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen D Wiviott
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Avivit Cahn
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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58
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Gyldenkerne C, Olesen KKW, Thrane PG, Madsen M, Thim T, Würtz M, Jensen LO, Raungaard B, Poulsen PL, Bøtker HE, Maeng M. Diabetes is not a risk factor for myocardial infarction in patients without coronary artery disease: A study from the Western Denmark Heart Registry. Diab Vasc Dis Res 2020; 17:1479164120941809. [PMID: 32722933 PMCID: PMC7510365 DOI: 10.1177/1479164120941809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Diabetes is considered a risk factor for myocardial infarction. However, we have previously found that diabetes was not a short-term risk factor for myocardial infarction in the absence of obstructive coronary artery disease. METHODS We conducted a cohort study of patients undergoing coronary angiography from 2003 to 2012 and followed them by cross-linking Danish health registries. Patients were stratified according to coronary artery disease and diabetes. Endpoints included myocardial infarction, cardiac death, all-cause death and coronary revascularization. RESULTS 86,202 patients were included in total (diabetes: n = 12,652). Median follow-up was 8.8 years. Using patients with neither coronary artery disease nor diabetes as reference (cumulative myocardial infarction incidence 2.6%), the risk of myocardial infarction was low and not substantially increased for patients with diabetes alone (3.2%; hazard ratio 1.202, 95% confidence interval 0.996-1.451), was increased for patients with coronary artery disease alone (9.3%; hazard ratio 2.75, 95% confidence interval 2.52-3.01) and was highest for patients with both coronary artery disease and diabetes (12.3%; hazard ratio 3.79, 95% confidence interval 3.43-4.20). Similar associations were observed for cardiac death and coronary revascularization. CONCLUSION Diabetes patients without coronary artery disease by coronary angiography have a low risk of myocardial infarction, not substantially increased compared to patients with neither coronary artery disease nor diabetes. In the presence of coronary artery disease, however, diabetes increases the risk of myocardial infarction.
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Affiliation(s)
| | - Kevin KW Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Pernille G Thrane
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Würtz
- Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Per L Poulsen
- Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Michael Maeng, Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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59
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Alfayez OM, Almohammed OA, Alkhezi OS, Almutairi AR, Al Yami MS. Indirect comparison of glucagon like peptide-1 receptor agonists regarding cardiovascular safety and mortality in patients with type 2 diabetes mellitus: network meta-analysis. Cardiovasc Diabetol 2020; 19:96. [PMID: 32571416 PMCID: PMC7310317 DOI: 10.1186/s12933-020-01070-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/16/2020] [Indexed: 12/25/2022] Open
Abstract
Background The cardiovascular outcome trials (CVOTs) have shown that glucagon like peptide-1 receptor agonists (GLP1RAs) have varying degrees of cardiovascular (CV) safety in patients with type 2 diabetes mellitus (T2DM.) The lack of any head-to-head comparative trials among GLP1RAs urged the need for an indirect comparison of these agents. Therefore, this study was conducted to indirectly compare the CV safety and mortality effects among different GLP1RAs in patients with T2DM using network meta-analysis (NMA). Methods Medline was searched to identify GLP1RA CVOTs to date. The outcomes of interest were CV death, myocardial infarction (IM), stroke, and death from any cause. An NMA with binomial likelihood logit link model was used for the binary outcomes. We conducted both fixed effects and random effects models for each outcome, and selected the best model based on the deviance information and the average posterior residual deviance. This NMA was reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA-NMA). Results A total of seven GLP1RA CVOTs were included having 56,004 patients. The NMA results showed that oral semaglutide was statistically better than exenatide (OR 0.47, 95% CI 0.21–0.99), dulaglutide (OR 0.46, 95% CI 0.20–0.97), albiglutide (OR 0.45, 95% CI 0.19–0.97), lixisenatide (OR 0.43, 95% CI 0.19–0.92) in reducing CV death events. No significant differences were detected between most of the treatments regarding reducing death from any cause, MI and stroke events. The ranking results showed that oral semaglutide had the highest probability to be ranked first (> 90%) in reducing CV death and death from any cause. Moreover, once weekly semaglutide had the highest probability to be ranked first in reducing MI and stroke events. Conclusion The GLP1RAs have shown significant benefits in terms of CV safety. The indirect comparison and ranking probability results have shown that one weekly semaglutide and oral semaglutide seems to be the preferred option in patients with T2DM and established or at high risk of CVD. This result can aid health care providers, pharmacy and therapeutics committees in hospitals, and insurance companies when deciding which GLP1RA to start or add to their formulary.
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Affiliation(s)
- Osamah M Alfayez
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Omar A Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
| | - Omar S Alkhezi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | - Majed S Al Yami
- Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Pineda ED, Liao IC, Godley PJ, Michel JB, Rascati KL. Cardiovascular Outcomes Among Patients with Type 2 Diabetes Newly Initiated on Sodium-Glucose Cotransporter-2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Other Antidiabetic Medications. J Manag Care Spec Pharm 2020; 26:610-618. [PMID: 32347181 PMCID: PMC10391160 DOI: 10.18553/jmcp.2020.26.5.610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the most prevalent cause of morbidity and mortality in patients with type 2 diabetes (T2D) and is a primary driver for health care costs associated with diabetes management. Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant reductions in cardiovascular endpoints in clinical trials compared with placebo. However, it is uncertain whether these findings can be applied to the broader T2D population because these trials specifically included high-risk patients with established CVD. OBJECTIVE To evaluate and compare cardiovascular outcomes among adults with T2D newly initiated on SGLT-2is, GLP-1 RAs, and other antidiabetic medications (oADMs) in a real-world setting. METHODS This retrospective new-user cohort study used administrative claims and electronic health record data from an integrated delivery network in Texas. Patients aged ≥18 years with T2D and ≥1 prescription claim for an SGLT-2i, a GLP-1 RA, or an oADM filled between April 2013 and December 2018 were included. Patients were divided into three 1:1 propensity-matched groups according to index medication identified. Primary outcomes were heart failure hospitalization and a composite end-point of myocardial infarction, stroke, unstable angina, or coronary revascularization. Cox proportional hazards regression was used to compare cumulative incidence of all outcome variables. RESULTS Among 9,477 patients, 1,134 were initiated on SGLT-2is, 1,072 on GLP-1 RAs, and 7,271 on oADMs. Patients initiating SGLT-2is versus oADMs had significantly lower risk of the composite endpoint (HR = 0.64, 95% CI = 0.46-0.90), heart failure hospitalization (HR = 0.56, 95% CI = 0.39-0.81), and unstable angina requiring hospitalization (HR = 0.56, 95% CI = 0.39-0.81). Patients initiating GLP-1 RAs compared with oADMs had significantly lower risk of the composite endpoint (HR = 0.71, 95% CI = 0.52-0.98) and unstable angina requiring hospitalization (HR = 0.60, 95% CI = 0.41-0.86). No differences in cardiovascular outcomes were found between SGLT-2is and GLP-1 RAs. CONCLUSIONS Both SGLT-2is and GLP-1 RAs showed significant reductions in the composite outcome and unstable angina requiring hospitalization versus oADMs. However, only SGLT-2is were associated with a lower risk for heart failure hospitalizations. Nevertheless, cardiovascular outcomes were similar between SGLT-2is and GLP-1 RAs. DISCLOSURES No outside funding supported this study. The authors have no conflicts of interest to report.
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Affiliation(s)
- Elmor D. Pineda
- Department of Pharmacy, Baylor Scott & White Health, Temple, Texas, and College of Pharmacy, University of Texas at Austin
| | - I-Chia Liao
- Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas
| | - Paul J. Godley
- Department of Pharmacy, Baylor Scott & White Health, Temple, Texas, and College of Pharmacy, University of Texas at Austin
| | - Jeffrey B. Michel
- Division of Cardiology, Baylor Scott and White Medical Center, Temple, Texas
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Abstract
Purpose of review Although type 2 diabetes (T2D) is one of the most important risk factors that leads to the development of de novo heart failure, there are limited data, particularly from a practical/qualitative standpoint, about predictors of heart failure in this population. Recent findings Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been shown to prevent the development of heart failure and the composite of heart failure and cardiovascular death in patients with T2D without known heart failure who have either established atherosclerotic vascular disease or multiple risk factors. The concept of primary prevention of heart failure has led many clinicians to inquire if there are specific risk/enrichment factors that may predict an increased risk of heart failure. Summary In this review, we identify some general and diabetes-specific risk factors that are associated with an increased risk of developing heart failure in people with T2D.
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The latency period between type 2 diabetes and development of Coronary Artery Disease based on psychological factors. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tang O, Matsushita K, Coresh J, Sharrett AR, McEvoy JW, Windham BG, Ballantyne CM, Selvin E. Mortality Implications of Prediabetes and Diabetes in Older Adults. Diabetes Care 2020; 43:382-388. [PMID: 31776141 PMCID: PMC6971785 DOI: 10.2337/dc19-1221] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/05/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes in older age is heterogeneous, and the treatment approach varies by patient characteristics. We characterized the short-term all-cause and cardiovascular mortality risk associated with hyperglycemia in older age. RESEARCH DESIGN AND METHODS We included 5,791 older adults in the Atherosclerosis Risk in Communities Study who attended visit 5 (2011-2013; ages 66-90 years). We compared prediabetes (HbA1c 5.7% to <6.5%), newly diagnosed diabetes (HbA1c ≥6.5%, prior diagnosis <1 year, or taking antihyperglycemic medications <1 year), short-duration diabetes (duration ≥1 year but <10 years [median]), and long-standing diabetes (duration ≥10 years). Outcomes were all-cause and cardiovascular mortality (median follow-up of 5.6 years). RESULTS Participants were 58% female, and 24% had prevalent cardiovascular disease. All-cause mortality rates, per 1,000 person-years, were 21.2 (95% CI 18.7, 24.1) among those without diabetes, 23.7 (95% CI 20.8, 27.1) for those with prediabetes, 33.8 (95% CI 25.2, 45.5) among those with recently diagnosed diabetes, 29.6 (95% CI 25.0, 35.1) for those with diabetes of short duration, and 48.6 (95% CI 42.4, 55.7) for those with long-standing diabetes. Cardiovascular mortality rates, per 1,000 person-years, were 5.8 (95% CI 4.6, 7.4) among those without diabetes, 6.6 (95% CI 5.2, 8.5) for those with prediabetes, 11.5 (95% CI 7.0, 19.1) among those with recently diagnosed diabetes, 8.2 (95% CI 5.9, 11.3) for those with diabetes of short duration, and 17.3 (95% CI 13.8, 21.7) for those with long-standing diabetes. After adjustment for other cardiovascular risk factors, prediabetes and newly diagnosed diabetes were not significantly associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.03 [95% CI 0.85, 1.23] and HR 1.31 [95% CI 0.94, 1.82], respectively) or cardiovascular mortality (HR 1.00 [95% CI 0.70, 1.43] and HR 1.35 [95% CI 0.74, 2.49], respectively). Excess mortality risk was primarily concentrated among those with long-standing diabetes (all-cause: HR 1.71 [95% CI 1.40, 2.10]; cardiovascular: HR 1.72 [95% CI 1.18, 2.51]). CONCLUSIONS In older adults, long-standing diabetes has a substantial and independent effect on short-term mortality. Older individuals with prediabetes remained at low mortality risk over a median 5.6 years of follow-up.
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Affiliation(s)
- Olive Tang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John W McEvoy
- Division of Cardiology and National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - B Gwen Windham
- Department of Geriatric Medicine, University of Mississippi School of Medicine, Jackson, MI
| | | | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Shi Z, Ji L, Ma RCW, Zimmet P. Early life exposure to 1959-1961 Chinese famine exacerbates association between diabetes and cardiovascular disease. J Diabetes 2020; 12:134-141. [PMID: 31390138 DOI: 10.1111/1753-0407.12975] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We aimed to assess whether early life exposure to the Chinese famine (1959-1961) modifies the association between type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in adulthood. METHODS Data from 4247 adults born between 1954 and 1964 from the 2011 and 2015 China Health and Retirement Longitudinal Study (CHARLS) were analyzed. CVD in 2011 and 2015 was based on self-reported doctor's diagnosis of cardiac events (heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems) and stroke. Diabetes in 2011 was defined by fasting blood glucose, HbA1C, or known diabetes. RESULTS Diabetes in 2011 was cross-sectionally associated with an increase of CVD risk in 2011 (OR 1.91, 95%CI 1.53-2.40, P < 0.001) after adjusting for age and gender. Famine exposure changed the association between diabetes and CVD in areas severely affected by famine. The odds ratios (OR) of diabetes in 2011 for CVD in 2015 were 1.24 (95%CI 0.73-2.10), 1.27 (95%CI 0.72-2.24), 2.25 (95%CI 1.29-3.91), 4.31 (95%CI 2.07-8.97) and 1.72 (95%CI 0.84-3.51) among adults in late childhood-, mid-childhood-, early childhood-, fetal-, and nonexposed cohorts in severe famine areas, respectively. CONCLUSION T2DM is associated with the risk of CVD among Chinese adults. Fetal and early childhood exposure to the Chinese famine exacerbated the associated risk.
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Affiliation(s)
- Zumin Shi
- Human Nutrition Department, College of Health Science, QU Health, Qatar University, Doha, Qatar
| | - Linong Ji
- Peking University Diabetes Center, Director of Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Ronald C W Ma
- Division of Endocrinology & Diabetes, Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
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Kung FP, Tsai CF, Lu CL, Huang LC, Lu CH. Diabetes pay-for-performance program can reduce all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Medicine (Baltimore) 2020; 99:e19139. [PMID: 32049836 PMCID: PMC7035087 DOI: 10.1097/md.0000000000019139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This study aimed to examine the effect of a diabetes pay-for-performance (P4P) program on all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Using a Taiwanese representative nationwide cohort, we recruited 5478 patients with newly diagnosed type 2 diabetes enrolled in the P4P program within 5 years after a diagnosis of diabetes between January 1, 2002 and December 31, 2010 and individuals not enrolled in the P4P program were recruited as the control group matched 1:1 with the study group. We used multivariate Cox proportional hazard models analysis to investigate the effect of the P4P program and adherence on all-cause mortality. A total of 250 patients died in the P4P group compared to 395 in the control group (mortality rate 104 vs 169 per 10,000 person-years, respectively, P < .0001). The control group also had more comorbidities. Patients enrolled in the P4P program demonstrated significant long-term survival benefits, of which the adjusted hazard ratio (aHR) for all-cause mortality was 0.58 [95% CI (0.48-0.69)]. In the study group, better adherence to the P4P program resulted in a greater reduction in mortality, with aHRs [95% CI] of 0.48 [0.38-0.62] and 0.36 [0.26-0.49] in subjects with a minimum 1-year and 2-year good P4P adherence, respectively. Participating in the P4P program within 5 years after the diagnosis of diabetes resulted in a significant reduction in all-cause mortality, and this effect was particularly pronounced in the patients with better adherence to the P4P program.
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Affiliation(s)
- Fang-Ping Kung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chin-Li Lu
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung-Hsing University, Taichung
| | - Li-Chung Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Division of Psychiatry, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chieh-Hsiang Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Kaohsiung Christian Hospital, Kaohsiung City, Taiwan
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van Mark G, Tittel SR, Sziegoleit S, Putz FJ, Durmaz M, Bortscheller M, Buschmann I, Seufert J, Holl RW, Bramlage P. Type 2 diabetes in older patients: an analysis of the DPV and DIVE databases. Ther Adv Endocrinol Metab 2020; 11:2042018820958296. [PMID: 33014328 PMCID: PMC7509713 DOI: 10.1177/2042018820958296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical profile differs between old and young patients with type 2 diabetes mellitus (T2DM). We explored, based on a large real-world database, patient and disease characteristics and actual treatment patterns by age. METHODS The analysis was based on the DIVE and DPV registries of patients with T2DM. Patients were analyzed by age groups 50-59 (middle-young), 60-69 (young-old), 70-79 (middle-old), 80-89 (old), and 90 years or more (oldest-old). RESULTS A total of 396,719 patients were analyzed, of which 17.7% were 50-59 years, 27.7% 60-69 years, 34.3% 70-79 years, 18.3% 80-89 years and 2.0% at least 90 years. We found that (a) T2DM in old and oldest-old patients was characterized much less by the presence of metabolic risk factors such as hypertension, obesity, dyslipidemia and smoking than in younger patients; (b) the HbA1c was much lower in oldest-old than in middle-young patients (7.2 ± 1.6% versus 8.0 ± 2.2%; p < 0.001), but it was associated with higher proportions of patients with severe hypoglycemia (7.0 versus 1.6%; p < 0.001); (c) this was potentially associated with the higher and increasing rates of insulin use in older patients (from 17.6% to 37.6%, p < 0.001) and the particular comorbidity profile of these patients, for example, chronic kidney disease (CKD); (d) patients with late diabetes onset had lower HbA1c values, lower bodyweight and less cardiovascular risk factors; (e) patients with a longer diabetes duration had a considerable increase in macrovascular and even more microvascular complications. CONCLUSION In very old patients there is a need for frequent careful routine assessment and a tailored pharmacotherapy in which patient safety is much more important than blood-glucose-lowering efficacy.
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Affiliation(s)
- Gesine van Mark
- Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany
| | - Sascha R. Tittel
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT; Universität Ulm, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung e.V., München-Neuherberg, Germany
| | | | | | - Mesut Durmaz
- Praxis für Innere Medizin, Endokrinologie & Diabetologie, Hof, Germany
| | | | - Ivo Buschmann
- Department of Angiology, Medical School Brandenburg (MHB) & Deutsches Angiologie Zentrum Brandenburg Berlin (DAZB), Brandenburg, Germany
| | - Jochen Seufert
- Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Germany
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Sheng Z, Zhou P, Liu C, Li J, Chen R, Zhou J, Song L, Zhao H, Yan H. Relationships of coronary culprit-plaque characteristics with duration of diabetes mellitus in acute myocardial infarction: an intravascular optical coherence tomography study. Cardiovasc Diabetol 2019; 18:136. [PMID: 31629406 PMCID: PMC6800495 DOI: 10.1186/s12933-019-0944-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/11/2019] [Indexed: 12/14/2022] Open
Abstract
Background Diabetes mellitus (DM) or pre-diabetes status is closely associated with features of vulnerable coronary lesions in patients with stable coronary heart disease or acute coronary syndrome. However, the association between duration of diabetes and the morphologies and features of vulnerable plaques has not been fully investigated in patients with acute myocardial infarction (AMI). Methods We enrolled a total of 279 patients who presented with AMI between March 2017 and March 2019 and underwent pre-intervention optical coherence tomography imaging of culprit lesions. Patients with DM were divided into two subgroups: a Short-DM group with DM duration of < 10 years and a Long-DM group with DM duration of ≥ 10 years. Baseline clinical data and culprit-plaque characteristics were compared between patients without DM (the non-DM group), those in the Short-DM group, and those in the Long-DM group. Results Patients with DM represented 34.1% of the study population (95 patients). The Short- and Long-DM groups included 64 (67.4%) and 31 patients (32.6%), respectively. Glycated hemoglobin A1c (HbA1c) levels were significantly higher in the Long-DM group than the Non- or Short-DM groups (8.4% [Long-DM] versus 5.7% [Non-DM] and 7.6% [Short-DM], P < 0.001). In addition, the highest prevalence of lipid-rich plaques, thin-cap fibroatheroma (TCFA), and plaque ruptures of culprit lesions were observed in the Long-DM group (lipid-rich plaques: 80.6% [Long-DM] versus 52.2% [Non-DM] and 62.5% [Short-DM], P = 0.007; TCFA: 41.9% [Long-DM] versus 19.6% [Non-DM] and 31.3% [Short-DM], P = 0.012; plaque rupture: 74.2% [Long-DM] versus 46.7% [Non-DM] and 48.4% [Short-DM], P = 0.017). The frequency of calcification was significantly higher among patients with DM than among those without (62.1% versus 46.2%, P = 0.016); however, no significant differences were found between the DM subgroups (61.3% [Long-DM] versus 62.5% [Short-DM], P = 0.999). Conclusions Increased duration of DM combined with higher HbA1c levels influences culprit-plaque characteristics in patients with DM who suffer AMI. These findings might account for the higher risks of cardiac death in DM patients with long disease duration. Trial registration This study is registered at clinicaltrials.gov as NCT03593928
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Affiliation(s)
- Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China.
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Rohan VS, McGillicuddy JW, Taber DJ, Nadig SN, Baliga PK, Bratton CF. Long‐standing diabetes mellitus and pancreas transplantation: An avenue to increase utilization of an ideal treatment modality. Clin Transplant 2019; 33:e13695. [DOI: 10.1111/ctr.13695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/03/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Vinayak S. Rohan
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - John W. McGillicuddy
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - David J. Taber
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Satish N. Nadig
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Prabhakar K. Baliga
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
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Ahmed AM. Correlation of Paraoxonase-1 with glycated hemoglobin and lipid profile among Sudanese diabetic patients. Pak J Med Sci 2019; 35:1050-1054. [PMID: 31372141 PMCID: PMC6659064 DOI: 10.12669/pjms.35.4.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To examine concentration of Paraoxonase 1 enzymes across both Sudanese patients suffering from Type-I and Type-II diabetes. Methods: This was a cross-sectional study done in Khartoum/Sudan during the period from June 24th 2018 to August 23, 2018. One hundred seven diabetic patients (40 T1DM and 67 T2DM) compared with 45 healthy people from both genders. Biochemical parameters include PON1, FBG, HbA1C, and lipids were done and compared between study groups. Results: PON1 was reduced in patients than controls (P < 0.01), in addition PON1 was lower in T1DM than T2DM (P < 0.01), moreover, FBG, HbA1c and lipids was higher in diabetes than controls (P < 0.05). PON1 inversely correlated with LDL and apo B in T1DM (P < 0.01) and T2DM (P < 0.05), in addition PON1 correlated with HDL and apo A1 in T1DM (P < 0.01), inversely correlated with LDL in T2DM (P < 0.05) and with apo A1 in T2DM (P < 0.01). Moreover, PON1 inversely correlated with diabetes duration in T1DM (P < 0.01) and T2DM (P < 0.05). Conclusion: Sudanese T1DM and T2DM have a lower PON1 concentration than healthy subjects, T1DM have lower level of PON1 than T2DM. PON1 was inversely correlated with bad lipids and duration of diabetes, but it has positive correlation with good lipids.
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Affiliation(s)
- Ahmed M Ahmed
- Dr. Ahmed Mohammed Ahmed, Assistant Professor, Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Taibah University, Al Madinah, Kingdom of Saudi Arabia
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Rozanski A, Berman D. Optimizing the Assessment of Patient Clinical Risk at the Time of Cardiac Stress Testing. JACC Cardiovasc Imaging 2019; 13:616-623. [PMID: 31326497 DOI: 10.1016/j.jcmg.2019.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 12/21/2022]
Abstract
Due to a marked temporal decline in inducible myocardial ischemia over recent decades, most diagnostic patients now referred for cardiac stress testing have nonischemic studies. Among nonischemic patients, however, long-term risk is heterogeneous and highly influenced by a variety of clinical parameters. Herein, we review 8 factors that can govern long-term clinical risk: coronary risk factor burden; patient symptoms; exercise capacity and exercise test responses; the need for pharmacologic stress testing; autonomic function; musculoskeletal status; subclinical atherosclerosis; and psychosocial risk. To capture the clinical benefit provided by both assessing myocardial ischemia and these additional parameters, the authors propose that a cardiac stress tests report have an additional component beyond statements as to the likelihood of obstructive coronary artery disease and/or magnitude of ischemia. This added component could be a comment section designed to make referring physicians aware of aspects of long-term risk that may influence clinical management and potentially lead to changes in the intensity of risk factor management, frequency of follow-up, need for further testing, or other management decisions. In this manner, the increasingly frequent normal stress test result might more commonly influence treatment recommendations and even patient behavior, thus leading to improvement in patient outcomes even in the setting of normal stress test results.
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Affiliation(s)
- Alan Rozanski
- Department of Cardiology, Mount Sinai St. Luke's and Mount Sinai Heart, New York, New York.
| | - Daniel Berman
- Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Gyldenkerne C, Olesen KKW, Madsen M, Thim T, Jensen LO, Raungaard B, Sørensen HT, Bøtker HE, Maeng M. Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease. Diab Vasc Dis Res 2019; 16:351-359. [PMID: 30939916 DOI: 10.1177/1479164119836227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. METHODS A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. RESULTS In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27-1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27-2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61-8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40-12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51-17.82). CONCLUSION The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.
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Affiliation(s)
| | - Kevin Kris Warnakula Olesen
- 1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- 2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Madsen
- 2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Thim
- 1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bent Raungaard
- 4 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Toft Sørensen
- 2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- 1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- 1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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72
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Verma S, Bain SC, Monk Fries T, Mazer CD, Nauck MA, Pratley RE, Rasmussen S, Saevereid HA, Zinman B, Buse JB. Duration of diabetes and cardiorenal efficacy of liraglutide and semaglutide: A post hoc analysis of the LEADER and SUSTAIN 6 clinical trials. Diabetes Obes Metab 2019; 21:1745-1751. [PMID: 30851070 PMCID: PMC6619033 DOI: 10.1111/dom.13698] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 01/16/2023]
Abstract
Cardiovascular risk reduction with liraglutide and semaglutide in patients with type 2 diabetes was demonstrated in the LEADER (ClinicalTrials.gov: NCT01179048) and SUSTAIN 6 (ClinicalTrials.gov: NCT01720446) cardiovascular outcome trials. This post hoc analysis assessed the impact of diabetes duration (<5, 5 to <15, 15 to <25 and ≥25 years at baseline) on cardiorenal efficacy of these human glucagon-like peptide-1 analogues using a Cox proportional hazards model. Proportions of patients in the LEADER trial across diabetes duration strata were 15% (<5 years, n = 1377), 50% (5 to <15 years, n = 4692), 27% (15 to <25 years, n = 2504) and 8% (≥25 years, n = 748); corresponding proportions in the SUSTAIN-6 trial were 13% (<5 years, n = 422), 48% (5 to <15 years, n = 1582), 30% (15 to <25 years, n = 977) and 10% (≥25 years, n = 316). Overall, longer diabetes duration was associated with higher age; higher prevalence of females; history of ischaemic stroke, peripheral arterial disease and insulin use; and inferior renal function. There was an increased frequency of major adverse cardiovascular events (MACE), expanded MACE and nephropathy events with increasing diabetes duration. Liraglutide and semaglutide consistently reduced the risk of cardiorenal outcomes across categories of diabetes duration (P-interaction was not significant for all endpoints analysed).
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Affiliation(s)
- Subodh Verma
- Department of Anesthesia, Division of Cardiac Surgery, St. Michael's Hospital and University of TorontoTorontoOntarioCanada
| | - Stephen C. Bain
- Institute of Life Science, Swansea University Medical SchoolSwanseaUK
| | | | - C. David Mazer
- Department of Anesthesia, Division of Cardiac Surgery, St. Michael's Hospital and University of TorontoTorontoOntarioCanada
| | - Michael A. Nauck
- Diabetes Center Bochum‐Hattingen, St Josef Hospital (Ruhr‐Universität Bochum)BochumGermany
| | - Richard E. Pratley
- Florida Hospital Translational Research Institute for Metabolism and DiabetesOrlandoFlorida
| | | | | | - Bernard Zinman
- Lunenfeld–Tanenbaum Research Institute, Mt. Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - John B. Buse
- Department of MedicineUniversity of North Carolina School of MedicineChapel HillNorth Carolina
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73
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Haifa Elhadi A, Faiza H. Reasons for admission of individual with diabetes to the Tripoli Medical Center in 2015. Diabetes Metab Syndr 2019; 13:2571-2578. [PMID: 31405678 DOI: 10.1016/j.dsx.2019.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Diabetes mellitus is a complex, chronic, metabolic disease manifested in hyperglycemia and associated with various complications, Consequently, people with diabetes have higher rates of hospital admissions than the general population. There is little information about the burden of hospitalizations of diabetic patients in Libya. AIM The aim was to identify the causes of admission of individual with diabetes and to identify the risk factors for hospitalization. PATIENTS AND METHODS This is a retrospective case-series study conducted in Tripoli Medical Center, Tripoli. It covers 1037 individual with diabetes admitted between 1 January 2015 and 31 December 2015. All the data were collected from the patient files. RESULTS The mean age of the patients was 60.7 years ±15.1 standard deviation. The male-to-female ratio was 1:1. Type 2 diabetes accounted for 90.2% of the patients, 56.5% of whom had diabetes for >10 years, 40.5% had no prior chronic illness, 26.7% had hypertension, and 26.4% had multiple co-morbidities. The mean hospital stay was 6.1 days, and 60.8% of the patients were on insulin therapy. The main causes of admission were infection (23%), mainly in the chest, followed by lower extremity disease (22.4%), cardiovascular disease (19.3%), cerebrovascular disease (14.4%) and renal disease (11.8%). CONCLUSIONS The main causes of hospitalization as shown by this study were infections, and chronic complications of diabetes in the lower extremities and cardiovascular system. Most of the patients were >60 years old, had diabetes type 2 for >10 years, were on insulin treatment, and had no other comorbidity.
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Affiliation(s)
| | - Hander Faiza
- Consultant Endocrinologist, Tripoli Medical Center, Tripoli, Libya
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74
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Miller M. Increased CVD Risk in Young Adults With Elevated Non–HDL-C. J Am Coll Cardiol 2019; 74:80-82. [DOI: 10.1016/j.jacc.2019.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
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75
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Wang C, Li Q, Song X, Dong X. Bayesian adaptive lasso for additive hazard regression with current status data. Stat Med 2019; 38:3703-3718. [PMID: 31197854 DOI: 10.1002/sim.8137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/27/2018] [Accepted: 02/01/2019] [Indexed: 12/18/2022]
Abstract
Variable selection is a crucial issue in model building and it has received considerable attention in the literature of survival analysis. However, available approaches in this direction have mainly focused on time-to-event data with right censoring. Moreover, a majority of existing variable selection procedures for survival models are developed in a frequentist framework. In this article, we consider additive hazards model in the presence of current status data. We propose a Bayesian adaptive least absolute shrinkage and selection operator procedure to conduct a simultaneous variable selection and parameter estimation. Efficient Markov chain Monte Carlo methods are developed to implement posterior sampling and inference. The empirical performance of the proposed method is demonstrated by simulation studies. An application to a study on the risk factors of heart failure disease for type 2 diabetes patients is presented.
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Affiliation(s)
- Chunjie Wang
- School of Mathematics and Statistics, Changchun University of Technology, Changchun, China
| | - Qun Li
- School of Mathematics and Statistics, Changchun University of Technology, Changchun, China
| | - Xinyuan Song
- Department of Statistics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiaogang Dong
- School of Mathematics and Statistics, Changchun University of Technology, Changchun, China
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76
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Gyldenkerne C, Olesen KKW, Madsen M, Thim T, Jensen LO, Raungaard B, Sørensen HT, Bøtker HE, Maeng M. Extent of coronary artery disease is associated with myocardial infarction and mortality in patients with diabetes mellitus. Clin Epidemiol 2019; 11:419-428. [PMID: 31191034 PMCID: PMC6536131 DOI: 10.2147/clep.s200173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/06/2019] [Indexed: 01/24/2023] Open
Abstract
Purpose: We examined risk of myocardial infarction and all-cause death associated with the extent of coronary artery disease ascertained by coronary angiography in patients with diabetes mellitus. We hypothesized that risks of myocardial infarction and death were associated with extent of coronary artery disease in diabetes patients. Patients and methods: We conducted a cohort study of patients with type 1 and type 2 diabetes, who underwent coronary angiography from 2004 to 2012. Patients were stratified according to extent of coronary artery disease: 0-, 1-, 2- or 3-vessel disease or diffuse vessel disease. Endpoints were myocardial infarction, all-cause death, and major adverse cardiovascular events (MACE), defined as the composite of myocardial infarction, cardiac death, or ischemic stroke. Adjusted incidence and mortality rate ratios (IRRsadj) were calculated using patients with 0-vessel disease as the reference group. Median follow-up was 3 years for a total of 45,164 person-years. Results: The study included 12,594 diabetes patients. Of these, 3,147 (25.0%) had 0-vessel disease, 1,195 (9.5%) had diffuse vessel disease, 3,001 (23.8%) had 1-vessel disease, 2,220 (17.6%) had 2-vessel disease, and 3,031 (24.1%) had 3-vessel disease. The myocardial infarction rate was 0.4 per 100 person-years (95% CI: 0.3–0.5) in patients with 0-vessel disease. Using patients with 0-vessel disease as reference, the risk of myocardial infarction increased according to the number of diseased vessels (diffuse vessel disease: 1.4 per 100 person-years, IRRadj 3.87, 95% CI: 2.41–6.23; 1-vessel disease: 1.9 per 100 person-years, IRRadj 4.99, 95% CI: 3.33–7.46; 2-vessel disease: 2.7 per 100 person-years, IRRadj 7.14, 95% CI: 4.78–10.65; and 3-vessel disease: 4.3 per 100 person-years, IRRadj 11.42, 95% CI: 7.76–16.82; ptrend<0.001). Similar associations were observed for all-cause death and MACE. Conclusion: The extent of coronary artery disease is a major risk factor for myocardial infarction and death in patients with diabetes mellitus.
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Affiliation(s)
| | - Kevin Kris Warnakula Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Noh M, Kwon H, Jung CH, Lee SW, Lee JY, Kim MJ, Han Y, Kwon TW, Cho YP. Impact of diabetes duration on heart failure in Korean patients without clinical cardiovascular disease. Medicine (Baltimore) 2019; 98:e14742. [PMID: 30817631 PMCID: PMC6831166 DOI: 10.1097/md.0000000000014742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 11/25/2022] Open
Abstract
We aimed to investigate the association between diabetes duration and the subsequent occurrence of heart failure (HF) in type 2 diabetes mellitus (T2DM) patients without clinical cardiovascular disease.In this single-center, observational cohort study, a total of 3724 T2DM patients were stratified by diabetes duration into three 5-year interval subgroups. The primary outcomes were the occurrence of new-onset HF and all-cause mortality.HF incidence (P < .001) and mortality (P = .001) were significantly higher in patients with a longer duration of diabetes (≥10 years) than in those with a shorter duration (<5 years). On multivariate analysis, diabetes duration ≥10 years was not independently associated with all-cause mortality compared with duration < 5 years, but there was a nonsignificant increased risk of HF in patients with a diabetes duration ≥10 years (P = .056). Poor glycemic control was associated with an increased risk of HF and mortality; statin use was associated with a significantly decreased risk of mortality.Our study indicated that a longer duration of diabetes is associated with an increased risk of new-onset HF occurrence and all-cause mortality in T2DM patients without clinical cardiovascular disease.
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Affiliation(s)
- Minsu Noh
- Division of Vascular Surgery, Department of Surgery
| | | | | | | | - Jong-Young Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery
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78
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Maciejewski ML, Hammill BG. Measuring the burden of multimorbidity among Medicare beneficiaries via condition counts and cumulative duration. Health Serv Res 2019. [PMID: 30790281 DOI: 10.1111/1475‐6773.13124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The study's purpose was to describe the cumulative duration of 19 chronic conditions among Medicare fee-for-service (FFS) beneficiaries and examine variation in total expenditures explained by cumulative duration and condition counts. DESIGN, SETTING, STUDY DESIGN, AND DATA EXTRACTION In a retrospective cohort of FFS beneficiaries age ≥68, 2015 Medicare enrollment and claims data (N = 20 124 230) were used to identify the presence or absence of 19 diagnosed chronic conditions, and to construct MCC categories (0-1, 2-3, 4-5, 6+) and cumulative duration of each of 19 conditions from the date of first possible occurrence in claims (1/1/1999) to the end of follow-up (date of death or 12/31/2015). Total Medicare expenditures were estimated using linear models adjusted for demographic characteristics. PRINCIPAL FINDINGS Multimorbidity was common (71.7 percent with 2+ conditions). The mean cumulative duration of all 19 conditions was 23.6 person-years, which varied greatly by age and number of conditions. Condition counts were more predictive of Medicare expenditures than cumulative duration (R-squared for continuous measures = 0.461 vs 0.272; R-squared for quartiles = 0.408 vs 0.266). CONCLUSIONS The cumulative duration of chronic conditions varied widely for Medicare beneficiaries, especially for those with 6+ conditions, but was less predictive of total expenditures than condition counts.
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Affiliation(s)
- Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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79
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Maciejewski ML, Hammill BG. Measuring the burden of multimorbidity among Medicare beneficiaries via condition counts and cumulative duration. Health Serv Res 2019; 54:484-491. [PMID: 30790281 DOI: 10.1111/1475-6773.13124] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The study's purpose was to describe the cumulative duration of 19 chronic conditions among Medicare fee-for-service (FFS) beneficiaries and examine variation in total expenditures explained by cumulative duration and condition counts. DESIGN, SETTING, STUDY DESIGN, AND DATA EXTRACTION In a retrospective cohort of FFS beneficiaries age ≥68, 2015 Medicare enrollment and claims data (N = 20 124 230) were used to identify the presence or absence of 19 diagnosed chronic conditions, and to construct MCC categories (0-1, 2-3, 4-5, 6+) and cumulative duration of each of 19 conditions from the date of first possible occurrence in claims (1/1/1999) to the end of follow-up (date of death or 12/31/2015). Total Medicare expenditures were estimated using linear models adjusted for demographic characteristics. PRINCIPAL FINDINGS Multimorbidity was common (71.7 percent with 2+ conditions). The mean cumulative duration of all 19 conditions was 23.6 person-years, which varied greatly by age and number of conditions. Condition counts were more predictive of Medicare expenditures than cumulative duration (R-squared for continuous measures = 0.461 vs 0.272; R-squared for quartiles = 0.408 vs 0.266). CONCLUSIONS The cumulative duration of chronic conditions varied widely for Medicare beneficiaries, especially for those with 6+ conditions, but was less predictive of total expenditures than condition counts.
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Affiliation(s)
- Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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80
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Hyperglycemia potentiates the effect of ionic calcium in photoreceptor ellipsoid zone disruption in diabetic retinopathy. Int Ophthalmol 2019; 39:2237-2243. [PMID: 30628026 DOI: 10.1007/s10792-018-01063-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/21/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To study the association of serum ionic calcium and glycated hemoglobin (HbA1c) with retinal photoreceptor ellipsoid zone (EZ) disruption in diabetic retinopathy (DR). METHODS This is a tertiary care center-based observational cross-sectional study. Sixty-three consecutive cases, divided into 21 cases each with no diabetic retinopathy, non-proliferative diabetic retinopathy and proliferative diabetic retinopathy were included. Twenty-one healthy controls were also included. Ellipsoid zone disruption was assessed using spectral-domain optical coherence tomography. Serum ionic calcium and HbA1c were measured using standard protocol. Patient data from cases were divided into two groups according to their HbA1c levels: group 1 (HbA1c < 7, n = 26) and group 2 (HbA1c > 7, n = 37). Data were analyzed statistically. RESULTS Mean ionic calcium levels in group 1 and group 2 were 1.131 ± 0.073 mmol/dL and 1.170 ± 0.070 mmol/dL, respectively. In group 1, 11 out of 26 had EZ disruption (42.3%). Similarly, in group 2, 29 out of 37 had EZ disruption (78.4%). On logistic regression analysis, as compared to group 1, ellipsoid zone disruption was found to be positively associated with serum ionic calcium (p = 0.01) in group 2 cases. CONCLUSION Increased levels of serum ionic calcium are associated with increased EZ disruption in patients with HbA1c > 7 in DR.
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81
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Muilwijk M, Ho F, Waddell H, Sillars A, Welsh P, Iliodromiti S, Brown R, Ferguson L, Stronks K, van Valkengoed I, Pell JP, Gray SR, Gill JMR, Sattar N, Celis-Morales C. Contribution of type 2 diabetes to all-cause mortality, cardiovascular disease incidence and cancer incidence in white Europeans and South Asians: findings from the UK Biobank population-based cohort study. BMJ Open Diabetes Res Care 2019; 7:e000765. [PMID: 31908795 PMCID: PMC6936483 DOI: 10.1136/bmjdrc-2019-000765] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate whether the health implications of having type 2 diabetes (T2D) were different in South Asian compared with white European participants. RESEARCH DESIGN AND METHODS Prospective data from UK Biobank were used, and 457 935 participants of white European and 7102 of South Asian background were included. Cox proportional regression was performed to investigate the association between T2D and health outcome by ethnicity. RESULTS Over a mean of 7.0 years (IQR 6.3-7.6) of follow-up, 12 974 participants had died, and 30 347 and 27 159 developed cardiovascular disease (CVD) and cancer, respectively. South Asians had a higher risk for CVD mortality (HR: 1.42, 95% CI 1.07 to 1.89) and incidence (HR: 1.78, 95% CI 1.63 to 1.94), but a decreased risk for cancer mortality (HR: 0.59, 95% CI 0.41 to 0.85) and incidence (HR: 0.80, 95% CI 0.70 to 0.92) compared with white Europeans. Compared with individuals without T2D, both white Europeans and South Asians with T2D had a higher risk for all-cause mortality (1.59 (1.48 to 1.71) vs 2.83 (1.76 to 4.53)), CVD mortality (2.04 (1.82 to 2.28) vs 4.40 (2.37 to 8.16)) and CVD incidence (1.37 (1.31 to 1.44) vs 1.60 (1.31 to 1.95)), respectively. However, the magnitude of the risk was higher for South Asians than white Europeans. CONCLUSIONS Although T2D was associated with a higher risk for all-cause mortality and CVD incidence and mortality, in both white Europeans and South Asians, the risk experienced by South Asians with T2D was higher than their white European counterparts.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Frederick Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Heather Waddell
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Anne Sillars
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stamatina Iliodromiti
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rosemary Brown
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lyn Ferguson
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Karien Stronks
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene van Valkengoed
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stuart Robert Gray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jason Martin Regnald Gill
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Centre for Research in Exercise Physiology (CIFE), Universidad Mayor, Santiago, Chile
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82
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Gunawardena KC, Jackson R, Robinett I, Dhaniska L, Jayamanne S, Kalpani S, Muthukuda D. The Influence of the Smart Glucose Manager Mobile Application on Diabetes Management. J Diabetes Sci Technol 2019; 13:75-81. [PMID: 30264583 PMCID: PMC6313277 DOI: 10.1177/1932296818804522] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Smartphone use is rapidly growing in developing countries, providing opportunity for development of new health-based mobile applications. The present study investigated the efficacy of a newly designed mobile application, Smart Glucose Manager (SGM), in Sri Lankan patients with diabetes. METHODS A total of 67 patients with access to Android smartphones were randomized into an SGM (n = 27) and a control group (n = 25). Glycosylated hemoglobin (A1c) levels were measured at baseline and every 3 months afterward. The SGM group utilized the application daily, while control-group patients were instructed to continue their standard methods of diabetes management. Independent t-tests were utilized to assess A1c differences at 3 and 6 months postrandomization. A1c improvement, defined as A1c at 6 months minus baseline, was compared with SGM usage to assess effectiveness of diabetic management. RESULTS At the 6-month follow up, the SGM group had significant lower A1c levels than the control group (7.2% vs 8.17%, P < .0001). For both groups, A1c values decreased from baseline to the 3 months (SGM: 9.52% to 8.16%, P < .0001; control: 9.44% to 8.31%, P < .0001). From 3 months to 6 months, the SGM group showed further improvement of A1c (-0.96% P < .0001), whereas the control group did not ( P = 0.19). A1c improvement was positively correlated with SGM usage ( R = .81, P < .001). CONCLUSION The SGM, a mobile application specifically designed to support self-management of diabetes, appeared to show long-term improvement of A1c levels in patients with diabetes residing in Sri Lanka.
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Affiliation(s)
- Kasun C. Gunawardena
- Ocean Lakes High School, Math and Science Academy, Virginia Beach, VA, USA
- Kasun C. Gunawardena, Ocean Lakes High School, Math and Science Academy, 885 Schumann Dr, Virginia Beach, VA 23454, USA.
| | - Renee Jackson
- Ocean Lakes High School, Math and Science Academy, Virginia Beach, VA, USA
| | - Iva Robinett
- Endocrinology Department, Sentara Medical Group, Norfolk, VA, USA
| | | | | | - Sumedha Kalpani
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Wharam JF, Lu CY, Zhang F, Callahan M, Xu X, Wallace J, Soumerai S, Ross-Degnan D, Newhouse JP. High-Deductible Insurance and Delay in Care for the Macrovascular Complications of Diabetes. Ann Intern Med 2018; 169:845-854. [PMID: 30458499 PMCID: PMC6934173 DOI: 10.7326/m17-3365] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions. OBJECTIVE To determine whether a transition from low-deductible to high-deductible insurance is associated with delayed medical care for macrovascular complications of diabetes. DESIGN Observational longitudinal comparison of matched groups. SETTING A large national health insurer during 2003 to 2012. PARTICIPANTS The intervention group comprised 33 957 persons with diabetes who were continuously enrolled in low-deductible (≤$500) insurance plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) plans. The control group included 294 942 persons with diabetes who were enrolled in low-deductible plans contemporaneously with matched intervention group members. INTERVENTION Employer-mandated transition to a high-deductible plan. MEASUREMENTS The number of months it took for persons in each study group to seek care for their first major macrovascular symptom, have their first major diagnostic test for macrovascular disease, and have their first major procedure-based treatment was determined. Between-group differences in time to reach a midpoint event rate were then calculated. RESULTS No baseline differences were found between groups. During follow-up, the delay for the high-deductible group was 1.5 months (95% CI, 0.8 to 2.3 months) for seeking care for the first major symptom, 1.9 months (CI, 1.4 to 2.3 months) for the first diagnostic test, and 3.1 months (CI, 0.5 to 5.8 months) for the first procedure-based treatment. LIMITATION Health outcomes were not examined. CONCLUSION Among persons with diabetes, mandated enrollment in a high-deductible insurance plan was associated with delays in seeking care for the first major symptoms of macrovascular disease, the first diagnostic test, and the first procedure-based treatment. PRIMARY FUNDING SOURCE National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
- J Frank Wharam
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Christine Y Lu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Fang Zhang
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Matthew Callahan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Xin Xu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Jamie Wallace
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Stephen Soumerai
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.)
| | - Joseph P Newhouse
- Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and Harvard Kennedy School and National Bureau of Economic Research, Cambridge, Massachusetts (J.P.N.)
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84
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Arellano Perez Vertti RD, Aguilar Muñiz LS, Morán Martínez J, González Galarza FF, Arguello Astorga R. Cartilage Oligomeric Matrix Protein Levels in Type 2 Diabetes Associated with Primary Knee Osteoarthritis Patients. Genet Test Mol Biomarkers 2018; 23:16-22. [PMID: 30526057 DOI: 10.1089/gtmb.2018.0184] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS (1) To evaluate the association between type 2 diabetes mellitus (T2D) and primary knee osteoarthritis (KOA); and (2) to compare synovial fluid (SF) cartilage oligomeric matrix protein (COMP) concentrations and glycemic control parameters in patients with T2D, with and without primary KOA. METHODS A total of 231 individuals were included in this study. Primary KOA was confirmed according to the criteria established by the American College of Rheumatology. The presence of T2D was determined by medical history. In addition, fasting plasma glucose and glycated hemoglobin were analyzed to confirm diabetic and nondiabetic status. RESULTS Our results showed an association between T2D and primary KOA after covariate adjustments (OR = 3.755, p = 0.000024, 95% CI: 2.033-6.934). In addition, SF COMP levels were significantly higher in T2D groups with and without primary KOA (p = 0.00035; p = 0.001 respectively) when compared to nonT2D controls. CONCLUSION This study suggests a strong association between T2D and primary KOA; in addition, the presence of T2D may have an influence in SF COMP levels in subjects with and without primary KOA. The glycemic control parameters and duration of diabetes may be useful as an indirect indicator of SF COMP levels to prevent the effects of chronic exposure to hyperglycemia and subsequent damage to the articular cartilage.
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Affiliation(s)
- Ruben Daniel Arellano Perez Vertti
- 1 Facultad de Medicina Torreon, Universidad Autonoma de Coahuila , Torreon, Mexico .,2 Instituto de Ciencia y Medicina Genómica , Torreon, Mexico
| | | | | | - Faviel Francisco González Galarza
- 1 Facultad de Medicina Torreon, Universidad Autonoma de Coahuila , Torreon, Mexico .,2 Instituto de Ciencia y Medicina Genómica , Torreon, Mexico
| | - Rafael Arguello Astorga
- 1 Facultad de Medicina Torreon, Universidad Autonoma de Coahuila , Torreon, Mexico .,2 Instituto de Ciencia y Medicina Genómica , Torreon, Mexico
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85
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Affiliation(s)
- Taylor C. Wallace
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
- Think Healthy Group, Inc., Washington, DC, USA
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86
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Katare R, Pearson JT, Lew JKS, Wei M, Tsuchimouchi H, Du CK, Zhan DY, Umetani K, Shirai M, Schwenke DO. Progressive Decrease in Coronary Vascular Function Associated With Type 2 Diabetic Heart Disease. Front Physiol 2018; 9:696. [PMID: 29928236 PMCID: PMC5997806 DOI: 10.3389/fphys.2018.00696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background: The causal factors underpinning the onset and progression of diabetic heart disease (DHD) remain to be fully elucidated. Myocardial function is critically dependent on optimal coronary blood flow. Considering vascular disease occurs early in diabetes due to endothelial dysfunction, this study aimed to determine whether impaired coronary perfusion contributes to the origins of myocardial dysfunction in DHD, or whether coronary and cardiac dysfunction are independent pathologies associated with diabetes. Methods: Synchrotron radiation microangiography was used to image the coronary circulation of type-2 diabetic db/db and non-diabetic db/+ mice in vivo at 8, 16, and 24 weeks of age. We further assessed vascular function based on the vasodilatory responses to acetylcholine (ACh, 3 μg/kg/min), sodium nitroprusside (SNP, 5 μg/kg/min) and the Rho-kinase inhibitor, fasudil (20 mg/kg, i.v.). Cardiac function was assessed using echocardiography, and cardiac eNOS and ROCK expression were measured using immunohistochemistry. Results: Coronary and cardiac function were normal in 8-week-old diabetic mice. However, by 16 weeks of age, diabetic mice had advanced cardiac dysfunction. In comparison, normal coronary perfusion was preserved in diabetes until 24 weeks of age. Moreover, only the 24-week-old diabetic mice showed clear evidence of advanced coronary vascular dysfunction, based on (i) the absence of a vasodilatory response to ACh, and (ii) an exaggerated vasodilatory response to fasudil. Interestingly, fasudil also restored normal coronary perfusion in the 24-week-old diabetic heart by restoring blood flow to previously constricted vessels (diameter < 100 μm). Importantly, there was a ubiquitous decrease, and increase, in the cardiac expression of eNOS and ROCK, respectively. Conclusion: These results suggest that both cardiac and coronary dysfunction appear to have independent origins associated with diabetes and Rho-kinase pathway may be playing a role in the onset and progression of DHD.
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Affiliation(s)
- Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - James T Pearson
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.,Bioscience Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia
| | - Jason Kar-Sheng Lew
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Melanie Wei
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Hirotsugu Tsuchimouchi
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Cheng-Kun Du
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Dong-Yun Zhan
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Keiji Umetani
- Japan Synchrotron Radiation Research Institute, Hyōgo, Japan
| | - Mikiyasu Shirai
- Department of Advanced Medical Research for Pulmonary Hypertension, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Daryl O Schwenke
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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87
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Herrington WG, Alegre-Díaz J, Wade R, Gnatiuc L, Ramirez-Reyes R, Hill M, Solano-Sánchez M, Baigent C, Lewington S, Collins R, Tapia-Conyer R, Peto R, Kuri-Morales P, Emberson JR. Effect of diabetes duration and glycaemic control on 14-year cause-specific mortality in Mexican adults: a blood-based prospective cohort study. Lancet Diabetes Endocrinol 2018; 6:455-463. [PMID: 29567074 PMCID: PMC5966587 DOI: 10.1016/s2213-8587(18)30050-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Diabetes is a cause of at least a third of all deaths in Mexican adults aged 35-74 years, with the excess mortality due mainly to vascular disease, renal disease, infection, and acute diabetic crises. We aimed to analyse the effect of diabetes duration and glycaemic control on death rate ratios (RRs) for these causes and to assess the relevance to cause-specific mortality of undiagnosed diabetes. METHODS About 100 000 women and 50 000 men aged 35 years or older from Mexico City were recruited into a blood-based prospective study between April 14, 1998, and Sept 28, 2004, and followed up until Jan 1, 2016, for cause-specific mortality. Participants who, at recruitment, reported any chronic disease other than diabetes and those who had missing data for HbA1c or diabetes duration were excluded. We used Cox models to estimate the associations of undiagnosed or previously diagnosed diabetes (almost all type 2) with risk of mortality from vascular disease, renal disease, and infection, exploring among those with previously diagnosed diabetes the independent relevance of diabetes duration (<5 years, ≥5 to <10 years, or ≥10 years) and HbA1c (<9%, ≥9% to <11%, or ≥11%). We also estimated the association of HbA1c with mortality in participants without diabetes at recruitment. FINDINGS 133 662 participants were aged 35-74 years and had complete data and no other chronic disease. 16 940 (13%) had previously diagnosed diabetes, 6541 (5%) had undiagnosed diabetes, and 110 181 (82%) had no diabetes. Among participants with previously diagnosed diabetes, glycaemic control was poor (median HbA1c 8·9% [IQR 7·0-10·9]), and was worse in those with longer duration of disease at recruitment. Compared with participants without diabetes, the death RRs at ages 35-74 years for the combination of vascular, renal, or infectious causes were 3·0 (95% CI 2·7-3·4) in those with undiagnosed diabetes, 4·5 (4·0-5·0) for the 5042 participants with a diabetes duration of less than 5 years, 6·6 (6·1-7·1) for the 7713 participants with a duration of 5 years to less than 10 years, and 11·7 (10·7-12·7) for the 4185 participants with a duration of at least 10 years. Similarly, the death RRs were 5·2 (4·8-5·7) for those with HbA1c less than 9%, 6·8 (6·2-7·4) for those with HbA1c of 9% to less than 11%, and 10·5 (9·7-11·5) for those with HbA1c of at least 11%. Diabetes was not strongly associated with the combination of deaths from other causes apart from acute glycaemic crises. Among participants without diabetes, higher HbA1c was not positively related to mortality. INTERPRETATION In Mexico, the rates of death from causes strongly associated with diabetes increased steeply with duration of diabetes and were higher still among people with poor glycaemic control. Delaying the onset of type 2 diabetes, as well as improving its treatment, is essential to reduce premature adult mortality in Mexico. FUNDING Wellcome Trust, the Mexican Health Ministry, the Mexican National Council of Science and Technology, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.
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Affiliation(s)
- William G Herrington
- Medical Research Council Population Heath Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jesus Alegre-Díaz
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | - Rachel Wade
- Medical Research Council Population Heath Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louisa Gnatiuc
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Raúl Ramirez-Reyes
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Michael Hill
- Medical Research Council Population Heath Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Colin Baigent
- Medical Research Council Population Heath Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Lewington
- Medical Research Council Population Heath Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Roberto Tapia-Conyer
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pablo Kuri-Morales
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jonathan R Emberson
- Medical Research Council Population Heath Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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88
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Reis JP, Allen NB, Bancks MP, Carr JJ, Lewis CE, Lima JA, Rana JS, Gidding SS, Schreiner PJ. Duration of Diabetes and Prediabetes During Adulthood and Subclinical Atherosclerosis and Cardiac Dysfunction in Middle Age: The CARDIA Study. Diabetes Care 2018; 41:731-738. [PMID: 29317451 PMCID: PMC5860835 DOI: 10.2337/dc17-2233] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/13/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether the duration of diabetes and duration of prediabetes estimated during a 25-year period in early adulthood are each independently associated with coronary artery calcified plaque (CAC) and abnormalities in left ventricular structure and function later in life. RESEARCH DESIGN AND METHODS Participants were 3,628 white and black adults aged 18-30 years without diabetes or prediabetes at baseline (1985-1986) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Durations of diabetes and prediabetes were estimated based on their identification at examinations 7, 10, 15, 20, and 25 years later. CAC was identified by computed tomography at years 15, 20, and 25. Left ventricular structure and function were measured via echocardiogram at year 25. RESULTS Of the 3,628 individuals, 12.7% and 53.8% developed diabetes and prediabetes, respectively; average (SD) duration was 10.7 (10.7) years and 9.5 (5.4) years. After adjustment for sociodemographic characteristics and other cardiovascular risk factors, and mutual adjustment for each other, the hazard ratio for the presence of CAC was 1.15 (95% CI 1.06, 1.25) and 1.07 (1.01, 1.13) times higher for each 5-year-longer duration of diabetes and prediabetes, respectively. Diabetes and prediabetes duration were associated with worse subclinical systolic function (longitudinal strain [Ptrend < 0.001 for both]) and early diastolic relaxation (e' [Ptrend 0.004 and 0.002, respectively]). Duration of diabetes was also associated with a higher diastolic filling pressure (E-to-e' ratio [Ptrend 0.001]). CONCLUSIONS Durations of diabetes and prediabetes during adulthood are both independently associated with subclinical atherosclerosis and left ventricular systolic and diastolic dysfunction in middle age.
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Affiliation(s)
- Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael P Bancks
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J Jeffrey Carr
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joao A Lima
- School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Division of Cardiology, Kaiser Permanente Northern California, Oakland, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Samuel S Gidding
- Nemours Cardiac Center, A.I. DuPont Hospital for Children, Wilmington, DE
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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89
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Roussel R, Steg PG, Mohammedi K, Marre M, Potier L. Prevention of cardiovascular disease through reduction of glycaemic exposure in type 2 diabetes: A perspective on glucose-lowering interventions. Diabetes Obes Metab 2018; 20:238-244. [PMID: 28597588 DOI: 10.1111/dom.13033] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 01/29/2023]
Abstract
Type 2 diabetes is a leading cause of cardiovascular disease (CVD). Observational studies have consistently shown an association between glycaemic level and risk of major adverse cardiovascular events (MACE); however, intervention studies have provided limited evidence supporting a reduction in the cardiovascular burden of diabetes through intensive glucose control. In the present review, we aimed to examine the concept of cumulative glycaemic exposure with regard to protection against CVD in diabetes. We address how we can move from a binary approach in trials, to a more quantitative approach based on differences in cumulative glycaemic exposure. We plotted the association between differing glycaemic exposures between study arms and the hazard ratio for MACE in randomized controls trials comparing intensive with conventional glycaemic control in type 2 diabetes. We found a strikingly strong correlation between differential exposure and cardiovascular risk reduction. Similar results were obtained for trials comparing antidiabetes drugs with placebo. The results suggest that a minimum study duration and a minimum gain in glycated haemoglobin (HbA1c) reduction are necessary to drive a relevant risk reduction in CVD risk, and we provide a quantitative perspective in that respect. The present analysis underlines that the duration of the intensification of glycemic control, and the amplitude of the resulting reduction in HbA1c, are important notions for clinical decision-making.
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Affiliation(s)
- Ronan Roussel
- INSERM, U-1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Paris, France
| | - Philippe Gabriel Steg
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Paris, France
- INSERM U-1148, LVTS, French Alliance for Cardiovascular Clinical Trials, Paris, France
- National Heart and Lung Institute, ICMS, Imperial College, Royal Brompton Hospital, London, UK
| | - Kamel Mohammedi
- Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Paris, France
| | - Michel Marre
- INSERM, U-1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Paris, France
| | - Louis Potier
- INSERM, U-1138, Centre de Recherche des Cordeliers, Paris, France
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France
- Assistance Publique Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Paris, France
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90
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Cho S, Kim M, Park K. Self-management levels of diet and metabolic risk factors according to disease duration in patients with type 2 diabetes. Nutr Res Pract 2018; 12:69-77. [PMID: 29399299 PMCID: PMC5792259 DOI: 10.4162/nrp.2018.12.1.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/18/2017] [Accepted: 12/24/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the duration of illness, and to examine the trends in self-management levels during the recent decades. SUBJECTS/METHODS Data were collected from the Korea National Health and Nutrition Examination Surveys (KNHANES, 1998-2014). In our analysis, 4,148 patients with T2DM, aged ≥ 30 years, were categorized according to the duration of their illness (< 5 years, 5-9 years, and ≥ 10 years). Demographic and lifestyle information was assessed through self-administered questionnaires, and biomarker levels (e.g., fasting glucose level, blood pressure, or lipid level) were obtained from a health examination. Dietary intake was assessed by a 24-recall, and adherence level to dietary guidelines (meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol) were assessed. Multivariable generalized linear regression and unconditional logistic regression models were used to compare the prevalence rates of hyperglycemia, dyslipidemia, and hypertension according to the duration of patients' illness, accounting for the complex survey design of the KNHANES. RESULTS In the multivariable adjusted models, patients with a longer duration (≥ 10 years) of T2DM had a higher prevalence of hyperglycemia than those with a shorter duration of T2DM (< 5 years) (odds ratio 2.20, 95% confidence interval 1.61-3.01, P for trend < 0.001). We did not observe any associations of disease duration with the prevalence of hypertension and dyslipidemia. In addition, the adherence levels to dietary recommendations did not significantly differ according to disease duration, except adherence to moderate alcohol consumption. There were significant decreasing trends in the prevalence of hyperglycemia in patients with a duration of illness ≥ 10 years (P for trend = 0.004). CONCLUSION Although the proportion of patients with adequate control of glucose levels has improved in recent decades, poorer self-management has been found in those with a longer disease duration. These findings suggest the need for well-planned and individualized patient education programs to improve self-management levels and quality of life by preventing or delaying diabetic complications.
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Affiliation(s)
- Sukyung Cho
- Department of Food and Nutrition, Yeungnam University, 280 Daehak-ro, Gyeongsan-si, Gyeongbuk 38541, Korea
| | - Minkyeong Kim
- Department of Food and Nutrition, Yeungnam University, 280 Daehak-ro, Gyeongsan-si, Gyeongbuk 38541, Korea
| | - Kyong Park
- Department of Food and Nutrition, Yeungnam University, 280 Daehak-ro, Gyeongsan-si, Gyeongbuk 38541, Korea
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91
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Park HW, Kang MG, Kim K, Koh JS, Park JR, Jeong YH, Ahn JH, Jang JY, Kwak CH, Park Y, Jeong MH, Kim YJ, Cho MC, Kim CJ, Hwang JY. Long-term Prognosis and Clinical Characteristics of Patients with Newly Diagnosed Diabetes Mellitus Detected after First Acute Myocardial Infarction: from KAMIR-NIH Registry. Korean Circ J 2018; 48:134-147. [PMID: 29441746 PMCID: PMC5861004 DOI: 10.4070/kcj.2017.0174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/06/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES After the first acute myocardial infarction (AMI), a considerable proportion of patients are newly diagnosed with diabetes mellitus (DM). However, in AMI, controversy remains regarding the disparity in prognosis between previously diagnosed DM (known-DM) and newly diagnosed DM (new-DM). METHODS The study included 10,455 patients with AMI (non-DM, 6,236; new-DM, 659; known-DM, 3,560) admitted to one of 15 participating centers in Korea between November 2011 and January 2016 (average follow-up, 523 days). We compared the characteristics and clinical course of patients with known-DM and those with new- or non-DM. RESULTS Compared to patients with known-DM, those with new-DM or non-DM were younger, more likely to be male, and less likely to have hypertension, dyslipidemia, prior stroke, angina, or myocardial infarction. Compared to patients with new-DM or non-DM (reference), those with known-DM had higher risks of major adverse cardiac events (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.06-1.35; p=0.004), cardiac death (HR, 1.26; 95% CI, 1.01-1.57; p=0.042), and congestive heart failure (HR, 1.58; 95% CI, 1.20-2.08). Unlike known-DM, new-DM did not increase the risk of cardiac events (including death). CONCLUSIONS Known-DM was associated with a significantly higher risk of cardiovascular events after AMI, while new-DM had a similar risk of cardiac events as that noted for non-DM. There were different cardiovascular outcomes according to diabetes status in patients with AMI.
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Affiliation(s)
- Hyun Woong Park
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Gyu Kang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyehwan Kim
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin Sin Koh
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jeong Rang Park
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Jong Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Jeong Yoon Jang
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Choong Hwan Kwak
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jin Yong Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
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92
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Seferovic JP, Bentley-Lewis R, Claggett B, Diaz R, Gerstein HC, Køber LV, Lawson FC, Lewis EF, Maggioni AP, McMurray JJV, Probstfield JL, Riddle MC, Solomon SD, Tardif JC, Pfeffer MA. Retinopathy, Neuropathy, and Subsequent Cardiovascular Events in Patients with Type 2 Diabetes and Acute Coronary Syndrome in the ELIXA: The Importance of Disease Duration. J Diabetes Res 2018; 2018:1631263. [PMID: 30648112 PMCID: PMC6311850 DOI: 10.1155/2018/1631263] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION We investigated the association of diabetic retinopathy and neuropathy with increased risk of recurrent cardiovascular (CV) events in 6068 patients with type 2 diabetes mellitus (T2DM) and recent acute coronary syndrome (ACS) enrolled in the Evaluation of Lixisenatide in Acute Coronary Syndrome (ELIXA). METHODS History of retinopathy and neuropathy as well as duration of T2DM were self-reported at screening. Proportional hazards regression models were used to assess relationships between retinopathy, neuropathy, and recurrent CV events. RESULTS At screening, retinopathy and neuropathy were reported in 10.7% and 17.5% of patients, respectively, while 5.7% reported both. When adjusted for randomized treatment only, both retinopathy and neuropathy were associated with a primary composite outcome (CV death, nonfatal MI, stroke, or hospitalization for unstable angina) (retinopathy: HR 1.44, 95% CI 1.19-1.75; neuropathy: HR 1.33, 95% CI 1.12-1.57), CV composite (CV death, nonfatal MI, stroke, hospitalization for heart failure (HF)) (retinopathy: HR 1.57, 95% CI 1.31-1.88; neuropathy: HR 1.38, 95% CI 1.19-1.62), myocardial infarction (retinopathy: HR 1.38, 95% CI 1.08-1.76; neuropathy: HR 1.26, 95% CI 1.02-1.54), HF hospitalization (retinopathy: HR 2.03, 95% CI 1.48-2.78; neuropathy: HR 1.71, 95% CI 1.30-2.27), and all-cause mortality (retinopathy: HR 1.65, 95% CI 1.28-2.12; neuropathy: HR 1.43, 95% CI 1.14-1.78). When included in the same model, and adjusted for T2DM duration, there were no independent associations of either with CV outcomes, while T2DM duration remained strongly associated with all outcomes. Addition of demographic characteristics and CV risk factors did not further alter these relationships. CONCLUSIONS In patients with T2DM and recent ACS, a history of retinopathy and/or neuropathy and longer T2DM duration could be considered clinical markers for high risk of recurrent CV events. This trial is registered with the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome), ClinicalTrials.gov registration number NCT01147250.
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Affiliation(s)
- Jelena P. Seferovic
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Rosario, Argentina
| | | | - Lars V. Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Eldrin F. Lewis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aldo P. Maggioni
- Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy
| | - John J. V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | | | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Marc A. Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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93
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Celis-Morales CA, Petermann F, Hui L, Lyall DM, Iliodromiti S, McLaren J, Anderson J, Welsh P, Mackay DF, Pell JP, Sattar N, Gill JMR, Gray SR. Associations Between Diabetes and Both Cardiovascular Disease and All-Cause Mortality Are Modified by Grip Strength: Evidence From UK Biobank, a Prospective Population-Based Cohort Study. Diabetes Care 2017; 40:1710-1718. [PMID: 28986505 DOI: 10.2337/dc17-0921] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/14/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Grip strength and diabetes are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to predispose to adverse health outcomes is unknown. This study determined the interactions between diabetes and grip strength and their association with health outcomes. RESEARCH DESIGN AND METHODS We undertook a prospective, general population cohort study by using UK Biobank. Cox proportional hazards models were used to explore the associations between both grip strength and diabetes and the outcomes of all-cause mortality and CVD incidence/mortality as well as to test for interactions between diabetes and grip strength. RESULTS A total of 347,130 UK Biobank participants with full data available (mean age 55.9 years, BMI 27.2 kg/m2, 54.2% women) were included in the analysis, of which 13,373 (4.0%) had diabetes. Over a median follow-up of 4.9 years (range 3.3-7.8 years), 6,209 died (594 as a result of CVD), and 4,301 developed CVD. Participants with diabetes were at higher risk of all-cause and CVD mortality and CVD incidence. Significant interactions (P < 0.05) existed whereby the risk of CVD mortality was higher in participants with diabetes with low (hazard ratio [HR] 4.05 [95% CI 2.72, 5.80]) versus high (HR 1.46 [0.87, 2.46]) grip strength. Similar results were observed for all-cause mortality and CVD incidence. CONCLUSIONS Risk of adverse health outcomes among people with diabetes is lower in those with high grip strength. Low grip strength may be useful to identify a higher-risk subgroup of patients with diabetes. Intervention studies are required to determine whether resistance exercise can reduce risk.
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Affiliation(s)
| | - Fanny Petermann
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Li Hui
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Donald M Lyall
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, U.K
| | | | - James McLaren
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Jana Anderson
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, U.K
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Daniel F Mackay
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, U.K
| | - Jill P Pell
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, U.K
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Jason M R Gill
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Stuart R Gray
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, U.K.
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94
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Malik S, Zhao Y, Budoff M, Nasir K, Blumenthal RS, Bertoni AG, Wong ND. Coronary Artery Calcium Score for Long-term Risk Classification in Individuals With Type 2 Diabetes and Metabolic Syndrome From the Multi-Ethnic Study of Atherosclerosis. JAMA Cardiol 2017; 2:1332-1340. [PMID: 29117273 PMCID: PMC5814996 DOI: 10.1001/jamacardio.2017.4191] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/21/2017] [Indexed: 01/22/2023]
Abstract
Importance Although the risk of type 2 diabetes is considered to be equivalent to coronary heart disease (CHD) risk, there is considerable heterogeneity among individuals for CHD and atherosclerotic cardiovascular disease (ASCVD) risk. It is not known whether coronary artery calcium (CAC) assessment at baseline in individuals with established metabolic syndrome (MetS) or diabetes identifies CHD and ASCVD prognostic indicators during a long follow-up period. Objective To compare improvement in long-term prognostication of incident CHD and ASCVD using CAC scores among those with diabetes, MetS, or neither condition. Design, Setting, and Participants This study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study of 6814 males and females aged 45 to 84 years without known CVD from 4 race/ethnicity groups (white [38.5%], African American [27.5%], Hispanic [22.1%], and Chinese [11.9%]) recruited from 6 US communities from July 2000 through August 2002. Follow-up for each participant extended to the first occurrence of an incident event, other death, loss to follow-up, or the last follow-up call through December 31, 2013. Data analysis was performed from June 1, 2016, to September 12, 2017. Cox proportional hazards regression models were used to estimate hazard ratios (HRs). Area under the receiver operator characteristic curve and net reclassification improvement were used to compare incremental contributions of CAC score when added to the Framingham risk score, ethnicity/race, and socioeconomic status. Main Outcomes and Measures CHD events, including myocardial infarction, resuscitated cardiac arrest, or CHD death. Results Of 6814 MESA participants, 6751 had complete risk factor and follow-up data and were included in this study (mean [SD] age, 62.2 [10.2] years; 3186 [47.2%] male). A total of 881 (13.0%) had diabetes, 1738 (25.7%) had MetS, and 4132 (61.2%) had neither condition. After 11.1 mean years of follow-up, CHD events occurred in 84 participants with diabetes (135 ASCVD events), 115 with MetS (175 ASCVD events), and 157 with neither (250 ASCVD events). The CAC score was independently associated with incident CHD in multivariable analyses in those with diabetes (HR, 1.30; 95% CI, 1.19-1.43), MetS (HR, 1.30; 95% CI, 1.20-1.41), and neither condition (HR, 1.37; 95% CI, 1.27-1.47). For incident CHD, net reclassification improvement with addition of CAC score was 0.23 (95% CI, 0.10-0.37) in those with diabetes, 0.22 (95% CI, 0.09-0.35) in those with MetS, and 0.25 (95% CI, 0.15-0.35) in those with neither condition. The CAC score was also a prognostic indicator of CHD and ASCVD after controlling for diabetes duration of 10 years or longer at baseline, insulin use, and glycemic control. Conclusions and Relevance In a large multiethnic cohort, the addition of CAC score to global risk assessment was associated with significantly improved risk classification in those with MetS and diabetes, even if diabetes duration was longer than a decade, suggesting a role for the CAC score in risk assessment in such patients.
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Affiliation(s)
- Shaista Malik
- Division of Cardiology, Department of Medicine, University of California, Irvine
- Susan Samueli Center for Integrative Medicine, University of California, Irvine
| | - Yanglu Zhao
- Department of Epidemiology, UCLA (University of California, Los Angeles), Los Angeles
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, California
| | - Khurram Nasir
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland
| | - Alain G. Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston–Salem, North Carolina
| | - Nathan D. Wong
- Division of Cardiology, Department of Medicine, University of California, Irvine
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95
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Jiang J, Zhao L, Lin L, Gui M, Aleteng Q, Wu B, Wang S, Pan B, Ling Y, Gao X. Postprandial Blood Glucose Outweighs Fasting Blood Glucose and HbA1c in screening Coronary Heart Disease. Sci Rep 2017; 7:14212. [PMID: 29079813 PMCID: PMC5660170 DOI: 10.1038/s41598-017-14152-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/05/2017] [Indexed: 12/16/2022] Open
Abstract
The objective of the present study is to assess the performance of fasting blood glucose (FBG), postprandial blood glucose (PBG), and glycated hemoglobin (HbA1c) as screening for coronary heart disease (CHD) in an inpatient population undergoing coronary angiography. 1852 consecutive patients scheduled for coronary angiography were classified into Normal Glucose Tolerance (NGT), Impaired Glucose Regulation (IGR), and diabetes, based on FBG, PBG, and HbA1c. Correlations of Gensini score with glucose metabolism and insulin resistance were analyzed. The associations between glycemic variables and Gensini score or the presence of CHD were analyzed by multiple linear regression and logistic regression, respectively. CHD was diagnosed in 488, 622, and 414 patients with NGT, IGR, and diabetes, respectively. Gensini score was positively correlated with FBG (r = 0.09, p < 0.01), PBG (r = 0.20, p < 0.01), and HbA1c (r = 0.19, p < 0.01). Gensini score was not correlated with fasting insulin (r = −0.081, p = 0.36), post-prandial insulin (r = −0.02, p = 0.61), or HOMAIR (r = −0.0059, p = 0.13). When FBG, PBG and HbA1c were pooled altogether, only PBG persisted in its association with Gensini score and the prevalence of CHD. The severity of CHD was associated with glucose rather than insulin resistance in this Chinese population. PBG was optimally correlated with the presence and severity of CHD.
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Affiliation(s)
- Jingjing Jiang
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Lin Zhao
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Liu Lin
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Minghui Gui
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Qiqige Aleteng
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Bingjie Wu
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Shanshan Wang
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Baishen Pan
- Department of Laboratory Medicine, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Yan Ling
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, ZhongShan Hospital, Fudan University, Shanghai, China.
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96
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Zarkogianni K, Athanasiou M, Thanopoulou AC. Comparison of Machine Learning Approaches Toward Assessing the Risk of Developing Cardiovascular Disease as a Long-Term Diabetes Complication. IEEE J Biomed Health Inform 2017; 22:1637-1647. [PMID: 29990007 DOI: 10.1109/jbhi.2017.2765639] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The estimation of long-term diabetes complications risk is essential in the process of medical decision making. Guidelines for the management of Type 2 Diabetes Mellitus (T2DM) advocate calculating the Cardiovascular Disease (CVD) risk to initiate appropriate treatment. The objective of this study is to investigate the use of sophisticated machine learning techniques toward the development of personalized models able to predict the risk of fatal or nonfatal CVD incidence in T2DM patients. The important challenge of handling the unbalanced nature of the available dataset is addressed by applying novel ensemble strategies. Hybrid Wavelet Neural Networks (HWNNs) and Self-Organizing Maps (SOMs) constitute the primary models for building ensembles following a subsampling approach. Different methods for combining the decisions of the primary models are applied and comparatively assessed. Data from the 5-year follow up of 560 patients with T2DM are used for development and evaluation purposes. The highest discrimination performance (Area Under the Curve (AUC): 71.48%) is achieved by taking into account both the HWNN- and SOM- based primary models' outputs. The proposed method is superior to the Binomial Linear Regression (BLR) model justifying the need to apply more sophisticated techniques in order to produce reliable CVD risk scores.
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97
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Noh M, Kwon H, Jung CH, Kwon SU, Kim MS, Lee WJ, Park JY, Han Y, Kim H, Kwon TW, Cho YP. Impact of diabetes duration and degree of carotid artery stenosis on major adverse cardiovascular events: a single-center, retrospective, observational cohort study. Cardiovasc Diabetol 2017; 16:74. [PMID: 28587650 PMCID: PMC5461631 DOI: 10.1186/s12933-017-0556-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/29/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We aimed to investigate the impact of diabetes duration and carotid artery stenosis (CAS) on the occurrence of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) without clinical cardiovascular disease. METHODS A total of 2006 patients with T2DM, without clinical cardiovascular disease, aged >50 years, and who underwent baseline carotid Doppler ultrasound screening with regular follow-ups at the outpatient clinic of our diabetes center, were stratified into four subgroups according to diabetes duration and CAS degree. The primary outcomes included the occurrence of MACE, defined as fatal or nonfatal stroke and myocardial infarction, and all-cause mortality. RESULTS The difference in the MACE incidence was significantly greater in patients with a longer diabetes duration (≥10 years) and significant CAS (50-69% luminal narrowing) (p < 0.001). Analysis of individual MACE components indicated a trend towards an increased incidence of stroke (p < 0.001), parallel to a longer diabetes duration and significant CAS. In contrast, the risk of myocardial infarction was significantly higher in patients with a diabetes duration <10 years and significant CAS (p = 0.039). Multivariate regression analysis showed that patients with both a longer diabetes duration and significant CAS demonstrated additive and very high risks of MACE (hazard ratio [HR], 2.07; 95% confidence interval [CI] 1.17-3.66; p = 0.012) and stroke (HR, 3.38; 95% CI 1.54-7.44; p = 0.002). CONCLUSIONS The risk of MACE is significantly greater in patients with T2DM, without clinical cardiovascular disease, who have both a longer diabetes duration and significant CAS, compared with those who have a shorter duration and/or nonsignificant CAS.
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Affiliation(s)
- Minsu Noh
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Hyunwook Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Chang Hee Jung
- Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Sun U. Kwon
- Department of Neurology, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Min Seon Kim
- Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Woo Je Lee
- Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Joong Yeol Park
- Department of Internal Medicine, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Youngjin Han
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Hyangkyoung Kim
- Department of Surgery, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973 South Korea
| | - Tae-Won Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
| | - Yong-Pil Cho
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 05505 South Korea
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98
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Hanefeld M, Traylor L, Gao L, Landgraf W. The use of lipid-lowering therapy and effects of antihyperglycaemic therapy on lipids in subjects with type 2 diabetes with or without cardiovascular disease: a pooled analysis of data from eleven randomized trials with insulin glargine 100 U/mL. Cardiovasc Diabetol 2017; 16:66. [PMID: 28526014 PMCID: PMC5438574 DOI: 10.1186/s12933-017-0548-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/05/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Dyslipidaemia is a major contributor to the increased risk of cardiovascular disease (CVD) associated with type 2 diabetes (T2D). This study aimed to characterize the extent of lipid-lowering therapy use and its impact on lipid and glycaemic outcomes in people with T2D uncontrolled on oral agents who were enrolled in insulin glargine 100 units/mL (Gla-100) randomized controlled trials (RCTs). METHODS A post hoc patient-level pooled analysis of eleven RCTs (≥24 weeks' duration) comparing Gla-100 (±oral antidiabetes drugs [OADs]) with OADs alone in people with T2D was performed. Baseline and Week 24 or study endpoint lipid status (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], non-high-density lipoprotein cholesterol [non-HDL-C] and triglycerides) and indices of glycaemic control (glycosylated haemoglobin, fasting plasma glucose [FPG]) were examined in patient groups according to treatment received and CVD status. Lipid-lowering therapy was provided at the discretion of physicians at baseline and throughout the studies. RESULTS Of the 4768 participants included in the analysis, 41% (n = 1940) received lipid-lowering therapy. Only 51% of participants with CVD (1885/3672) were treated with lipid-lowering therapy; these participants had significantly lower levels of LDL-C, HDL-C and non-HDL-C, and higher levels of triglycerides versus patients not treated with lipid-lowering therapy at baseline and study endpoint (P < 0.001 for all). Antihyperglycaemia therapy resulted in decreases in glycosylated haemoglobin (-1.4 to -1.6%) and FPG (-68.9 to -75.3 mg/dL) at Week 24. Furthermore, slight improvements in non-HDL-C (-3.9 to -9.1 mg/dL) and triglyceride levels (-25.8 to -51.2 mg/dL) were observed. Similar changes were seen irrespective of lipid-lowering therapy or CVD status. CONCLUSIONS In a T2D cohort included in Gla-100 clinical studies, many participants with T2D and CVD did not receive lipid-lowering therapy, and for most categories of lipid the levels were outside the optimal range. Even in patients treated with antihyperglycaemic therapy but not lipid-lowering therapy, there were modest improvements in non-HDL-C and triglyceride levels in all participants with T2D and CVD. There is a need for increased implementation of guideline recommendations such as American College of Cardiology/American Heart Association for the management of dyslipidaemia in patients with T2D.
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Affiliation(s)
- Markolf Hanefeld
- Study Center Metabolic Vascular Medicine, GWT-TU Dresden GmbH/UKD, Medical clinic III, Fiedler Str. 34, 01307 Dresden, Germany
- University Hospital Carl Gustav Carus, Dresden, Germany
| | - Louise Traylor
- Sanofi Us Inc., 55 Corporate Dr, Bridgewater, NJ 08807 USA
| | | | - Wolfgang Landgraf
- Sanofi, K703, Industriepark Höchst, 65926 Frankfurt Am Main, Germany
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99
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Newman JD, Rockman CB, Kosiborod M, Guo Y, Zhong H, Weintraub HS, Schwartzbard AZ, Adelman MA, Berger JS. Diabetes mellitus is a coronary heart disease risk equivalent for peripheral vascular disease. Am Heart J 2017; 184:114-120. [PMID: 28224925 DOI: 10.1016/j.ahj.2016.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
Diabetes mellitus (diabetes) is associated with significantly increased risk of peripheral vascular disease. Diabetes is classified as a coronary heart disease (CHD) risk equivalent, but it is unknown whether diabetes is a CHD risk equivalent for peripheral vascular disease. The objective was to evaluate the odds of peripheral arterial disease (PAD) or carotid artery stenosis (CAS) among participants with diabetes, CHD, or both, compared with participants without diabetes or CHD, in a nationwide vascular screening database. We hypothesized that diabetes and CHD would confer similar odds of PAD and CAS. METHODS A cross-sectional analysis of all eligible Life Line Screening Inc participants age 30 to 90 years with ankle brachial indices for PAD (ankle brachial index <0.9 in either leg) and carotid artery duplex ultrasonographic imaging for CAS (internal CAS ≥50%) was performed (N=3,522,890). RESULTS Diabetes and CHD were present in 372,330 (10.7%) and 182,760 (5.8%) of participants, respectively; PAD and CAS were present in 155,000 (4.4%) and 130,347 (3.7%) of participants. After multivariable adjustment, PAD odds were 1.56 (95% CI 1.54-1.59) and 1.69 (95% CI 1.65-1.73) for participants with diabetes or CHD, respectively. Participants with both diabetes and CHD had 2.75-fold increased odds of PAD (95% CI 2.66-2.85). Findings were similar for CAS; compared with no diabetes or CHD, CAS odds increased for participants with diabetes alone (1.53, 95% CI 1.50-1.56), CHD alone (1.72, 95% CI 1.68-1.76), and both diabetes and CHD (2.57, 95% CI 2.49-2.66). Findings were consistent for women and men. CONCLUSION In a large database of more than 3.5 million self-referred participants, diabetes was a CHD risk equivalent for PAD and CAS, and participants with comorbid diabetes and CHD had an especially robust association with PAD and CAS. Counseling regarding screening and prevention of peripheral vascular disease may be useful for patients with diabetes.
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100
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Lew JKS, Pearson JT, Schwenke DO, Katare R. Exercise mediated protection of diabetic heart through modulation of microRNA mediated molecular pathways. Cardiovasc Diabetol 2017; 16:10. [PMID: 28086863 PMCID: PMC5237289 DOI: 10.1186/s12933-016-0484-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/17/2016] [Indexed: 12/18/2022] Open
Abstract
Hyperglycaemia, hypertension, dyslipidemia and insulin resistance collectively impact on the myocardium of people with diabetes, triggering molecular, structural and myocardial abnormalities. These have been suggested to aggravate oxidative stress, systemic inflammation, myocardial lipotoxicity and impaired myocardial substrate utilization. As a consequence, this leads to the development of a spectrum of cardiovascular diseases, which may include but not limited to coronary endothelial dysfunction, and left ventricular remodelling and dysfunction. Diabetic heart disease (DHD) is the term used to describe the presence of heart disease specifically in diabetic patients. Despite significant advances in medical research and long clinical history of anti-diabetic medications, the risk of heart failure in people with diabetes never declines. Interestingly, sustainable and long-term exercise regimen has emerged as an effective synergistic therapy to combat the cardiovascular complications in people with diabetes, although the precise molecular mechanism(s) underlying this protection remain unclear. This review provides an overview of the underlying mechanisms of hyperglycaemia- and insulin resistance-mediated DHD with a detailed discussion on the role of different intensities of exercise in mitigating these molecular alterations in diabetic heart. In particular, we provide the possible role of exercise on microRNAs, the key molecular regulators of several pathophysiological processes.
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Affiliation(s)
- Jason Kar Sheng Lew
- Department of Physiology, HeartOtago, University of Otago, 270, Great King Street, Dunedin, 9010, New Zealand
| | - James T Pearson
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan.,Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Australia
| | - Daryl O Schwenke
- Department of Physiology, HeartOtago, University of Otago, 270, Great King Street, Dunedin, 9010, New Zealand.
| | - Rajesh Katare
- Department of Physiology, HeartOtago, University of Otago, 270, Great King Street, Dunedin, 9010, New Zealand.
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