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Gribsholt SB, Schmidt M, Kristiansen EB, Richelsen B, Sørensen HT. Risk of cardiovascular disease after hospital-diagnosed overweight or obesity. Endocr Connect 2024; 13:e230452. [PMID: 38363150 PMCID: PMC10959045 DOI: 10.1530/ec-23-0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/16/2024] [Indexed: 02/17/2024]
Abstract
Objective The aim was to examine the association between hospital-diagnosed overweight/obesity and incident CVD according to the time period of the overweight/obesity diagnosis. Design This is a cohort study. Methods From Danish national health registries, we identified all residents with a first-time hospital-based overweight/obesity diagnosis code, 1977-2018 (n = 195,221), and an age and sex-matched general population comparison cohort (n = 1,952,210). We computed adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) using Cox regression. We adjusted for comorbidities and educational level and applied 10 years of follow-up. Results The overall incidence rate was 10.1 (95% CI 10.0-10.1) per 1000 person-years for the comparison cohort and 25.1 (95% CI 24.8-25.4) per 1000 person-years for the overweight/obesity cohort, corresponding to an aHR of 2.5 (95% CI 2.4-2.5). The aHR was elevated for all subtypes of CVD: heart failure: 3.9 (95% CI 3.7-4.1), bradyarrhythmia: 2.9 (95% CI 2.7-3.1), angina pectoris: 2.7 (95% CI 2.7-2.8), atrial fibrillation or flutter: 2.6 (95% CI 2.5-2.6), acute myocardial infarction: 2.4 (95% CI 2.3-2.4), revascularization procedure: 2.4 (95% CI 2.2-2.5), valvular heart disease: 1.7 (95% CI 1.6-1.8), ischemic stroke: 1.6 (95% CI 1.4-1.7), transient ischemic attack: 1.6 (95% CI 1.5-1.7), and cardiovascular death: 1.6 (95% CI 1.5-1.6). The 1-10-year aHR of any CVD associated with an overweight/obesity diagnosis decreased from 2.8 (95% CI 2.7-2.9) in 1977-1987 to 1.8 (95% CI 1.8-1.9) in 2008-2018. Conclusion Patients with hospital-diagnosed overweight/obesity had high rates of ischemic heart disease, heart failure, structural heart disease, arrhythmia, stroke, and death, although the strength of the association decreased in recent years. Significance statement Obesity is linked to metabolic abnormalities that predispose individuals to an increased risk of subtypes of CVD. In this population-based nationwide 40-year cohort study, we found that of 195,221 patients with an overweight/obesity diagnosis, more than 31,000 (15.9%) were admitted to hospital within 10 years because of CVD; corresponding to a 2.5-fold greater relative risk of any CVD associated with overweight/obesity than in the general population. We observed an increased risk for most CVD subtypes, including ischemic heart disease, heart failure, structural heart disease, arrhythmia, stroke, and cardiovascular death, although the strength of the association decreased in recent years. Our study emphasizes the importance of improved clinical handling of obesity and underscores the need to prevent associated complications to alleviate the burden of obesity.
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Affiliation(s)
- Sigrid Bjerge Gribsholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Eskild Bendix Kristiansen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Bjørn Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Sharma A, Aruna D, Beatrice A. A Study to Evaluate the Effect of Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors on Oxidative Stress Parameters in Type 2 Diabetes Mellitus Patients. Cureus 2024; 16:e58536. [PMID: 38765344 PMCID: PMC11101606 DOI: 10.7759/cureus.58536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Diabetes mellitus (DM) is a global health issue with 50 million diabetics currently residing in India. Hyperglycemia causes tissue damage due to mitochondrial overproduction of reactive oxygen species. Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) have shown a decrease in oxidative stress by either amelioration of free-radical generation or potentiation of cellular antioxidative capacity in preclinical studies. However, there is a paucity of published clinical studies. Hence, this study was undertaken to evaluate the effect of co-administration of SGLT2i with other drugs on oxidative stress in type 2 DM (T2DM) patients. Methods A prospective, parallel, open-label study in T2DM patients attending endocrinology OPD was conducted for a period of 12 months. At the clinician's discretion, patients were grouped as SGLT2i as an add-on to standard drugs vs standard drugs alone. Blood samples were collected at baseline and at the end of 12 weeks to estimate malondialdehyde (MDA), nitric oxide (NO), and glutathione (GSH) levels. Secondary parameters - glycemic indices and lipid profile - were estimated every four weeks. Results A total of 32 patients were enrolled in the study (16 per group). There was a significant decrease in MDA (p < 0.05) and NO (p < 0.01) and a highly significant increase in GSH (p < 0.001) at 12 weeks from baseline in the SGLT2i group. A reduction in fasting blood sugar (FBS) and post-prandial blood sugar (PPBS) and a 0.56% difference in HbA1c were also noted in the SGLT2i group. Significant lowering of low-density lipoprotein (LDL, p < 0.05) and elevation in HDL levels (p < 0.05) from baseline was seen in the SGLT2i group. Conclusion Co-administration of SGLT2i with antidiabetic drugs demonstrated a significant effect in improving oxidative stress biomarkers and glycemic and lipid profiles among T2DM patients.
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Affiliation(s)
- Ankita Sharma
- Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Hyderabad, IND
| | - D Aruna
- Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Hyderabad, IND
| | - Anne Beatrice
- Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, IND
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Behnoush AH, Maleki S, Arzhangzadeh A, Khalaji A, Pezeshki PS, Vaziri Z, Esmaeili Z, Ebrahimi P, Ashraf H, Masoudkabir F, Vasheghani‐Farahani A, Hosseini K, Mehrani M, Hernandez AV. Prediabetes and major adverse cardiac events after acute coronary syndrome: An overestimated concept. Clin Cardiol 2024; 47:e24262. [PMID: 38558072 PMCID: PMC10983809 DOI: 10.1002/clc.24262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Unlike diabetes, the effect of prediabetes on outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) is not much investigated. We investigated the association between fasting glycemic status and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS undergoing PCI and had mid to long-term follow-up after coronary stenting. METHODS Registry-based retrospective cohort study included ACS patients who underwent PCI at the Tehran Heart Center from 2015 to 2021 with a median follow-up of 378 days. Patients were allocated into normoglycemic, prediabetic, and diabetic groups. The primary and secondary outcomes were MACCE and its components, respectively. Unadjusted and adjusted Cox models were used to evaluate the association between glycemic status and outcomes. RESULTS Among 13 682 patients, 3151 (23%) were prediabetic, and 5834 (42.6%) were diabetic. MACCE risk was significantly higher for diabetic versus normoglycemic (adjusted hazard ratio [aHR]: 1.22, 95% confidence interval [CI]: 1.06-1.41), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 0.95, 95% CI: 0.78-1.10). All-cause mortality risk was significantly higher in diabetic versus normoglycemic (aHR: 1.42, 95% CI: 1.08-1.86), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 1.15, 95% CI: 0.84-1.59). Among other components of MACCE, only coronary artery bypass grafting was significantly higher in diabetic patients, and not prediabetic, compared with normoglycemic. CONCLUSIONS Prediabetic ACS patients undergoing PCI, unlike diabetics, are not at increased risk of MACCE and all-cause mortality. While prediabetic patients could be regarded as having the same risk as nondiabetics, careful consideration to provide more intensive pre- and post-PCI care in diabetic patients is mandatory.
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Affiliation(s)
- Amir Hossein Behnoush
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Saba Maleki
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineGuilan University of Medical Sciences (GUMS)RashtGuilan ProvinceIran
| | - Alireza Arzhangzadeh
- Department of Cardiology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Amirmohammad Khalaji
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Parmida Sadat Pezeshki
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Zahra Vaziri
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Student Research CommitteeBabol University of Medical SciencesBabolIran
| | - Zahra Esmaeili
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Pouya Ebrahimi
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Jundishapur University of Medical SciencesAhvazIran
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Vasheghani‐Farahani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Mehdi Mehrani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Adrian V. Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) GroupUniversity of Connecticut School of PharmacyStorrsConnecticutUSA
- Unidad de Revisiones Sistemáticas y Meta‐análisis (URSIGET), Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
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104
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Ragavan N, Thavalam R, Moorthy S. The Effect of Glycemic Status on P Wave Dispersion. Cureus 2024; 16:e58233. [PMID: 38745813 PMCID: PMC11092425 DOI: 10.7759/cureus.58233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
Background and aim The growing number of people with diabetes mellitus (DM) across the world is a public health concern. The diabetes epidemic involves enormous health costs to the patients, their careers, and society at large. Cardiovascular diseases such as atrial fibrillation (AF) often develop in the diabetic population. An increase in the P wave dispersion (PWD) has been established as an independent risk factor for the occurrence of AF, hence the present study was conducted to establish a possible relationship between PWD and the glycemic status of the individual to predict the occurrence of AF ahead of clinical symptomology. Methodology A comparative cross-sectional study was conducted at a tertiary care hospital after obtaining approval from the institutional ethics committee and written consent of each study subject. The main steps included the selection and categorization of the study population based on their glycemic status, collection of demographic data, performing ECGs calculating PWD using digital calipers, and recording the data systematically for evaluation. Results In this study, 234 patients with a mean age of 53.3 ± 13.1 years were studied, of which 121 (51.7%) were male and 113 (48.29%) were female. The 234 patients were divided into four groups based on their glycemic status - 74 uncontrolled DM patients (31.62%), 51 type 2 DM (T2DM) patients (21.78%), 56 prediabetes patients (23.93%), and 53 patients in the control group (22.64%; not a known case of diabetes with normal HbA1c and fasting blood sugar (FBS) levels). Minimal correlation was observed between FBS with PWD (r value 0.175) and age with PWD (r value 0.161), but statistical significance was observed only between age and PWD (p-value 0.014). The difference in means between the four different study groups was found to be not statistically significant (p-value- 0.104); hence, no intergroup variation was noted. Conclusion Advancing age and higher fasting blood sugars have shown minimal correlation with widening P-wave dispersion. With further studies involving larger populations, this can be a promising aid in identifying PWD as a probable early predictor of atrial arrhythmias among diabetic patients.
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Affiliation(s)
- Niranjan Ragavan
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Rida Thavalam
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Swathy Moorthy
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Rathod MB, Moukthika S, Karikunnel AJ, Harika K, Talla P, Jalakam M. A Cross-Sectional Evaluation of Cardiovascular Risk Assessment in Type 2 Diabetes Mellitus Patients Using the Framingham Risk Score. Cureus 2024; 16:e58026. [PMID: 38738131 PMCID: PMC11088481 DOI: 10.7759/cureus.58026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The global burden of type 2 diabetes mellitus (T2DM) is continuously increasing, particularly in India. The risk of cardiovascular disease (CVD) is higher in T2DM individuals when compared to non-diabetics, which imposes significant morbidity and mortality. The main aim of the present study was to assess the risk factors for CVD in T2DM patients. The secondary aim was to assess the association between cardiovascular risk profile and 10-year cardiovascular risk using the Framingham risk score. METHODS This was a cross-sectional study conducted on 110 T2DM patients, and the anthropometric and biochemical parameters were analyzed. The Framingham cardiovascular risk prediction model was used to calculate the 10-year risk for CVD. The CVD risk factor was compared among the genders. Further, the association between the Framingham cardiovascular risk and the various categories of risk factors was also analyzed. RESULTS Based on the Framingham cardiovascular risk score, 23 (20.9%) were at low risk, 39 (35.5%) were at moderate risk, and 48 (43.6%) were at low risk. A higher proportion of males had hypertension (55.2 vs. 17.3%; p=0.007), elevated cholesterol levels (48.3% vs. 23.1%; p=0.008), and smoking or tobacco use (31% vs. 7.7%; p=0.006) as compared to females. The significant risk factors for high 10-year CVD risk were hypertension (p=0.001), elevated total cholesterol (p=0.03), smoking or tobacco use (p=0.007), and glycemic control (p=0.04). CONCLUSION The Framingham cardiovascular risk score estimates reveal that male gender, hypertension, smoking, and uncontrolled diabetes are the important risk factors for CVD progression among diabetic patients. Therefore, it is imperative to generate awareness regarding the potential risks and then implement suitable interventions during the early phases at the primary healthcare level.
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Affiliation(s)
- Mitali B Rathod
- Department of General Medicine, NAMO Medical Education and Research Institute, Silvassa, IND
| | | | - Allwyn John Karikunnel
- Department of Accident and Emergency, Milton Keynes University Hospital, Milton Keynes, GBR
| | - Kottala Harika
- Department of General Medicine, ONE Hospitals, Karimnagar, IND
| | - Prathibha Talla
- Department of General Medicine, KIMS (Krishna Institute of Medical Sciences) Hospitals, Ongole, IND
| | - Madhurika Jalakam
- Department of General Medicine, MNR Medical College and Hospitals, Hyderabad, IND
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Priyadarsini N, Likhitha D, Ramachandran M, Behera KK. Impaired Cardiovagal Activity as a Link Between Hyperglycemia and Arterial Stiffness in Adults With Type 2 Diabetes Mellitus Among an Eastern Indian Population: A Cross-sectional Study. Can J Diabetes 2024; 48:147-154. [PMID: 38142036 DOI: 10.1016/j.jcjd.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Cardiac autonomic neuropathy (CAN) is one of the most common yet overlooked complications of type 2 diabetes mellitus (T2DM). Individuals with T2DM with CAN have a 5-fold higher rate of cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, only sparse data are available suggesting any association between autonomic dysfunction and arterial stiffness in T2DM. METHODS We recruited 80 people with T2DM and 74 healthy controls for our study. Heart rate variability (HRV) testing was performed to assess autonomic function. Assessment of arterial stiffness was done by measuring the brachial pulse wave velocity (baPWV) and augmentation index (AI). RESULTS The time-domain parameters were significantly decreased (p<0.001) and frequency-domain parameters, such as total power and high-frequency band expressed as a normalized unit, were found to be significantly reduced in people with T2DM (p<0.001). Both baPWV and AI were significantly higher in people with T2DM compared with healthy controls (p<0.001). We observed a moderate correlation between standard deviation of normal to normal interval (SDNN) and baPWV (r=-0.437, p=0.002) and AI (r=-0.403, p=0.002). A multiple linear regression model showed an association between SDNN and arterial stiffness parameters, such as baPWV and AI, which were statistically significant (p<0.05) in a fully adjusted model that included the conventional risk factors for atherosclerosis. CONCLUSIONS Impaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV testing into the diabetes management protocol would have potential benefits for identifying individuals at high risk of developing cardiovascular events. Hence, preventive measures can be taken as early as possible to improve patient outcomes.
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Affiliation(s)
- Nibedita Priyadarsini
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Devineni Likhitha
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Kishore Kumar Behera
- Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, India
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Lau DCW, Shaw E, Farris MS, McMullen S, Brar S, Cowling T, Chatterjee S, Quansah K, Kyaw MH, Girard LP. Prevalence of Adult Type 2 Diabetes Mellitus and Related Complications in Alberta, Canada: A Retrospective, Observational Study Using Administrative Data. Can J Diabetes 2024; 48:155-162.e8. [PMID: 38135113 DOI: 10.1016/j.jcjd.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease and a leading cause of morbidity/mortality in Canada. We evaluated the burden of T2DM in Alberta, Canada, by estimating the 5-year period prevalence of T2DM and rates of comorbidities and complications/conditions after T2DM. METHODS We conducted a population-based, retrospective study linking administrative health databases. Individuals with T2DM (≥18 years of age) were identified between 2008-2009 and 2018-2019 using a published algorithm, with follow-up data to March 2020. The 5-year period prevalence was estimated for 2014-2015 to 2018-2019. Individuals with newly identified T2DM, ascertained between 2010-2011 and 2017-2018 with a lookback period between 2008-2009 and 2009-2010 and a minimum 1 year of follow-up data, were evaluated for subsequent cardiovascular, diabetic, renal, and other complication/condition frequencies (%) and rates (per 100 person-years). Complications/conditions were stratified by atherosclerotic cardiovascular disease (ASCVD) status at index and age. RESULTS The 5-year period prevalence of T2DM was 11,051 per 100,000 persons, with the highest prevalence in men 65 to <75 years of age. There were 195,102 individuals included in the cohort (mean age 56.7±14.7 years). The most frequently reported complications/conditions (rates per 100 person-years) were acute infection (23.10, 95% confidence interval [CI] 23.00 to 23.30), hypertension (17.30, 95% CI 16.80 to 17.70), and dyslipidemia (12.20, 95% CI 11.90 to 12.40). Individuals who had an ASCVD event/procedure and those ≥75 years of age had higher rates of complications/conditions. CONCLUSIONS We found that over half of the individuals had hypertension or infection after T2DM. Also, those with ASCVD had higher rates of complications/conditions. Strategies to mitigate complications/conditions after T2DM are required to reduce the burden of this disease on individuals and health-care systems.
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Affiliation(s)
- David C W Lau
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
| | - Eileen Shaw
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Megan S Farris
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | | | - Saman Brar
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Satabdi Chatterjee
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Kobina Quansah
- Boehringer Ingelheim (Canada), Ltd, Burlington, Ontario, Canada
| | - Moe H Kyaw
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Louis P Girard
- Division of Nephrology, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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108
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McCoy RG, Herrin J, Swarna KS, Deng Y, Kent DM, Ross JS, Umpierrez GE, Galindo RJ, Crown WH, Borah BJ, Montori VM, Brito JP, Neumiller JJ, Mickelson MM, Polley EC. Effectiveness of glucose-lowering medications on cardiovascular outcomes in patients with type 2 diabetes at moderate cardiovascular risk. NATURE CARDIOVASCULAR RESEARCH 2024; 3:431-440. [PMID: 38846711 PMCID: PMC11156225 DOI: 10.1038/s44161-024-00453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/22/2024] [Indexed: 06/09/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among people with type 2 diabetes1-5, most of whom are at moderate CVD risk6, yet there is limited evidence on the preferred choice of glucose-lowering medication for CVD risk reduction in this population. Here, we report the results of a retrospective cohort study where data for US adults with type 2 diabetes and moderate risk for CVD are used to compare the risks of experiencing a major adverse cardiovascular event with initiation of glucagon-like peptide-1 receptor agonists (GLP-1RA; n = 44,188), sodium-glucose cotransporter 2 inhibitors (SGLT2i; n = 47,094), dipeptidyl peptidase-4 inhibitors (DPP4i; n = 84,315) and sulfonylureas (n = 210,679). Compared to DPP4i, GLP-1RA (hazard ratio (HR) 0.87; 95% confidence interval (CI) 0.82-0.93) and SGLT2i (HR 0.85; 95% CI 0.81-0.90) were associated with a lower risk of a major adverse cardiovascular event, whereas sulfonylureas were associated with a higher risk (HR 1.19; 95% CI 1.16-1.22). Thus, GLP-1RA and SGLT2i may be the preferred glucose-lowering agents for cardiovascular risk reduction in patients at moderate baseline risk for CVD. ClinicalTrials.gov registration: NCT05214573.
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Affiliation(s)
- Rozalina G McCoy
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland Institute for Health Computing, Bethesda, MD, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- OptumLabs, Eden Prairie, MN, USA
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kavya Sindhu Swarna
- OptumLabs, Eden Prairie, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Yihong Deng
- OptumLabs, Eden Prairie, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Joseph S Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Guillermo E Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rodolfo J Galindo
- Division of Endocrinology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William H Crown
- Florence Heller Graduate School, Brandeis University, Waltham, MA, USA
| | - Bijan J Borah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Victor M Montori
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joshua J Neumiller
- Department of Pharmacotherapy, Washington State University, Spokane, WA, USA
- Providence Medical Research Center, Spokane, WA, USA
| | - Mindy M Mickelson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Eric C Polley
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Tuncer O, Du Y, Michalski N, Reitzle L. Diabetes-related amputations in Germany: analysis of time trend from 2015 to 2022 and differences by area-level socioeconomic deprivation. JOURNAL OF HEALTH MONITORING 2024; 9:e12026. [PMID: 38828280 PMCID: PMC11137759 DOI: 10.25646/12026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/07/2024] [Indexed: 06/05/2024]
Abstract
Background Diabetes-related amputations reduce health-related quality of life and are an indicator of the quality of care of diabetes. Methods Population-based age-standardized rates for diabetes-related cases of major and minor amputation were calculated and reported for the years 2015 - 2022 using the Diagnosis-related groups statistics. For 2022 these rates were also reported according to area-level socioeconomic deprivation. Results Diabetes-related major amputations decreased from 6.8 to 5.2 per 100,000 residents in women and from 18.6 to 17.5 per 100,000 residents in men between 2015 and 2022. In 2021 and 2022, there was no further decrease in men compared to the previous year. Diabetes-related minor amputations decreased in women between 2015 and 2022, but increased in men. Amputation rates were higher in regions with high deprivation than in regions with low deprivation. Conclusions Diabetes care should consider socioeconomic differences into account. The monitoring of the trends in amputations needs to be continued.
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Affiliation(s)
- Oktay Tuncer
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
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McCoy RG, Swarna KS, Deng Y, Herrin JS, Ross JS, Kent DM, Borah BJ, Crown WH, Montori VM, Umpierrez GE, Galindo RJ, Brito JP, Mickelson MM, Polley EC. Derivation of an Annualized Claims-Based Major Adverse Cardiovascular Event Estimator in Type 2 Diabetes. JACC. ADVANCES 2024; 3:100852. [PMID: 38939660 PMCID: PMC11198625 DOI: 10.1016/j.jacadv.2024.100852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 06/29/2024]
Abstract
Background Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality among adults with type 2 diabetes. Currently, available MACE prediction models have important limitations, including reliance on data that may not be routinely available, narrow focus on primary prevention, limited patient populations, and longtime horizons for risk prediction. Objectives The purpose of this study was to derive and internally validate a claims-based prediction model for 1-year risk of MACE in type 2 diabetes. Methods Using medical and pharmacy claims for adults with type 2 diabetes enrolled in commercial, Medicare Advantage, and Medicare fee-for-service plans between 2014 and 2021, we derived and internally validated the annualized claims-based MACE estimator (ACME) model to predict the risk of MACE (nonfatal acute myocardial infarction, nonfatal stroke, and all-cause mortality). The Cox proportional hazards model was composed of 30 covariates, including patient age, sex, comorbidities, and medications. Results The study cohort comprised 6,623,526 adults with type 2 diabetes, mean age 68.1 ± 10.6 years, 49.8% women, and 73.0% Non-Hispanic White. ACME had a concordance index of 0.74 (validation index range: 0.739-0.741). The predicted 1-year risk of the study cohort ranged from 0.4% to 99.9%, with a median risk of 3.4% (IQR: 2.3%-6.5%). Conclusions ACME was derived in a large usual care population, relies on routinely available data, and estimates short-term MACE risk. It can support population risk stratification at the health system and payer levels, participant identification for decentralized clinical trials of cardiovascular disease, and risk-stratified observational studies using real-world data.
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Affiliation(s)
- Rozalina G. McCoy
- Division of Endocrinology, Diabetes, & Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- University of Maryland Institute for Health Computing, Bethesda, Maryland, USA
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- OptumLabs, Eden Prairie, Minnesota, USA
| | - Kavya Sindhu Swarna
- OptumLabs, Eden Prairie, Minnesota, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Yihong Deng
- OptumLabs, Eden Prairie, Minnesota, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Jeph S. Herrin
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - David M. Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Bijan J. Borah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - William H. Crown
- Florence Heller Graduate School, Brandeis University, Waltham, Massachusetts, USA
| | - Victor M. Montori
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Guillermo E. Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rodolfo J. Galindo
- Division of Endocrinology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Juan P. Brito
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Mindy M. Mickelson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Eric C. Polley
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
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Han Y, Li YF, Ye CW, Gu YY, Chen X, Gu Q, Xu QQ, Wang XM, He SM, Wang DD. Effects of dapagliflozin on body weight in patients with type 2 diabetes mellitus: Evidence‑based practice. Exp Ther Med 2024; 27:173. [PMID: 38476895 PMCID: PMC10928832 DOI: 10.3892/etm.2024.12461] [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] [Received: 07/10/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
The dose-dependent pharmacological response to dapagliflozin in patients with type 2 diabetes mellitus (T2DM) with regard to weight loss remain unknown. The aim of the present study was to investigate the effects of dapagliflozin on weight loss in patients with T2DM. A total of 8,545 patients with T2DM from 24 randomized controlled trials reported in the literature were selected for inclusion in the study. Data from these trials were analyzed using maximal effect (Emax) models with nonlinear mixed effects modeling; the evaluation index was the body weight change rate from baseline values. Patients treated with 2.5 mg/day dapagliflozin exhibited an Emax of -3.04%, and the time taken for therapy to reach half of the Emax (ET50) was estimated to be 30.8 weeks for patients treated with this dose. Patients treated with 5, 10 and 20 mg/day dapagliflozin exhibited Emax values of -6.57, -4.12 and -3.23%, respectively, and their ET50 values were estimated to be 27.3, 20.4 and 4.23 weeks, respectively. The data indicated ideal linear relationships between individual predictions and observations, suggesting the optimal fitting of the final models. The present study is the first systematic analysis of the effect of dapagliflozin on weight loss in patients with T2DM. The application of dapagliflozin at 5 mg/day exhibited a greater weight loss effect compared with the other doses used, and the weight loss onset time shortened as the dose of dapagliflozin increased.
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Affiliation(s)
- Yan Han
- Department of Emergency Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221116, P.R. China
| | - Ya-Feng Li
- Department of Pharmacy, Feng Xian People's Hospital, Xuzhou, Jiangsu 221700, P.R. China
| | - Chao-Wei Ye
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Yao-Yang Gu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Xiao Chen
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Qian Gu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Qiang-Qiang Xu
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Xian-Ming Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
| | - Su-Mei He
- Department of Pharmacy, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, Jiangsu 215153, P.R. China
| | - Dong-Dong Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, School of Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P.R. China
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Lone SS, Majid S, Bhat MH, Wani GA. Exploring the burden of mixed dyslipidemia in patients with type 2 diabetes mellitus: A cross-sectional study in Kashmir, India. Am J Hum Biol 2024; 36:e24012. [PMID: 37982356 DOI: 10.1002/ajhb.24012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Diabetes-related dyslipidemia is a multifaceted, complicated disorder characterized by an abnormal lipid profile in individuals with diabetes. The incidence of different types of dyslipidemia, however, was not a focus of prior investigations. The patients were characterized into three categories of dyslipidemia. Different patterns of dyslipidemia were combined into single dyslipidemia (7 patterns), mixed dyslipidemia (16 patterns), and triple dyslipidemia (4 patterns). METHODS In this cross-sectional study, 586 people suffering from type 2 diabetes mellitus (T2DM) were included. We assessed the serum lipid profile and used log (TG/HDL-C) to determine the atherogenic index of plasma (AIP). Dyslipidemia was examined as a categorical variable, and the findings were presented as percentages and numbers. To compare categorical variables, we either utilized Fisher exact tests or Chi square tests. RESULTS The study comprised of 586 T2DM patients, with 310 (52.9%) women and 276 (47.1%) men. Women have significantly higher hypertension (33.6%) as compared to men (23.2%). 18.94% (111) of patients were having coronary artery disease (CAD) history consisting of 12.28% (72) females and 6.66% (39) males, a difference which is statistically significant. 98.12% of total individuals had as a minimum of one lipid abnormality. 4.61% (27) of study subjects were having isolated dyslipidemia and 93.51% (548) had dual or triple pattern of dyslipidemia (mixed dyslipidemia). High AIP >0.24 (94.8%) was the most predominant trend of dyslipidemia. The dual combination of AIP (>0.24) and HDL (<50 mg/dL in Females and <40 mg/dL in Males) was found to be the most common pattern of mixed dyslipidemia (68.08%). The most prevalent trend of isolated dyslipidemia was found to be high AIP (>0.24), In patients with CAD history. Among the mixed dyslipidemia, the common pattern of dyslipidemia (71.17%) was the dual combination of high AIP (>0.24) and low HDL (<50 mg/dL women and <40 mg/dL males). The triple combination of TG (≥200 mg/dL) and HDL (<40 and <50 mg/dL) and LDL (≥100 mg/dL) was only found in females. CONCLUSION In conclusion, dyslipidemia is highly prevalent in T2DM patients, with mixed dyslipidemia being the most common type observed in the community of Kashmir valley, India. High AIP was the most prevalent pattern in the current investigation.
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Affiliation(s)
- Suhail Shafi Lone
- Department of Biochemistry, Government Medical College Srinagar, Srinagar, India
- Multidisciplinary Research Unit (MRU), Government Medical College Srinagar, Srinagar, India
| | - Sabhiya Majid
- Department of Biochemistry, Government Medical College Srinagar, Srinagar, India
| | - Mohammad Hayat Bhat
- Department of Medicine, Government Medical College Srinagar, Srinagar, India
| | - Gulzar Ahmad Wani
- Department of Biochemistry, Government Medical College Srinagar, Srinagar, India
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113
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Uceda AB, Mariño L, Casasnovas R, Adrover M. An overview on glycation: molecular mechanisms, impact on proteins, pathogenesis, and inhibition. Biophys Rev 2024; 16:189-218. [PMID: 38737201 PMCID: PMC11078917 DOI: 10.1007/s12551-024-01188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/14/2024] Open
Abstract
The formation of a heterogeneous set of advanced glycation end products (AGEs) is the final outcome of a non-enzymatic process that occurs in vivo on long-life biomolecules. This process, known as glycation, starts with the reaction between reducing sugars, or their autoxidation products, with the amino groups of proteins, DNA, or lipids, thus gaining relevance under hyperglycemic conditions. Once AGEs are formed, they might affect the biological function of the biomacromolecule and, therefore, induce the development of pathophysiological events. In fact, the accumulation of AGEs has been pointed as a triggering factor of obesity, diabetes-related diseases, coronary artery disease, neurological disorders, or chronic renal failure, among others. Given the deleterious consequences of glycation, evolution has designed endogenous mechanisms to undo glycation or to prevent it. In addition, many exogenous molecules have also emerged as powerful glycation inhibitors. This review aims to provide an overview on what glycation is. It starts by explaining the similarities and differences between glycation and glycosylation. Then, it describes in detail the molecular mechanism underlying glycation reactions, and the bio-molecular targets with higher propensity to be glycated. Next, it discusses the precise effects of glycation on protein structure, function, and aggregation, and how computational chemistry has provided insights on these aspects. Finally, it reports the most prevalent diseases induced by glycation, and the endogenous mechanisms and the current therapeutic interventions against it.
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Affiliation(s)
- Ana Belén Uceda
- Departament de Química, Universitat de Les Illes Balears, Health Research Institute of the Balearic Islands (IdISBa), Ctra. Valldemossa Km 7.5, 07122 Palma, Spain
| | - Laura Mariño
- Departament de Química, Universitat de Les Illes Balears, Health Research Institute of the Balearic Islands (IdISBa), Ctra. Valldemossa Km 7.5, 07122 Palma, Spain
| | - Rodrigo Casasnovas
- Departament de Química, Universitat de Les Illes Balears, Health Research Institute of the Balearic Islands (IdISBa), Ctra. Valldemossa Km 7.5, 07122 Palma, Spain
| | - Miquel Adrover
- Departament de Química, Universitat de Les Illes Balears, Health Research Institute of the Balearic Islands (IdISBa), Ctra. Valldemossa Km 7.5, 07122 Palma, Spain
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114
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Ballister B, Hernandez RL, Quffa LH, Franck AJ. Clinical Pharmacy Specialist Collaborative Management and Prescription of Diabetes Medications with Cardiovascular Benefit. J Pharm Pract 2024; 37:435-441. [PMID: 36469659 DOI: 10.1177/08971900221144399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background: Involvement of Clinical Pharmacy Specialists (CPS) in the care of patients with diabetes mellitus (DM) has been demonstrated to be beneficial. Whether this positive impact applies to increased use of cardiovascular risk-reducing medications is less well established. Objective: To determine the association of CPS co-management on the prescription of diabetes medications with proven cardiovascular benefits for patients with DM and established cardiovascular disease in the primary care setting. Methods: This retrospective cohort study evaluated patients in a Veterans Affairs health-system in primary care settings from February 1, 2019, through January 31, 2020. Patients were included if they had type 2 DM treated with at least one medication and had CVD. Patients were grouped into two cohorts for comparison, those with CPS co-management and those without. The primary outcome was the proportion of patients in each group with new prescriptions for empagliflozin or liraglutide initiated during the study timeframe. Results: In total, 8058 patients were found eligible for inclusion in the study. Clinical co-management by a CPS was provided to 2099 patients. Study medications were prescribed, approved, and initiated in 596 patients during the study period, including 391 (18.6%) in the CPS group and 205 (3.4%) in the non-CPS group (P < .001). Conclusion: This study showed CPS involvement is associated with increased prescribing of diabetes medications with proven cardiovascular benefits.
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Affiliation(s)
- Briana Ballister
- VA North Florida South Georgia Veterans Health System, Gainesville, FL, USA
| | - Rebecca L Hernandez
- VA North Florida South Georgia Veterans Health System, Gainesville, FL, USA
- Washington DC VA Medical Center, Washington, DC, USA
| | - Lieth H Quffa
- VA North Florida South Georgia Veterans Health System, Gainesville, FL, USA
| | - Andrew J Franck
- VA North Florida South Georgia Veterans Health System, Gainesville, FL, USA
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115
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Haslwanter V, Rochau U, Hallsson LR, Siebert U, Schönherr HR, Lechleitner M, Oberaigner W. The assessment of quality of care of patients with type 2 diabetes mellitus in a population-based cohort in the District of Landeck in Austria. Prim Care Diabetes 2024; 18:163-168. [PMID: 38336533 DOI: 10.1016/j.pcd.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Structured diabetes care based on evidence-based guidelines is one of the main strategies to improve glycemic control and to reduce long-term complications in diabetes mellitus. METHODS This study is based on the "Diabetes-Landeck Cohort", a population-based cohort of patients with diabetes mellitus type 2 (T2DM). We assessed the quality of diabetes care and compared it between three groups of care units, that is, general practitioners (GP), diabetes specialists in private practice (DSPP), and hospitals (HOSP). RESULTS The total study population comprised 1616 patients with T2DM, including 378 patients of GP, 281 of DSPP, and 957 from HOSP. We identified statistically significant differences: DSPP showed the highest percentage of structured training, sufficient training, eye examinations and foot examinations. The group HOSP showed the highest proportion for increased HbA1c≥ 7.5 and almost all long-term complications surveyed, that is, nephropathy (23.2%), neuropathy (14.4%), diabetic foot (5.1%), and cerebrovascular diseases (10.9%). CONCLUSION This population-based cohort study on patients with T2DM in Austria showed significant differences in important quality-of-care process and outcome parameters across different groups of care units. Future research should also include prediction modeling for early warning and monitoring systems as well as adjustment for patient characteristics and duration and severity of disease.
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Affiliation(s)
- Veronika Haslwanter
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Health Technology, Hall in Tirol, Austria.
| | - Ursula Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Health Technology, Hall in Tirol, Austria
| | - Lára R Hallsson
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Health Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Health Technology, Hall in Tirol, Austria; Center for Health Decision Science, Departments of Health Policy & Management and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Monika Lechleitner
- AVOMED (Arbeitskreis für Vorsorgemedizin und Gesundheitsförderung in Tirol), Austria
| | - Willi Oberaigner
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Health Technology, Hall in Tirol, Austria
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Abd Rahman R, Jayasingh Chellammal HS, Ali Shah SA, Mohd Zohdi R, Ramachandran D, Mohsin HF. Exploring the therapeutic potential of Derris elliptica (Wall.) Benth in Streptozotocin-Induced diabetic Rats: Phytochemical characterization and antidiabetic evaluation. Saudi Pharm J 2024; 32:102016. [PMID: 38463183 PMCID: PMC10920961 DOI: 10.1016/j.jsps.2024.102016] [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] [Received: 11/13/2023] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Derris elliptica (Wall.) Benth, a native medicinal plant, has been used to treat diabetes for centuries; however, comprehensive documentation of its bioactive constituents and therapeutic effectiveness is lacking. In this study, we investigated the phytochemical profile and antidiabetic potential of D. elliptica methanolic leaf extract (DEME) in diabetic Sprague Dawley rats induced with streptozotocin (STZ). In normal rats, acute oral toxicity evaluations were conducted, and in STZ-induced rats, antidiabetic properties were investigated. 14 days of oral administration of standard glibenclamide and the extract at 200 and 400 mg/kg body weight to diabetic rodents. Assessed parameters included blood glucose levels, alterations in body weight, biochemical markers, and histological analysis of the pancreas, liver, and kidney. Numerous phytoconstituents were uncovered through qualitative phytochemical assays, 1H NMR, and 1H-13C HSQC screening. Quercetin was identified by 1H NMR characterization, and a ceramide analogue compound was isolated and partially characterized by 1H NMR. There were no indications of toxicity or mortality. The treatment with DEME significantly (p < 0.001) decreased body weight and had a remarkable hypoglycemic effect. Both 200 mg/kg and 400 mg/kg extract concentrations decreased total cholesterol levels significantly (p < 0.01 and p < 0.05, respectively). In addition, glibenclamide and the 400 mg/kg dose of extract increased serum insulin levels substantially (p < 0.05) and decreased total bilirubin, lactic acid dehydrogenase, aspartate aminotransferase, and alanine aminotransferase levels. In addition to glibenclamide, treatment with DEME has exhibited cytoprotective effects and increased insulin secretion, thereby exerting a potent antihyperglycemic effect. These results suggest that D. elliptica may have therapeutic potential for the treatment of diabetes mellitus.
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Affiliation(s)
- Rassheda Abd Rahman
- Department of Pharmacology and Pharmaceutical Chemistry, Faculty of Pharmacy, UiTM Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
- Department of Pharmacology, School of Pharmacy, KPJ Healthcare University, Kota Seriemas, 71800 Nilai, Negeri Sembilan, Malaysia
| | - Hanish Singh Jayasingh Chellammal
- Department of Pharmacology and Pharmaceutical Chemistry, Faculty of Pharmacy, UiTM Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
| | - Syed Adnan Ali Shah
- Department of Pharmacology and Pharmaceutical Chemistry, Faculty of Pharmacy, UiTM Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
| | - Rozaini Mohd Zohdi
- Atta-ur-Rahman Institute for Natural Product Discovery, UiTM Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
| | - Dhani Ramachandran
- International Medical School, Management and Science University, University Drive, Off Persiaran Olahraga, 40100 Shah Alam, Selangor, Malaysia
| | - Hannis Fadzillah Mohsin
- Department of Pharmacology and Pharmaceutical Chemistry, Faculty of Pharmacy, UiTM Selangor, Puncak Alam Campus, 42300 Bandar Puncak Alam, Selangor, Malaysia
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Thakur MR, Nachane SS, Tupe RS. Alleviation of albumin glycation-induced diabetic cardiomyopathy by L-Arginine: Insights into Nrf-2 signaling. Int J Biol Macromol 2024; 264:130478. [PMID: 38428781 DOI: 10.1016/j.ijbiomac.2024.130478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
In hyperglycemia, accelerated glycation and oxidative stress give rise to many diabetic complications, such as diabetic cardiomyopathy (DCM). Glycated human serum albumin (GHSA) has disturbed structural integrity and hampered functional capabilities. When GHSA accumulates around cardiac cells, Nrf-2 is dysregulated, aiding oxidative stress. L-Arginine (L-Arg) is prescribed to patients with diabetes and cardiovascular diseases. This research contributes to the mechanistic insights on antiglycation and antioxidant potential of L-Arg in alleviating DCM. HSA was glycated with methylglyoxal in the presence of L-Arg (20-640 mM). Structural and functional modifications of HSA were studied. L-Arg and HSA, GHSA interactions, and thermodynamics were determined by steady-state fluorescence. H9c2 cardiomyocytes were given treatments of GHSA-L-Arg along with the inhibitor of the receptor of AGEs. Cellular antioxidant levels, detoxification enzyme activities were measured. Gene, protein expressions, and immunofluorescence data examined the activation and nuclear translocation of Nrf-2 during glycation and oxidative stress. L-Arg protected HSA from glycation-induced structural and functional modifications. The binding affinity of L-Arg was more towards HSA (104 M-1). L-Arg, specifically at lower concentration (20 mM), upregulated Nrf-2 gene, protein expressions and facilitated its nuclear translocation by activating Nrf-2 signaling. The study concluded that L-Arg can be of therapeutic advantage in glycation-induced DCM and associated oxidative stress.
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Affiliation(s)
- Muskan R Thakur
- Symbiosis School of Biological Sciences (SSBS), Symbiosis International (Deemed University) (SIU), Lavale, Pune 412115, Maharashtra State, India
| | - Sampada S Nachane
- Symbiosis School of Biological Sciences (SSBS), Symbiosis International (Deemed University) (SIU), Lavale, Pune 412115, Maharashtra State, India
| | - Rashmi S Tupe
- Symbiosis School of Biological Sciences (SSBS), Symbiosis International (Deemed University) (SIU), Lavale, Pune 412115, Maharashtra State, India.
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Kim H, Choi CU, Rhew K, Park J, Lim Y, Kim MG, Kim K. Comparative effects of glucose-lowering agents on endothelial function and arterial stiffness in patients with type 2 diabetes: A network meta-analysis. Atherosclerosis 2024; 391:117490. [PMID: 38452432 DOI: 10.1016/j.atherosclerosis.2024.117490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIMS Despite accumulating evidence on the potential of glucose-lowering agents (GLAs) to prevent cardiovascular events, the comparative effects of GLAs on vascular function remain unclear. This study utilized validated indicators such as flow-mediated dilation (FMD; positive value favors) and pulse wave velocity (PWV; negative value favors) to uncover the comparative effects of GLAs on vascular function. METHODS Randomized controlled trials (RCTs) comparing the effects of GLAs on FMD or PWV with placebo or other GLAs in patients with type 2 diabetes (T2DM) were searched through PubMed and Embase. The frequentist method of network meta-analysis (NMA) was conducted using a random effects model, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. RESULTS The NMA included 38 RCTs with 2,065 patients. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose cotransporter-2 inhibitors (SGLT-2Is) had significantly more positive effects on FMD improvement and PWV reduction than placebo. Thiazolidinedione (TZD) treatment resulted in significantly improved FMD compared to other GLAs as well as placebo (SMD: 1.14; 95% CI: 0.84 to 1.43). Both pioglitazone and rosiglitazone were discovered to have considerably more favorable effects on improving FMD and reducing PWV compared to placebo and other GLAs, as a result of the analysis incorporating each drug in the TZD class. The sensitivity analysis results corroborated the main findings. CONCLUSIONS This NMA showed more favorable effects of GLP-1RAs and SGLT-2Is than placebo in improving both arterial stiffness and endothelial function in patients with T2DM. In addition, TZDs showed superior effects in improving endothelial function as compared with the other GLAs and placebo.
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Affiliation(s)
- Hayeon Kim
- College of Pharmacy, Korea University, Sejong, 30019, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, 08308, Republic of Korea
| | - Kiyon Rhew
- College of Pharmacy, Dongduk Women's University, Seoul, 02748, Republic of Korea
| | - Jiwon Park
- College of Pharmacy, Korea University, Sejong, 30019, Republic of Korea
| | - Yejee Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, 13620, Republic of Korea
| | - Myeong Gyu Kim
- College of Pharmacy, Ewha Womans University, Seoul, 03760, Republic of Korea; Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, Republic of Korea.
| | - Kyungim Kim
- College of Pharmacy, Korea University, Sejong, 30019, Republic of Korea; Institute of Pharmaceutical Science, Korea University, Sejong, 30019, Republic of Korea.
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Mezzetto L, Mastrorilli D, Zanetti E, Scoccia E, Pecoraro B, Sboarina A, Mantovani A, Veraldi GF. Clinical risk factors and features on computed tomography angiography in high-risk carotid artery plaque in patients with type 2 diabetes. INT ANGIOL 2024; 43:280-289. [PMID: 38470152 DOI: 10.23736/s0392-9590.24.05154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND High-risk carotid artery plaque (HPR) is associated with a markedly increased risk of ischemic stroke. The aims of this study were: 1) to examine the prevalence of HRP in a cohort of asymptomatic adults with type 2 diabetes (T2D); 2) to investigate the relationship between HRP, established cardiovascular risk factors and computed tomography angiography (CTA) profile; and 3) to assess whether the presence of HRP is associated with an increased risk of major adverse cardiovascular events (MACE). METHODS This was a retrospective cohort study of T2D asymptomatic patients who underwent carotid endarterectomy (CEA) from January 2018 to July 2021. The carotid atherosclerotic plaque (CAP) was assessed for the presence of ulceration, the presence of lipids, fibrosis, thrombotic deposits, hemorrhage, neovascularization, and inflammation. A CAP presenting at least five of these histological features was defined as a HRP (Group A); in all other cases it was defined as a mild to moderate heterogeneous plaque and no-HRP (Group B). CTA features included the presence of rim sign consisting of thin peripheral adventitial calcification (<2 mm) and internal soft plaque (≥2 mm), NASCET percent diameter stenosis, maximum plaque thickness, ulceration, calcification, and intraluminal thrombus were recorded. Binary logistic regression with Uni- and Multivariate was used to evaluate possible predictors for HRP while multivariable Cox Proportional Hazards was used to assess independent predictors for MACE. RESULTS One hundred eighty-five asymptomatic patients (mean age 73±8 years, 131 men), undergoing carotid endarterectomy, were included. Of these, 124 (67%) had HRP, and the 61 (33%) did not. Diabetic complications (OR 2.4, 95% CI: 1.1-5.1, P=0.01), NASCET stenosis ≥75% (OR 2.4, 95% CI: 1.2-3.7, P=0.02) and carotid RIM sign (OR 4.3, 95% CI: 3.9-7.3, P<0.001) were independently associated with HRP. However, HRP was not associated with a higher risk of MACE (freedom from MACE at 5 years: HRP 83.4% vs. non HRP 87.8%, P=0.72) or a reduction of survival (5-year survival estimates: HRP 96.4% vs. non HRP: 94.6%, P=0.76). CONCLUSIONS A high prevalence of HRP (67%) was observed in asymptomatic and elderly T2D patients. Independent predictors of HRP were diabetic complications, NASCET stenosis ≥75% and carotid RIM sign (OR 4.3, 95% CI: 3.9-7.3, P<0.001). HRP was not associated with an increased risk of MACE during a mean follow-up of 39±24 years.
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Affiliation(s)
- Luca Mezzetto
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy
| | - Davide Mastrorilli
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy -
| | - Elisa Zanetti
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy
| | - Enrico Scoccia
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Barbara Pecoraro
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Andrea Sboarina
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Gian F Veraldi
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, Verona, Italy
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Spasovski G, Rroji M, Hristov G, Bushljetikj O, Spahia N, Rambabova Bushletikj I. A New Hope on the Horizon for Kidney and Cardiovascular Protection with SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Mineralocorticoid Receptor Antagonists in Type 2 Diabetic and Chronic Kidney Disease Patients. Metab Syndr Relat Disord 2024; 22:170-178. [PMID: 38386800 DOI: 10.1089/met.2023.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD). In addition, the cardiovascular prevalence in diabetic patients is around 32.2%, with a two-fold increased mortality risk compared to those without diabetes. Recent investigations have shed light on the promising cardioprotective and nephroprotective benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) for individuals with T2D. The evidence robustly indicates that SGLT2i and GLP-1RA significantly reduce the risk of CKD and cardiovascular disease (CVD), all while effectively managing blood glucose levels. Furthermore, combining SGLT2i with nsMRAs amplifies the benefits, potentially offering a more profound reduction in cardiovascular and renal outcomes. The data analysis strongly supports the integration of these pharmacological agents in the management strategies for CKD and CVD prevention among T2D patients, highlighting the importance of awareness among nephrologists, especially in regions with limited healthcare resources.
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Affiliation(s)
- Goce Spasovski
- Department of Nephrology, Medical Faculty, University Sts. Cyril and Methodius, Skopje, North Macedonia
| | - Merita Rroji
- Department of Nephrology, University of Medicine of Tirana, Tirana, Albania
| | - Goce Hristov
- Department of Internal Medicine and Diabetes, General Public Hospital Strumica, Strumica, North Macedonia
| | - Oliver Bushljetikj
- Department of Cardiology, Medical Faculty, University Sts. Cyril and Methodius, Skopje, North Macedonia
| | - Nereida Spahia
- Department of Nephrology, University of Medicine of Tirana, Tirana, Albania
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Dhokte S, Czaja K. Visceral Adipose Tissue: The Hidden Culprit for Type 2 Diabetes. Nutrients 2024; 16:1015. [PMID: 38613048 PMCID: PMC11013274 DOI: 10.3390/nu16071015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by insulin resistance in various tissues. Though conventionally associated with obesity, current research indicates that visceral adipose tissue (VAT) is the leading determining factor, wielding more influence regardless of individual body mass. The heightened metabolic activity of VAT encourages the circulation of free fatty acid (FFA) molecules, which induce insulin resistance in surrounding tissues. Individuals most vulnerable to this preferential fat deposition are older males with ancestral ties to Asian countries because genetics and sex hormones are pivotal factors for VAT accumulation. However, interventions in one's diet and lifestyle have the potential to strategically discourage the growth of VAT. This illuminates the possibility that the expansion of VAT and, subsequently, the risk of T2D development are preventable. Therefore, by reducing the amount of VAT accumulated in an individual and preventing it from building up, one can effectively control and prevent the development of T2D.
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Affiliation(s)
| | - Krzysztof Czaja
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA;
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122
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Ha KS. Transglutaminase 2 in diabetes mellitus: Unraveling its multifaceted role and therapeutic implications for vascular complications. Theranostics 2024; 14:2329-2344. [PMID: 38646650 PMCID: PMC11024853 DOI: 10.7150/thno.95742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024] Open
Abstract
Diabetes, a severe metabolic disease characterized by chronic hypoglycemia, poses debilitating and life-threatening risks of microvascular and macrovascular complications, including blindness, kidney failure, heart attacks, and limb amputation. Addressing these complications is paramount, urging the development of interventions targeting diabetes-associated vascular dysfunctions. To effectively combat diabetes, a comprehensive understanding of the pathological mechanisms underlying complications and identification of precise therapeutic targets are imperative. Transglutaminase 2 (TGase2) is a multifunctional enzyme implicated in the pathogenesis of diverse diseases such as neurodegenerative disorders, fibrosis, and inflammatory conditions. TGase2 has recently emerged as a key player in both the pathogenesis and therapeutic intervention of diabetic complications. This review highlights TGase2 as a therapeutic target for diabetic complications and explores TGase2 inhibition as a promising therapeutic approach in their treatment.
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Affiliation(s)
- Kwon-Soo Ha
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Kangwon-do 24341, Korea
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123
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Liu T, Fan Z, Xiao B, He C, Wang S. Association of sodium-glucose cotransporter 2 inhibitors with risk of major adverse cardiovascular events in type 2 diabetes patients with acute coronary syndrome: a propensity score‑matched analysis. Cardiovasc Diabetol 2024; 23:106. [PMID: 38528542 PMCID: PMC10964669 DOI: 10.1186/s12933-024-02200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study aimed to investigate the association of sodium-glucose cotransporter 2 inhibitors (SGLT2i) use with cardiovascular (CV) clinical outcomes in type 2 diabetes (T2D) patients with acute coronary syndrome (ACS). METHODS Data of T2D patients hospitalized for ACS at Civil Aviation General Hospital from January 2019 to December 2022 were collected. Based on SGLT2i use or not, patients were stratified as SGLT2i group and SGLT2i-free group. A 1:1 nearest-neighbor propensity score-matched (PSM) was performed to adjust for the confounding factors and facilitate the robust comparisons between groups. The first occurrence of major adverse cardiovascular events (MACE) with 1 year follow-up, which consisted of CV death, all cause death, non-fatal myocardial infarction or stroke, coronary revascularization or heart failure readmission, was assessed. Kaplan-Meier analysis and Cox regressions were conducted to evaluate the prognostic significance of SGLT2i use. Subgroup analyses were performed to assess the interaction between subgroups and SGLT2i use. RESULTS A total of 925 patients were included, and the SGLT2i use increased from 9.9% in 2019 to 43.8% in 2022. 226 pairs were finally matched using the PSM model. During 1 year follow-up period, a total of 110 patients experienced MACE in the matched cohort, with a rate of 24.3%. Survival analyses showed cumulative incidence of MACE, CV death, and heart failure readmission in the SGLT2i group were significantly lower than the SGLT2i-free group. Additionally, the adjusted Cox analyses demonstrated that SGLT2i was associated with a 34.1% lower risk of MACE (HR 0.659, 95% CI 0.487-0.892, P = 0.007), which was primarily driven by a decrease in the risk of CV death by 12.0% (HR 0.880, 95% CI 0.7830.990, P = 0.033), and heart failure readmission by 45.5% (HR 0.545, 95% CI 0.332-0.893, P = 0.016). This MACE preventive benefit was consistent across different subgroups (P interaction > 0.05 for all comparisons). CONCLUSIONS In T2D patients with ACS, there was a clear increasing trend in SGLT2i use. SGLT2i was associated with a significantly lower risk of MACE, driven by the decrease in the risk of CV death, and heart failure readmission. Our study confirmed real-world use and efficacy of SGLT2i in a general T2D population with ACS.
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Affiliation(s)
- Tao Liu
- Department of Coronary Heart Disease, Civil Aviation General Hospital, No. 1 Gaojingjia Road, Chaoyang District, Beijing, China
| | - Zeyuan Fan
- Department of Coronary Heart Disease, Civil Aviation General Hospital, No. 1 Gaojingjia Road, Chaoyang District, Beijing, China.
| | - Bing Xiao
- Department of Coronary Heart Disease, Civil Aviation General Hospital, No. 1 Gaojingjia Road, Chaoyang District, Beijing, China
| | - Chang He
- Department of Coronary Heart Disease, Civil Aviation General Hospital, No. 1 Gaojingjia Road, Chaoyang District, Beijing, China
| | - Shicong Wang
- Department of Coronary Heart Disease, Civil Aviation General Hospital, No. 1 Gaojingjia Road, Chaoyang District, Beijing, China
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Schnell O, Barnard-Kelly K, Battelino T, Ceriello A, Larsson HE, Fernández-Fernández B, Forst T, Frias JP, Gavin JR, Giorgino F, Groop PH, Heerspink HJL, Herzig S, Hummel M, Huntley G, Ibrahim M, Itzhak B, Jacob S, Ji L, Kosiborod M, Lalic N, Macieira S, Malik RA, Mankovsky B, Marx N, Mathieu C, Müller TD, Ray K, Rodbard HW, Rossing P, Rydén L, Schumm-Draeger PM, Schwarz P, Škrha J, Snoek F, Tacke F, Taylor B, Jeppesen BT, Tesfaye S, Topsever P, Vilsbøll T, Yu X, Standl E. CVOT Summit Report 2023: new cardiovascular, kidney, and metabolic outcomes. Cardiovasc Diabetol 2024; 23:104. [PMID: 38504284 PMCID: PMC10953147 DOI: 10.1186/s12933-024-02180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
The 9th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 30-December 1, 2023. This reference congress served as a platform for in-depth discussions and exchange on recently completed outcomes trials including dapagliflozin (DAPA-MI), semaglutide (SELECT and STEP-HFpEF) and bempedoic acid (CLEAR Outcomes), and the advances they represent in reducing the risk of major adverse cardiovascular events (MACE), improving metabolic outcomes, and treating obesity-related heart failure with preserved ejection fraction (HFpEF). A broad audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians participated in online discussions on guideline updates for the management of cardiovascular disease (CVD) in diabetes, heart failure (HF) and chronic kidney disease (CKD); advances in the management of type 1 diabetes (T1D) and its comorbidities; advances in the management of CKD with SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists (nsMRAs); and advances in the treatment of obesity with GLP-1 and dual GIP/GLP-1 receptor agonists. The association of diabetes and obesity with nonalcoholic steatohepatitis (NASH; metabolic dysfunction-associated steatohepatitis, MASH) and cancer and possible treatments for these complications were also explored. It is generally assumed that treatment of chronic diseases is equally effective for all patients. However, as discussed at the Summit, this assumption may not be true. Therefore, it is important to enroll patients from diverse racial and ethnic groups in clinical trials and to analyze patient-reported outcomes to assess treatment efficacy, and to develop innovative approaches to tailor medications to those who benefit most with minimal side effects. Other keys to a successful management of diabetes and comorbidities, including dementia, entail the use of continuous glucose monitoring (CGM) technology and the implementation of appropriate patient-physician communication strategies. The 10th Cardiovascular Outcome Trial Summit will be held virtually on December 5-6, 2024 ( http://www.cvot.org ).
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e. V, Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Neuherberg (Munich), Germany.
| | | | - Tadej Battelino
- University Medical Center, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Helena Elding Larsson
- Department of Pediatrics, Skåne University Hospital, Malmö/Lund, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | | | - Thomas Forst
- CRS Clinical Research Services Mannheim GmbH, Mannheim, Germany
| | | | - James R Gavin
- Emory University School of Medicine, Atlanta, GA, United States of America
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Diabetes, Central Medical School, Monash University, Melbourne, Australia
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Herzig
- Division Diabetic Complications, Institute for Diabetes and Cancer, Helmholtz Center Munich, Neuherberg, Germany
| | - Michael Hummel
- Forschergruppe Diabetes e. V, Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Neuherberg (Munich), Germany
| | - George Huntley
- Diabetes Leadership Council, Indianapolis, IN, United States of America
| | - Mahmoud Ibrahim
- Center for Diabetes Education, EDC, Charlotte, NC, United States of America
| | - Baruch Itzhak
- Clalit Health Services, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Stephan Jacob
- Practice for Prevention and Therapy and Cardio-Metabolic Institute, Villingen-Schwenningen, Germany
| | - Linong Ji
- Peking University People's Hospital, Xicheng District, Beijing, China
| | - Mikhail Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Nebosja Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Ar-Rayyan, Doha, Qatar
| | - Boris Mankovsky
- Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Nikolaus Marx
- Clinic for Cardiology, Pneumology, Angiology and Internal Intensive Care Medicine (Medical Clinic I), RWTH Aachen University Hospital, Aachen, Germany
| | - Chantal Mathieu
- Department of Endocrinology, Catholic University Leuven, Leuven, Belgium
| | - Timo D Müller
- Institute for Diabetes and Obesity, Helmholtz Munich, Munich, Germany
- Walther-Straub Institute for Pharmacology and Toxicology, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Kausik Ray
- School of Public Health, Imperial College London, London, United Kingdom
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, United States of America
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Peter Schwarz
- Medical Clinic III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Škrha
- Third Medical Department and Laboratory for Endocrinology and Metabolism, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Frank Snoek
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Bruce Taylor
- Diabetes Patient Advocacy Coalition, Tampa, FL, United States of America
| | | | - Solomon Tesfaye
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
- University of Sheffield, Sheffield, United Kingdom
| | - Pinar Topsever
- Department of Family Medicine, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Türkiye
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Eberhard Standl
- Forschergruppe Diabetes e. V, Helmholtz Center Munich, Ingolstaedter Landstraße 1, 85764, Neuherberg (Munich), Germany
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Zeng C, Liu M, Zhang Y, Deng S, Xin Y, Hu X. Association of Urine Albumin to Creatinine Ratio With Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:1080-1093. [PMID: 37922304 PMCID: PMC10940266 DOI: 10.1210/clinem/dgad645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023]
Abstract
CONTEXT The urinary albumin to creatinine ratio (UACR) is a widely used indicator of albuminuria and has predictive value for adverse cardiovascular events. OBJECTIVE To evaluate the correlation between the UACR and the risk of developing major adverse cardiovascular events (MACEs) and total mortality in patients with type 2 diabetes mellitus (T2DM). METHODS This post hoc analysis included 10 171 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the ACCORD follow-up study (ACCORDION) with baseline UACR data. The natural logarithm (ln) of each UACR measurement was calculated. Univariate and multivariate Cox proportional hazard regression analyses were conducted to examine the association between the UACR and the risk of MACEs and total mortality. The additional predictive value of UACR was further evaluated. Similar methods were used to analyze the correlation between the UACR and MACEs and total mortality within the normal range. RESULTS During a median follow-up period of 8.83 years, 1808 (17.78%) participants experienced MACEs, and there were 1934 (19.01%) total deaths. After adjusting for traditional cardiovascular risk factors, the multivariate analysis revealed a significant association between the UACR and the risk of MACEs and total mortality. The inclusion of UACR in the conventional risk model enhanced the predictive efficacy for MACEs and total mortality. CONCLUSION An elevated UACR is associated with a higher risk of MACEs and total mortality in patients with T2DM, even when it falls within the normal range. The UACR improves prediction of MACE and total mortality risk in patients with T2DM.
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Affiliation(s)
- Cheng Zeng
- Department of Cardiology, The Second Xiangya Hospital of Central South University, No. 139, Middle Ren-min Road, Changsha 410011, Hunan Province, People's Republic of China
| | - Maojun Liu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, No. 139, Middle Ren-min Road, Changsha 410011, Hunan Province, People's Republic of China
| | - Yifeng Zhang
- Department of Cardiology, The Second Xiangya Hospital of Central South University, No. 139, Middle Ren-min Road, Changsha 410011, Hunan Province, People's Republic of China
| | - Simin Deng
- Department of Cardiology, The Second Xiangya Hospital of Central South University, No. 139, Middle Ren-min Road, Changsha 410011, Hunan Province, People's Republic of China
| | - Ying Xin
- Department of Cardiology, The Second Xiangya Hospital of Central South University, No. 139, Middle Ren-min Road, Changsha 410011, Hunan Province, People's Republic of China
| | - Xinqun Hu
- Department of Cardiology, The Second Xiangya Hospital of Central South University, No. 139, Middle Ren-min Road, Changsha 410011, Hunan Province, People's Republic of China
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Bernard M, Kober F. Editorial for "Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis in Patients with Type 2 Diabetes Using Quantitative Perfusion MRI". J Magn Reson Imaging 2024. [PMID: 38454884 DOI: 10.1002/jmri.29346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
| | - Frank Kober
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
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Gui LK, Liu HJ, Jin LJ, Peng XC. Krüpple-like factors in cardiomyopathy: emerging player and therapeutic opportunities. Front Cardiovasc Med 2024; 11:1342173. [PMID: 38516000 PMCID: PMC10955087 DOI: 10.3389/fcvm.2024.1342173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Cardiomyopathy, a heterogeneous pathological condition characterized by changes in cardiac structure or function, represents a significant risk factor for the prevalence and mortality of cardiovascular disease (CVD). Research conducted over the years has led to the modification of definition and classification of cardiomyopathy. Herein, we reviewed seven of the most common types of cardiomyopathies, including Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), diabetic cardiomyopathy, Dilated Cardiomyopathy (DCM), desmin-associated cardiomyopathy, Hypertrophic Cardiomyopathy (HCM), Ischemic Cardiomyopathy (ICM), and obesity cardiomyopathy, focusing on their definitions, epidemiology, and influencing factors. Cardiomyopathies manifest in various ways ranging from microscopic alterations in cardiomyocytes, to tissue hypoperfusion, cardiac failure, and arrhythmias caused by electrical conduction abnormalities. As pleiotropic Transcription Factors (TFs), the Krüppel-Like Factors (KLFs), a family of zinc finger proteins, are involved in regulating the setting and development of cardiomyopathies, and play critical roles in associated biological processes, including Oxidative Stress (OS), inflammatory reactions, myocardial hypertrophy and fibrosis, and cellular autophagy and apoptosis, particularly in diabetic cardiomyopathy. However, research into KLFs in cardiomyopathy is still in its early stages, and the pathophysiologic mechanisms of some KLF members in various types of cardiomyopathies remain unclear. This article reviews the roles and recent research advances in KLFs, specifically those targeting and regulating several cardiomyopathy-associated processes.
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Affiliation(s)
- Le-Kun Gui
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
- School of Medicine, Yangtze University, Jingzhou, Hubei, China
| | - Huang-Jun Liu
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Li-Jun Jin
- Department of Cardiology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Xiao-Chun Peng
- Department of Pathophysiology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Laboratory of Oncology, School of Basic Medicine, Center for Molecular Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
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128
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Da Porto A, Candido R, Rocca A, Manicardi V, Nicolucci A, Miranda C, Cimino E, Di Bartolo P, Di Cianni G, Russo G. Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals. J Endocrinol Invest 2024:10.1007/s40618-024-02327-0. [PMID: 38436903 DOI: 10.1007/s40618-024-02327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia. METHODS This was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score. RESULTS Using the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM. CONCLUSIONS In conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.
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Affiliation(s)
- A Da Porto
- Diabetes and Metabolism Unit, Clinica Medica, University of Udine, Udine, Italy.
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | | | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy
| | - C Miranda
- Endocrinology and Diabetes Unit, ASFO, Pordenone, Italy
| | - E Cimino
- UOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - P Di Bartolo
- Ravenna Diabetes Center-Romagna Local Health Authority, Ravenna, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
| | - G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Barber MJ, Gotham D, Bygrave H, Cepuch C. Estimated Sustainable Cost-Based Prices for Diabetes Medicines. JAMA Netw Open 2024; 7:e243474. [PMID: 38536176 PMCID: PMC10973901 DOI: 10.1001/jamanetworkopen.2024.3474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/29/2024] [Indexed: 04/23/2024] Open
Abstract
Importance The burden of diabetes is growing worldwide. The costs associated with diabetes put substantial pressure on patients and health budgets, especially in low- and middle-income countries. The prices of diabetes medicines are a key determinant for access, yet little is known about the association between manufacturing costs and current market prices. Objectives To estimate the cost of manufacturing insulins, sodium-glucose cotransporter 2 inhibitors (SGLT2Is), and glucagonlike peptide 1 agonists (GLP1As), derive sustainable cost-based prices (CBPs), and compare these with current market prices. Design, Setting, and Participants In this economic evaluation, the cost of manufacturing insulins, SGLT2Is, and GLP1As was modeled. Active pharmaceutical ingredient cost per unit (weighted least-squares regression model using data from a commercial database of trade shipments, data from January 1, 2016, to March 31, 2023) was combined with costs of formulation and other operating expenses, plus a profit margin with an allowance for tax, to estimate CBPs. Cost-based prices were compared with current prices in 13 countries, collected in January 2023 from public databases. Countries were selected to provide representation of different income levels and geographic regions based on the availability of public databases. Main Outcomes and Measures Estimated CBPs; lowest current market prices (2023 US dollars). Results In this economic evaluation of manufacturing costs, estimated CBPs for treatment with insulin in a reusable pen device could be as low as $96 (human insulin) or $111 (insulin analogues) per year for a basal-bolus regimen, $61 per year using twice-daily injections of mixed human insulin, and $50 (human insulin) or $72 (insulin analogues) per year for a once-daily basal insulin injection (for type 2 diabetes), including the cost of injection devices and needles. Cost-based prices ranged from $1.30 to $3.45 per month for SGLT2Is (except canagliflozin: $25.00-$46.79) and from $0.75 to $72.49 per month for GLP1As. These CBPs were substantially lower than current prices in the 13 countries surveyed. Conclusions and Relevance High prices limit access to newer diabetes medicines in many countries. The findings of this study suggest that robust generic and biosimilar competition could reduce prices to more affordable levels and enable expansion of diabetes treatment globally.
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Affiliation(s)
- Melissa J. Barber
- Yale Collaboration for Regulatory Rigor, Integrity, and Transparency (CRRIT), New Haven, Connecticut
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dzintars Gotham
- King’s College Hospital, London, United Kingdom
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
| | - Helen Bygrave
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
| | - Christa Cepuch
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
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130
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Alkhami F, Borderie G, Foussard N, Larroumet A, Blanco L, Barbet-Massin MA, Ferriere A, Ducos C, Mohammedi K, Fawaz S, Couffinhal T, Rigalleau V. Skin autofluorescence of advanced glycation end-products relates to new cardiovascular events in type 2 diabetes: A longitudinal observational study. DIABETES & METABOLISM 2024; 50:101524. [PMID: 38346471 DOI: 10.1016/j.diabet.2024.101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Cardiovascular disease is frequent in type 2 diabetes mellitus (T2DM). We investigated the relationship between skin autofluorescence (SAF) of advanced glycation end-products and later cardiovascular events (CVEs) in patients with T2DM. RESEARCH DESIGN AND METHODS We conducted a retrospective analysis of 504 patients hospitalized for uncontrolled and/or complicated T2DM between 2009 and 2017. SAF was measured using an AGE-Reader. Participants were followed up from admission to December 2020, for the onset of a CVE (myocardial infarction, stroke, revascularization procedures or cardiovascular death). The relationship between SAF and CVE was analyzed by multivariable Cox regression. Log-rank curves were used to compare CVE-free survival in patients whose SAF at admission was above versus below the whole-population median. The analysis was repeated in subjects without/with macroangiopathy (defined as myocardial infarction, stroke, peripheral revascularization) at baseline. FINDINGS During 54 months of follow-up, 69 (13.7%) patients had a CVE. Baseline SAF was significantly higher in patients with T2DM who later experienced a CVE (2.89 ± 0.70 arbitrary units versus 2.64 ± 0.62 in others, P = 0.002). This relationship was significant after adjusting for age, sex, conventional risk factors (diabetes duration, HbA1c, arterial hypertension, dyslipidemia, smoking, body mass index), vascular complications, C-reactive protein, and treatments for diabetes. The CVE-free survival curves differed between subjects whose SAF was above the whole-population median (log-rank: P = 0.002) and those whose SAF was above the macroangiopathy-free sub-population median (log-rank: P = 0.016). CONCLUSION SAF of advanced glycation end-products was related to a higher incidence of later CVE in patients with T2DM.
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Affiliation(s)
- Fadi Alkhami
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Gauthier Borderie
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Ninon Foussard
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Alice Larroumet
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Laurence Blanco
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | | | - Amandine Ferriere
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Claire Ducos
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Kamel Mohammedi
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Sami Fawaz
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Thierry Couffinhal
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France
| | - Vincent Rigalleau
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Cardiology, 33000 Bordeaux, France.
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Chen X, Hou X, Gao J, Yu X, Zeng W, Lv R, Yang X, Liu Y. Ethnic disparities in cardiovascular and renal responses to canagliflozin between Asian and White patients with type 2 diabetes mellitus: A post hoc analysis of the CANVAS Program. Diabetes Obes Metab 2024; 26:878-890. [PMID: 38031821 DOI: 10.1111/dom.15380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
AIM To assess the potential heterogeneity in cardiovascular (CV), renal and safety outcomes of canagliflozin between Whites and Asians, as well as these outcomes in each subgroup. MATERIALS AND METHODS The CANVAS Program enrolled 10 142 patients with type 2 diabetes, comprising 78.34% Whites and 12.66% Asians. CV, renal and safety outcomes were comprehensively analysed using Cox regression models, while intermediate markers were assessed using time-varying mixed-effects models. Racial heterogeneity was evaluated by adding a treatment-race interacion term. RESULTS Canagliflozin showed no significant racial disparities in the majority of the CV, renal and safety outcomes. The heterogeneity (p = .04) was observed on all-cause mortality, with reduced risk in Whites (hazard ratio 0.84; 95% confidence interval 0.71-0.99) and a statistically non-significant increased risk in Asians (hazard ratio 1.64; 95% confidence interval 0.94-2.90). There was a significant racial difference in acute kidney injury (p = .04) and a marginally significant racial heterogeneity for the composite of hospitalization for heart failure and CV death (p = .06) and serious renal-related adverse events (p = .07). CONCLUSION Canagliflozin reduced CV and renal risks similarly in Whites and Asians; however, there was a significant racial discrepancy in all-cause mortality. This distinction may be attributed to the fact that Asian patients exhibited diminished CV protection effects and more renal adverse events with canagliflozin, potentially resulting from the smaller reductions in weight and uric acid. These findings highlight the importance of investigating the impact of race on treatment response to sodium-glucose cotransporter-2 inhibitors and provide more precise treatment strategies.
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Affiliation(s)
- Xi Chen
- Department of Pharmacy, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Xingyun Hou
- Buddhism and Science Research Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong, China
| | - Junling Gao
- Department of Pharmacy, Shanghai ChangZheng Hospital, Shanghai, China
| | - Xiaxia Yu
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
| | - Weixian Zeng
- Department of Critical Care Medicine, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Ronggui Lv
- Department of Critical Care Medicine, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Xixiao Yang
- Department of Pharmacy, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Yong Liu
- Department of Critical Care Medicine, Shenzhen Hospital of Southern Medical University, Shenzhen, China
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132
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Tomic D, Chen L, Moran LL, Magliano DJ, Shaw JE. Causes of death among Australians with type 1 or type 2 diabetes, 2002-2019. Diabet Med 2024; 41:e15206. [PMID: 37597240 DOI: 10.1111/dme.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
AIMS This population-based study sought to explore in detail the conditions driving the diversification in causes of death among people with diabetes. METHODS We linked Australians with type 1 or type 2 diabetes of all ages on the National Diabetes Services Scheme to the National Death Index for 2002-2019. We investigated the proportional contributions of different causes of death to total deaths over time across eight categories of causes of death, stratified by sex and diabetes type. The underlying causes of death were classified according to the International Classification of Diseases, Tenth Revision codes. RESULTS Between 2002 and 2019, there was a shift in the causes of death among Australians with diabetes away from cardiovascular disease. The proportion of deaths attributed to cardiovascular disease declined in both sexes (ptrend <0.001), most substantially among women with type 2 diabetes from 48.2% in 2002 to 30.7% in 2019. Among men with type 2 diabetes, cancer replaced cardiovascular disease as the leading cause of death. The proportion of deaths due to dementia increased overall, from 2% in 2002 to over 7% in 2019, and across all age groups, notably from 1% to 4% in those aged 70-79. The proportion of deaths due to falls and Parkinson's disease also increased. CONCLUSIONS There has been a shift of causes of death among those with diabetes away from cardiovascular disease. The proportion of deaths due to conditions such as dementia and falls is increasing among those with diabetes, which will require consideration when planning future resource allocation.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lei Chen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Lauren L Moran
- Australian Bureau of Statistics, Belconnen, Australian Capital Territory, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Yin J, Fu X, Luo Y, Leng Y, Ao L, Xie C. A Narrative Review of Diabetic Macroangiopathy: From Molecular Mechanism to Therapeutic Approaches. Diabetes Ther 2024; 15:585-609. [PMID: 38302838 PMCID: PMC10942953 DOI: 10.1007/s13300-024-01532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
Diabetic macroangiopathy, a prevalent and severe complication of diabetes mellitus, significantly contributes to the increased morbidity and mortality rates among affected individuals. This complex disorder involves multifaceted molecular mechanisms that lead to the dysfunction and damage of large blood vessels, including atherosclerosis (AS) and peripheral arterial disease. Understanding the intricate pathways underlying the development and progression of diabetic macroangiopathy is crucial for the development of effective therapeutic interventions. This review aims to shed light on the molecular mechanism implicated in the pathogenesis of diabetic macroangiopathy. We delve into the intricate interplay of chronic inflammation, oxidative stress, endothelial dysfunction, and dysregulated angiogenesis, all of which contribute to the vascular complications observed in this disorder. By exploring the molecular mechanism involved in the disease we provide insight into potential therapeutic targets and strategies. Moreover, we discuss the current therapeutic approaches used for treating diabetic macroangiopathy, including glycemic control, lipid-lowering agents, and vascular interventions.
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Affiliation(s)
- Jiacheng Yin
- Hospital of Chengdu University of Traditional Chinese Medicine No, 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Xiaoxu Fu
- Hospital of Chengdu University of Traditional Chinese Medicine No, 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, No. 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
- Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Yue Luo
- Hospital of Chengdu University of Traditional Chinese Medicine No, 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Yuling Leng
- Hospital of Chengdu University of Traditional Chinese Medicine No, 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Lianjun Ao
- Hospital of Chengdu University of Traditional Chinese Medicine No, 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Chunguang Xie
- Hospital of Chengdu University of Traditional Chinese Medicine No, 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China.
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, No. 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China.
- Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China.
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Jiu L, Wang J, Javier Somolinos-Simón F, Tapia-Galisteo J, García-Sáez G, Hernando M, Li X, Vreman RA, Mantel-Teeuwisse AK, Goettsch WG. A literature review of quality assessment and applicability to HTA of risk prediction models of coronary heart disease in patients with diabetes. Diabetes Res Clin Pract 2024; 209:111574. [PMID: 38346592 DOI: 10.1016/j.diabres.2024.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/17/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
This literature review had two objectives: to identify models for predicting the risk of coronary heart diseases in patients with diabetes (DM); and to assess model quality in terms of risk of bias (RoB) and applicability for the purpose of health technology assessment (HTA). We undertook a targeted review of journal articles published in English, Dutch, Chinese, or Spanish in 5 databases from 1st January 2016 to 18th December 2022, and searched three systematic reviews for the models published after 2012. We used PROBAST (Prediction model Risk Of Bias Assessment Tool) to assess RoB, and used findings from Betts et al. 2019, which summarized recommendations and criticisms of HTA agencies on cardiovascular risk prediction models, to assess model applicability for the purpose of HTA. As a result, 71 % and 67 % models reporting C-index showed good discrimination abilities (C-index >= 0.7). Of the 26 model studies and 30 models identified, only one model study showed low RoB in all domains, and no model was fully applicable for HTA. Since the major cause of high RoB is inappropriate use of analysis method, we advise clinicians to carefully examine the model performance declared by model developers, and to trust a model if all PROBAST domains except analysis show low RoB and at least one validation study conducted in the same setting (e.g. country) is available. Moreover, since general model applicability is not informative for HTA, novel adapted tools may need to be developed.
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Affiliation(s)
- Li Jiu
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands
| | - Junfeng Wang
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands
| | - Francisco Javier Somolinos-Simón
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Jose Tapia-Galisteo
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain; CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Gema García-Sáez
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain; CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Mariaelena Hernando
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, ETSI de Telecomunicación, Universidad Politécnica de Madrid, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain; CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Parque Científico y Tecnológico de la UPM, Crta. M40, Km. 38, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Xinyu Li
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands; University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Broerstraat 5, 9712 CP Groningen, the Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands; National Health Care Institute (ZIN), Diemen, Willem Dudokhof 1, 1112 ZA Diemen, Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, Netherlands; National Health Care Institute (ZIN), Diemen, Willem Dudokhof 1, 1112 ZA Diemen, Netherlands.
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Ibrahim AO, Bello IS, Ajetunmobi OA, Olusuyi KM, Ajani GO, Adewoye KR, Oguntoye OO, Sonibare OO, Alabi AK. Asymptomatic bacteriuria in patients with type 2 diabetes mellitus in rural southwestern Nigeria: a cross-sectional study. J Int Med Res 2024; 52:3000605241233515. [PMID: 38452049 PMCID: PMC10921853 DOI: 10.1177/03000605241233515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES We aimed to identify the prevalence, bacterial isolates, antimicrobial susceptibility profile, and factors associated with asymptomatic bacteriuria (ASB) in patients with type 2 diabetes mellitus (T2DM) in rural southwestern Nigeria. METHODS We performed a hospital-based cross-sectional study of patients with T2DM and ASB. Demographic and clinical data were collected using questionnaires. Urine samples were cultured using standard laboratory procedures, and bacterial colonies were isolated and antimicrobial sensitivity was performed using the disc diffusion technique. Relationships between variables were assessed using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS Of the 280 participants, 73 (26.1%) had ASB (95% CI: 20.9%-31.2%). The most commonly identified isolate was E. coli (45/73; 61.7%), 100.0% of which were sensitive to cefuroxime but resistant to ciprofloxacin. Female sex (AOR, 6.132; 95% CI: 2.327-16.157), living below the poverty line (AOR, 2.066; 95% CI: 1.059-4.029), uncontrolled blood glucose (AOR, 2.097; 95% CI: 1.000-4.404), and a history of indwelling urethral catheterization (AOR, 14.521; 95% CI: 4.914-42.908) were associated with ASB. CONCLUSION The findings suggest that cefuroxime should be used as an empirical treatment, pending urine culture and sensitivity, and that efforts should be made to prevent ASB in rural southwestern Nigeria.
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Affiliation(s)
- Azeez Oyemomi Ibrahim
- Department of Family Medicine, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Ibrahim Sebutu Bello
- Department of Family Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | | | | | | | - Kayode Rasaq Adewoye
- Department of Community Health, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | | | | | - Ayodele Kamal Alabi
- Department of Community Health, Federal Teaching Hospital Ido-Ekiti, Ekiti State, Nigeria
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Sherrill CH, Hwang AY. Use of Cardioprotective Antidiabetic Medications in Adults With and Without Cardiovascular Disease, 2015 to March 2020. Ann Pharmacother 2024; 58:248-254. [PMID: 37323006 DOI: 10.1177/10600280231178886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Certain glucagon-like peptide-1 receptor (GLP-1) agonists and sodium-glucose cotransporter-2 inhibitors (SGLT2-inhibitors) can reduce cardiovascular risk in individuals with type 2 diabetes and cardiovascular disease (CVD). However, these medications can be expensive, potentially limiting their use. Objectives: The primary objective was to characterize the use of cardioprotective GLP-1 agonists and SGLT2-inhibitors among adults with diabetes with and without CVD. The secondary objective was to investigate the association of socioeconomic factors and health care utilization with the use of these medications. METHODS Adults aged ≥20 years old with self-reported diabetes, A1c ≥6.5%, or fasting glucose ≥126 mg/dL were identified using the 2015 to March 2020 National Health and Nutrition Examination Survey. The primary outcome was the use of cardioprotective GLP-1 agonists or SGLT2-inhibitors compared in individuals with and without CVD. Secondary analyses included identification of socioeconomic factors and health care utilization associated with the use of cardioprotective antidiabetic medications, stratified by CVD status. Weighted analyses were conducted to account for the complex survey design. RESULTS Use of cardioprotective antidiabetic medications was higher in adults with CVD compared to those without CVD (7.8% vs. 4.6%, P = 0.02), which was driven by the use of cardioprotective SGLT2-inhibitors (4.6% versus 1.9%, P = 0.002). Lower income level and less frequent health care visits within the past year were associated with lower likelihood of using these medications. CONCLUSION AND RELEVANCE Despite preferential use in individuals with diabetes and CVD, the prevalence of cardioprotective antidiabetic medication use remains relatively low. Disparities in use appear to exist based on income level and health care utilization.
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Affiliation(s)
- Christina H Sherrill
- Department of Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC, USA
| | - Andrew Y Hwang
- Department of Pharmacy Practice, School of Pharmacy, MCPHS University, Boston, MA, USA
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Tusongtuoheti X, Shu Y, Huang G, Mao Y. Predicting the risk of subclinical atherosclerosis based on interpretable machine models in a Chinese T2DM population. Front Endocrinol (Lausanne) 2024; 15:1332982. [PMID: 38476673 PMCID: PMC10929018 DOI: 10.3389/fendo.2024.1332982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
Background Cardiovascular disease (CVD) has emerged as a global public health concern. Identifying and preventing subclinical atherosclerosis (SCAS), an early indicator of CVD, is critical for improving cardiovascular outcomes. This study aimed to construct interpretable machine learning models for predicting SCAS risk in type 2 diabetes mellitus (T2DM) patients. Methods This study included 3084 T2DM individuals who received health care at Zhenhai Lianhua Hospital, Ningbo, China, from January 2018 to December 2022. The least absolute shrinkage and selection operator combined with random forest-recursive feature elimination were used to screen for characteristic variables. Linear discriminant analysis, logistic regression, Naive Bayes, random forest, support vector machine, and extreme gradient boosting were employed in constructing risk prediction models for SCAS in T2DM patients. The area under the receiver operating characteristic curve (AUC) was employed to assess the predictive capacity of the model through 10-fold cross-validation. Additionally, the SHapley Additive exPlanations were utilized to interpret the best-performing model. Results The percentage of SCAS was 38.46% (n=1186) in the study population. Fourteen variables, including age, white blood cell count, and basophil count, were identified as independent risk factors for SCAS. Nine predictors, including age, albumin, and total protein, were screened for the construction of risk prediction models. After validation, the random forest model exhibited the best clinical predictive value in the training set with an AUC of 0.729 (95% CI: 0.709-0.749), and it also demonstrated good predictive value in the internal validation set [AUC: 0.715 (95% CI: 0.688-0.742)]. The model interpretation revealed that age, albumin, total protein, total cholesterol, and serum creatinine were the top five variables contributing to the prediction model. Conclusion The construction of SCAS risk models based on the Chinese T2DM population contributes to its early prevention and intervention, which would reduce the incidence of adverse cardiovascular prognostic events.
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Affiliation(s)
- Ximisinuer Tusongtuoheti
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Yimeng Shu
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Guoqing Huang
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Yushan Mao
- Department of Endocrinology, The First Affiliated Hospital of Ningbo University, Ningbo University, Ningbo, China
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Dubey V, Kansagra J, Sureja V, Kheni D. Efficacy evaluation of Berberis aristata and Silybum marianum fixed dose combination on glycaemic and insulin resistance parameters in adult population: a systematic review and meta-analysis of randomized controlled trials. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2024; 10:28. [DOI: 10.1186/s43094-024-00603-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024] Open
Abstract
Abstract
Background
Diabetes is one of the most prevalent metabolic diseases with high rate of morbidity and mortality. The increased level of blood glucose level and increased insulin resistance is the hallmark of diabetes. Currently, various non-pharmacological and pharmacological therapeutic options are used for lowering the glucose level and improving the insulin activity. The current systematic review and meta-analysis study was conducted to evaluate the efficacy of Berberis aristata and Silybum marianum fixed dose nutraceutical combination on serum glucose and glycated haemoglobin level and insulin resistance parameters.
Main Body
Randomized controlled trials, identified from three online databases, evaluating the efficacy of Berberis aristata and Silybum marianum fixed dose combination were identified and evaluated as per pre-defined protocol. Quality of studies was evaluated using PEDro scale, and risk of bias was assessed using Cochrane Risk of Bias Tool. Pooled effect was reported as mean difference (MD) and 95% confidence interval, while the complete study was conducted as per PRISMA and Cochrane guidelines. After complete literature screening and evaluation process, seven studies were included in the final analysis. Data of 825 participants (active group: 416 participants and control group: 409 participants) were utilized for the statistical analysis. All included studies (except one) were of good quality. Supplementation of fixed dose combination significantly reduced glucose level (MD: − 5.26 mg/dl; p = 0.02) and glycated haemoglobin (HbA1c) level (MD: − 0.69%; p < 0.0001) as compared to control therapy, while greater insulin resistance reduction was observed in active group and the difference approached significance (MD: − 0.64 HOMA-IR score; p = 0.08). Risk of bias analysis revealed some concerns regarding biasness (mainly due to randomization, outcome measurement and selected reporting biasness). All included studies had moderate risk of biasness. Sensitivity analysis revealed effect of particular study on overall heterogeneity observed, while neither significant publication bias nor any missing study was observed.
Conclusion
The results of current study suggest that B. aristata and S. marianum fixed dose combination is effective in improving glycaemic and insulin parameters and can be effective in diabetic population. The observed sensitivity of certain studies on overall heterogeneity and the moderate risk of biasness warrants further well-designed clinical studies to strengthen the results of current study.
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Luca SA, Bungau RM, Lazar S, Potre O, Timar B. To What Extent Does Cardiovascular Risk Classification of Patients with Type 2 Diabetes Differ between European Guidelines from 2023, 2021, and 2019? A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:334. [PMID: 38399621 PMCID: PMC10890196 DOI: 10.3390/medicina60020334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Type 2 Diabetes (T2DM) is intricately associated with an increased cardiovascular (CV) risk, highlighting the imperative for tailored intervention in the prevention and management of CV diseases. To assess the CV risk and subsequent interventions in patients with diabetes, the European Society of Cardiology (ESC) has been consistently developing and updating specific guidelines for risk assessment and patient management since 2019. The 2023 risk classification method has significantly changed, introducing a novel probability-based assessment through the implementation of SCORE2-Diabetes instrument. This marks a shift from the risk factor-based classification employed in the 2019 and 2021 methods, representing an innovative approach in risk assessment for individuals with T2DM. This study aims to evaluate the differences in the CV risk classification among hospitalized patients with T2DM using the three proposed methods within the Romanian population, a European population considered to be at very high cardiovascular risk. Materials and Methods: in a consecutive-case, population-based study design, 70 patients hospitalized with T2DM from a European population characterized by very high CV risk were assessed for CV risk using the three proposed methods. The differences between these classifications were subsequently analyzed. Results: In the study group, according to 2023 classification, one patient (1.4%) was classified with moderate CV risk, eight (11.4%) with high cardiovascular risk, and sixty-one (87.2%) with very high cardiovascular risk. A total of 36 patients (51.4%) were classified differently compared to 2021 criteria, the differences being statistically significant (p = 0.047), while 13 (18.6%) were different compared to 2019 criteria, the differences being statistically non-significant (p = 0.731). By comparing the 2021 to the 2019 ESC Guidelines recommendations, 40 patients had a one-step decrease in cardiovascular risk category, from very high to high risk. Conclusions: Most patients included in the analysis were classified as very high CV risk (87.2%). Within a European population characterized by very high CV risk, the SCORE2-Diabetes instrument proves to be a valuable tool, contributing to most step-ups in CV risk classes within the 2023 classification. In a very-high-risk demographic, the 2023 algorithm resulted in different classifications in contrast to the 2021 method but similar classifications observed with the 2019 method.
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Affiliation(s)
- Silvia Ana Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Centre for Molecular Research in Nephrology and Vascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (B.T.)
| | - Raluca Malina Bungau
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300736 Timisoara, Romania;
| | - Sandra Lazar
- Centre for Molecular Research in Nephrology and Vascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (B.T.)
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ovidiu Potre
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Multidisciplinary Research Centre for Malignant Hematological Diseases (CCMHM), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Timar
- Centre for Molecular Research in Nephrology and Vascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (B.T.)
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300736 Timisoara, Romania;
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Al-Muhaiteeb A, Alahmad B, Abu-Farha M, Abubaker J, Thanaraj TA, Ali H, Al-Mulla F, Qaddoumi M. Long-Term Mortality and SGLT2 Inhibitors in Type 2 Diabetes with and without Renal Impairment: An Observational Cohort Study. Med Princ Pract 2024; 33:251-259. [PMID: 38359814 PMCID: PMC11175602 DOI: 10.1159/000537850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/14/2024] [Indexed: 02/17/2024] Open
Abstract
AIM Sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as a vital part of management of type 2 diabetes, as they have been shown to have both cardiovascular and renal benefits along with an improved survival rate in several randomized clinical trials. We designed a retrospective cohort study to investigate the impact of SGLT2 inhibitors on mortality among type 2 diabetes patients. METHODS Patients with type 2 diabetes who presented to the Dasman Diabetes Institute in Kuwait were followed from January 1st, 2015, until January 20th, 2023. To control for non-random allocation of SGLT2 inhibitors and measured confounders, we performed one-to-one propensity score matching and evaluated outcomes in the matched cohorts using a Cox proportional hazards model. The primary treatment variable was SGLT2 inhibitor use; time to mortality from any cause was used as the outcome of interest. RESULTS 1,551 patients were taking SGLT2 inhibitors, and 1,687 patients were not. After propensity score matching, 845 patients were on SGLT2 inhibitors, and 845 patients were not. In post-matching analysis, all-cause mortality was higher among patients who did not take SGLT2 inhibitors compared to patients taking SGLT2 inhibitors (5.2 vs. 2.1%, p = 0.0012). The hazard ratio of all-cause mortality in patients taking SGLT2 inhibitors was 0.42 (95% confidence interval [95% CI], 0.24-0.72). Additional adjustment of matching factors did not change the results. CONCLUSION This observational study demonstrated substantial long-term reduction in mortality risk among patients with type 2 diabetes treated with SGLT2 inhibitors. This is irrespective of the stage of their renal diseases or GLP1 agonist.
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Affiliation(s)
| | - Barrak Alahmad
- Department of Environmental Health at Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohamed Abu-Farha
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jehad Abubaker
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Thangavel A. Thanaraj
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Hamad Ali
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Medical Laboratory Sciences, College of Allied Health Sciences, Kuwait University, Jabriya, Kuwait
| | - Fahd Al-Mulla
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Mohammad Qaddoumi
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Pharmacology and Therapeutics, College of Pharmacy, Kuwait University, Kuwait City, Kuwait
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Gurung RL, Liu S, Liu JJ, M Y, Zheng H, Chan C, Ang K, Subramaniam T, Sum CF, Lim SC. Association of plasma angiogenin with risk of major cardiovascular events in type 2 diabetes. Cardiovasc Diabetol 2024; 23:70. [PMID: 38360721 PMCID: PMC10870605 DOI: 10.1186/s12933-024-02156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Angiogenin, an enzyme belonging to the ribonucleases A superfamily, plays an important role in vascular biology. Here, we sought to study the association of plasma angiogenin and major adverse cardiovascular events (MACEs) in patients with type 2 diabetes (T2D). METHODS This prospective study included 1083 T2D individuals recruited from a secondary hospital and a primary care facility. The primary outcome was a composite of four-point MACE (nonfatal myocardial infarction, stroke, unstable angina pectoris leading to hospitalization and cardiovascular death). Circulating angiogenin was measured by a proximity extension assay. Cox regression models were used to evaluate the association of baseline plasma angiogenin with the risk of MACE. RESULTS During a median follow-up of 9.3 years, 109 (10%) MACE were identified. Plasma angiogenin was significantly higher in participants with MACE than in those without MACE (P < 0.001). Doubling of plasma angiogenin concentration was associated with a 3.10-fold (95% CI 1.84-5.22) increased risk for MACE. The association was only moderately attenuated after adjustment for demographic and cardiometabolic risk factors (adjusted HR 2.38, 95% CI 1.34-4.23) and remained statistically significant after additional adjustment for estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (uACR) (adjusted HR 1.90, 95% CI 1.02-3.53). A consistent outcome was obtained when plasma angiogenin was analysed as a categorical variable in tertiles. CONCLUSIONS Plasma angiogenin was associated with the risk of future cardiovascular events in patients with T2D and may be a promising novel biomarker for identifying high-risk T2D patients for early management.
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Affiliation(s)
- Resham L Gurung
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Signature Research Program, Duke-NUS Medical School, Singapore, Singapore
| | - Sylvia Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Jian-Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yiamunaa M
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Huili Zheng
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clara Chan
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore.
- Saw Swee Hock School of Public Heath, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Sheng L, Yang G, Chai X, Zhou Y, Sun X, Xing Z. Glycemic variability evaluated by HbA1c rather than fasting plasma glucose is associated with adverse cardiovascular events. Front Endocrinol (Lausanne) 2024; 15:1323571. [PMID: 38419951 PMCID: PMC10899469 DOI: 10.3389/fendo.2024.1323571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Background Although studies have shown that glycemic variability is positively associated with an increased risk of cardiovascular disease, few studies have compared hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) variability with adverse cardiovascular events in patients with type 2 diabetes mellitus (T2DM). Methods This was a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Cox proportional hazards models were used to explore the relationship between HbA1c or FPG variability and the incidence of major adverse cardiovascular events (MACEs). Results In total, 9,547 patients with T2DM were enrolled in this study. During the median 4.6 ± 1.5 years follow-up period, 907 patients developed MACEs. The risk of MACEs increased in the HbA1c variability group in each higher quartile of HbA1c variability (P < 0.01). Compared with those in the first quartile of HbA1c variability, patients in the fourth quartile had a hazard ratio of 1.37 (Model 2, 95% confidence interval: 1.13-1.67) for MACEs. Higher FPG variability was not associated with a higher risk of MACEs in patients with T2DM (P for trend=0.28). A U-shaped relationship was observed between HbA1c and FPG variability, and MACEs. Glucose control therapy modified the relationship between HbA1c and MACEs; participants with higher HbA1c variability receiving intensive glucose control were more likely to develop MACEs (P for interaction <0.01). Conclusion In adults with T2DM, the relationship between glycemic variability evaluated using HbA1c and FPG was U-shaped, and an increase in HbA1c variability rather than FPG variability was significantly associated with MACEs. The relationship between HbA1c variability and MACEs was affected by the glucose control strategy, and a higher HbA1c variability was more strongly associated with MACEs in patients receiving an intensive glucose control strategy.
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Affiliation(s)
- Lijuan Sheng
- Clinical Nursing Teaching and Research Section, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Trauma Center, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Trauma Center, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Zhou
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Trauma Center, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xin Sun
- College of nursing, Changsha Medical University, Changsha, China
| | - Zhenhua Xing
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Trauma Center, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
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Sharma A, Razaghizad A, Joury A, Levin A, Bajaj HS, Mancini GBJ, Wong NC, Slee A, Ang FG, Rapattoni W, Neuen BL, Arnott C, Perkovic V, Mahaffey KW. Primary and Secondary Cardiovascular and Kidney Prevention With Canagliflozin: Insights From the CANVAS Program and CREDENCE Trial. J Am Heart Assoc 2024; 13:e031586. [PMID: 38240199 PMCID: PMC11056176 DOI: 10.1161/jaha.123.031586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND This study evaluated the effects of canagliflozin in patients with type 2 diabetes with and without prevalent cardiovascular disease (secondary and primary prevention). METHODS AND RESULTS This was a pooled participant-level analysis of the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program and CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) trial. The CANVAS Program included participants with type 2 diabetes at elevated cardiovascular risk, whereas the CREDENCE trial included participants with type 2 diabetes and albuminuric chronic kidney disease. Hazard ratios (HRs) with interaction terms were obtained from Cox regression models to estimate relative risk reduction with canagliflozin versus placebo across the primary and secondary prevention groups. We analyzed 5616 (38.9%) and 8804 (61.1%) individuals in the primary and secondary prevention subgroups, respectively. Primary versus secondary prevention participants were on average younger (62.2 versus 63.8 years of age) and more often women (42% versus 31%). Canagliflozin reduced the risk of major adverse cardiovascular events (HR, 0.84 [95% CI, 0.76-0.94]) consistently across primary and secondary prevention subgroups (Pinteraction=0.86). Similarly, no treatment effect heterogeneity was observed with canagliflozin for hospitalization for heart failure, cardiovascular death, end-stage kidney disease, or all-cause mortality (all Pinteraction>0.5). CONCLUSIONS Canagliflozin reduced cardiovascular and kidney outcomes with no statistical evidence of heterogeneity for the treatment effect across the primary and secondary prevention subgroups in the CANVAS Program and CREDENCE trial. Although studies on the optimal implementation of canagliflozin within these populations are warranted, these results reinforce canagliflozin's role in cardiorenal prevention and treatment in individuals with type 2 diabetes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01032629, NCT01989754, NCT02065791.
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Affiliation(s)
- Abhinav Sharma
- Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health CentreMontrealQCCanada
- Division of CardiologyMcGill University Health Centre, McGill UniversityMontrealQCCanada
- DREAM‐CV LaboratoryMcGill University Health Centre, McGill UniversityMontrealQCCanada
| | - Amir Razaghizad
- Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health CentreMontrealQCCanada
- Division of CardiologyMcGill University Health Centre, McGill UniversityMontrealQCCanada
- DREAM‐CV LaboratoryMcGill University Health Centre, McGill UniversityMontrealQCCanada
| | - Abdulaziz Joury
- Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health CentreMontrealQCCanada
- Division of CardiologyMcGill University Health Centre, McGill UniversityMontrealQCCanada
- DREAM‐CV LaboratoryMcGill University Health Centre, McGill UniversityMontrealQCCanada
- King Salman Heart Center, King Fahad Medical CityRiyadhSaudi Arabia
| | - Adeera Levin
- Division of NephrologyUniversity of British ColumbiaVancouverBCCanada
| | | | - G. B. John Mancini
- Centre for Cardiovascular InnovationUniversity of British ColumbiaVancouverBCCanada
| | | | | | | | | | - Brendon L. Neuen
- The George Institute for Global Health, UNSW SydneySydneyAustralia
- Royal North Shore HospitalSydneyAustralia
| | - Clare Arnott
- The George Institute for Global Health, UNSW SydneySydneyAustralia
- Faculty of Medicine, UNSW SydneySydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
- Sydney Medical SchoolUniversity of SydneyAustralia
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW SydneySydneyAustralia
- Royal North Shore HospitalSydneyAustralia
- Faculty of Medicine, UNSW SydneySydneyAustralia
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Department of MedicineStanford University School of MedicineStanfordCA
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Huang Z, Zhuang X, Huang R, Liu M, Xu X, Fan Z, Dai R, Li H, Xiong Z, Guo Y, Liang Q, Liao X. Physical Activity and Weight Loss Among Adults With Type 2 Diabetes and Overweight or Obesity: A Post Hoc Analysis of the Look AHEAD Trial. JAMA Netw Open 2024; 7:e240219. [PMID: 38386318 PMCID: PMC10884882 DOI: 10.1001/jamanetworkopen.2024.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Importance Prior findings from the Look AHEAD trial showed no significant reduction in the risk of cardiovascular events by lifestyle-induced weight loss among individuals with type 2 diabetes (T2D) and overweight or obesity. However, physical activity (PA) may modify the changes in cardiovascular risk associated with weight loss. Objective To examine the joint association of weight loss and PA with the risk of adverse cardiovascular events in patients with T2D and overweight or obesity. Design, Setting, and Participants This cohort study was a post hoc analysis of the Look AHEAD randomized clinical trial, which compared the cardiovascular effects of weight loss by intensive lifestyle intervention vs diabetes support and education among individuals with T2D and overweight or obesity. The study was conducted from June 2001 to September 2012, and participants were patients in the substudy of accelerometry-measured PA from 8 locations in the United States. Data were analyzed from June to August 2023. Exposures Body weight change and accelerometer-derived PA volume across the first 4 years. Main Outcomes and Measures The primary outcome was a composite cardiovascular outcome including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina. Results Among a total of 1229 participants (mean [SD] age, 60 [7] years; 533 male [43%]), 333 (27%) achieved and maintained weight loss for the first 4 years. Among the individuals who maintained weight loss, 105 (32%) maintained high PA volume. During a median of 9.5 years of follow-up, 198 participants (16.1%) experienced the primary outcome. Compared with those with low PA volume and no weight loss (105 [15.8%]), maintaining high PA volume and weight loss was associated with a 61% lower risk of the primary end point (hazard ratio, 0.39; 95% CI, 0.19-0.81; P = .01). However, there was no significant difference in the risk of the primary end point among those with either weight loss only or high PA only. The multiplicative interaction between weight loss and PA for the risk of cardiovascular events was also significant (P for interaction = .01). Conclusions and Relevance In this cohort study, maintaining weight loss and higher PA volume was associated with a lower risk of the composite cardiovascular outcome. The findings suggest that the cardiovascular benefits of PA may vary and be enhanced by weight loss among individuals with T2D and overweight or obesity.
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Affiliation(s)
- Zihao Huang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Rihua Huang
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Xinghao Xu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Ziyan Fan
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Rongling Dai
- School of Journalism and Communication, Sun Yat-Sen University, Guangzhou, China
| | - Hansheng Li
- School of Critical Studies, University of Glasgow, Glasgow, United Kingdom
| | - Zhenyu Xiong
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
| | - Qi Liang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China
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145
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Ayalew TL. Case cancellations and associated factors on the day of surgery in hospitals of Wolaita Zone, South Ethiopia. BMC Surg 2024; 24:45. [PMID: 38311751 PMCID: PMC10840272 DOI: 10.1186/s12893-024-02330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Cancellations of elective surgery cases are frequent and have significant negative consequences. It causes wasting of valuable resources, patient unhappiness, and psychological stress of patients. Despite this, little is known about the case cancellation and associated factors on the day of surgery in Ethiopia, particularly in the study area. OBJECTIVE This study aimed to assess the magnitude of case cancellation and associated factors on the day of surgery in hospitals in Wolaita zone, South Ethiopia, from May 17 to June 17, 2023. METHODS A hospital-based cross-sectional study involving 322 patients was conducted at Wolaita Sodo Zone, South Ethiopia. All elective surgical cases scheduled during the study period were included. The entire number of participants was selected using a systematic random sampling process. Epidata V.3 was used to enter data, and SPSS V.25 was used to analyze it. Binary logistic regression was used to check for a possible association. P-values < 0.05 and 95% CI were used on multi-variable analysis as the threshold for the significant statistical association. RESULT A total of 313 study participants were scheduled for elective surgical procedures during the study period and gave a response rate of 97.2%. The mean (± SD) age of the study participants was 39.18 (± 10.64) years. The two-third of patients, 53(64%) were rural residents, and more than half (178, or 55.3%) of the participants were female. This finding showed that the case cancellation was 22.4% (95% CI: 19.3 -25.9%). Among the total canceled cases, 49(58.3%) were males. Variables like rural residence (AOR = 3.48 95% CI: 1.22-9.95), Lack of lab result (AOR = 2.33, 95%CI:1.20-4.51), ophthalmology dept. (AOR = 2.53 95% CI:1.52-4.49), HTN (AOR = 2.53, 95% CI:1.52-4.49), patient refusal (AOR = 3.01 95% CI:1.22-5.05), and age b/n 31 and 43 (AOR = 1.50, 95% CI:1.02-2.01) were significantly associated factors with cancellation of elective surgical cases. CONCLUSION In this study schedule of case cancellation was high. The contributing factors of case cancellation were rural residence, Lack of lab results, ophthalmology dept, HTN, patient refusal, and age. To decrease unnecessary cancellations and increase cost efficiency, hospital administration and medical staff must plan ahead carefully, communicate effectively, and make efficient use of hospital resources.
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Affiliation(s)
- Tadele Lankrew Ayalew
- Department of Nursing, College of medicine and health science, Wolaita Sodo University, Wolaita, Ethiopia.
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146
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Liu B, Gu S, Zhang J, Zhou H, Su J, Wang S, Sun Q, Zhou Z, Zhou J, Dong C. Green tea consumption and incidence of cardiovascular disease in type 2 diabetic patients with overweight/obesity: a community-based cohort study. Arch Public Health 2024; 82:18. [PMID: 38308353 PMCID: PMC10835928 DOI: 10.1186/s13690-024-01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Green tea has been reported to be potentially protective against the development of cardiovascular disease (CVD). This study aimed to investigate the association between green tea consumption and incident CVD in type 2 diabetes (T2D) patients with overweight/obesity. METHODS A total of 4756 Chinese overweight/obese T2D patients were recruited and followed up for 6.27 years. Information on green tea consumption was collected at baseline using interviewer-administered questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD according to green tea consumption were estimated using the Cox proportional hazards model. RESULTS Compared with non-habitual consumers, participants who consumed > 5 g/day of green tea leaves reduced the risk of CVD by 29% (95%CI: 0.55-0.92), stroke by 30% (95%CI: 0.51-0.95) and coronary heart disease (CHD) by 40% (95%CI: 0.40-0.89). Similarly, participants who consumed green tea for ≥ 40 years reduced the risk of CVD by 31% (95%CI: 0.54-0.88), stroke by 33% (95%CI: 0.50-0.90) and CHD by 39% (95%CI: 0.42-0.88). Among participants with < 5-year history of T2D, > 5 g/day of tea leaves and > 40 years of tea consumption were associated with 59% (95%CI: 0.23-0.72) and 57% (95%CI: 0.26-0.74) reduced risk of stroke, respectively. However, among participants with ≥ 5-year history of T2D, > 5 g/day of tea leaves and > 40 years of tea consumption were associated with a 50% (95%CI: 0.30-0.82) and 46% (95%CI: 0.35-0.85) reduced risk of CHD, respectively. CONCLUSIONS Green tea consumption is associated with reduced risk of CVD, stroke, and CHD in overweight/obese T2D patients.
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Affiliation(s)
- Bingyue Liu
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China
| | - Shujun Gu
- Suzhou Changshu Centers for Disease Control and Prevention, Soochow, China
| | - Jin Zhang
- Suzhou Industrial Park Centers for Disease Control and Prevention, Soochow, China
| | - Hui Zhou
- Suzhou Industrial Park Centers for Disease Control and Prevention, Soochow, China
| | - Jian Su
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China
| | - Sudan Wang
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China
| | - Qian Sun
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China
| | - Zhengyuan Zhou
- Suzhou Changshu Centers for Disease Control and Prevention, Soochow, China
| | - Jinyi Zhou
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China.
| | - Chen Dong
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China.
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147
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Wang Q, Gan Z, Gao Q, Wang M, Zhan B. The associations of risk of cardiovascular disease with development stages of diabetes in Chinese population: findings from a retrospective cohort study in QuZhou city. BMC Endocr Disord 2024; 24:18. [PMID: 38302943 PMCID: PMC10835855 DOI: 10.1186/s12902-024-01544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Risk analysis is an important area of research in diabetes and cardiovascular disease (CVD), both of which have significant global health burdens. Although there is evidence that patients with prediabetes and diabetes mellitus may have an increased risk of CVD, few studies have been conducted in mainland China. METHODS This retrospective cohort study utilized data from the Quzhou City Resident Health Information System and the Zhejiang Province Chronic Disease Surveillance System in China. Prediabetes and diabetes mellitus were the exposure interests, and the outcome event was defined as the onset of cardiovascular and cerebrovascular disease (including coronary heart disease and stroke). The start date of the study was January 1, 2015, and the follow-up deadline was December 31, 2020. Multivariate Cox proportional hazard model were used to assess the associations among prediabetes, diabetes, and CVD risk. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Our study used follow-up time as the time scale, while adjusting for age, sex, physical activity, smoking, alcohol consumption, BMI in the models Sensitivity analyses were conducted to assess the stability of the results, by excluding participants who smoked and drank alcohol, participants who developed CVD in the first year of follow-up. RESULTS In total, 138,970 participants were included in our study, with a mean follow-up of 5.8 years. The mean age of the participants was 58.82 ± 14.44 years, with 42.79% (n = 59,466) males and 57.21% (n = 79,504) females. During the study period 4357 cases of CVD were recorded. Participants with prediabetes (P = 0.003) and diabetes (P < 0.001) had a higher risk of CVD than those who were Normal (HR [95% CI]: 1.14 [1.05-1.24]; 1.68 [1.55-1.81], respectively). Prediabetes and patients living with diabetes had a 14% and 68% increased risk of CVD, respectively. The results of the sensitivity analyses were consistent with those of the main analyses after excluding those who developed CVD within one year of follow-up and those who were concurrent smokers or alcohol drinkers. CONCLUSIONS Our research found that prediabetes is significantly associated with the risk of diabetes and CVD.
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Affiliation(s)
- Qi Wang
- Zhejiang Chinese Medicine University, 548 Binwen Road, Binjiang District, 310053, Hangzhou, Zhejiang Province, China
| | - Zhijuan Gan
- Quzhou Center for Disease Control and Prevention , 154 Xi'an Road, Kecheng District, 324003, Quzhou , Zhejiang Province, China
| | - Qing Gao
- Zhejiang Chinese Medicine University, 548 Binwen Road, Binjiang District, 310053, Hangzhou, Zhejiang Province, China
| | - Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, China.
| | - Bingdong Zhan
- Zhejiang Chinese Medicine University, 548 Binwen Road, Binjiang District, 310053, Hangzhou, Zhejiang Province, China.
- Quzhou Center for Disease Control and Prevention , 154 Xi'an Road, Kecheng District, 324003, Quzhou , Zhejiang Province, China.
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148
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Boonpor J, Pell JP, Ho FK, Celis-Morales C, Gray SR. In people with type 2 diabetes, sarcopenia is associated with the incidence of cardiovascular disease: A prospective cohort study from the UK Biobank. Diabetes Obes Metab 2024; 26:524-531. [PMID: 37881162 DOI: 10.1111/dom.15338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
AIM To investigate the association of sarcopenia with cardiovascular disease (CVD) incidence in people with type 2 diabetes. MATERIALS AND METHODS A prospective cohort study with 11 974 White European UK Biobank participants with type 2 diabetes, aged 40-70 years, included. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People as either non-sarcopenic or sarcopenic. Outcomes included CVD, stroke, heart failure (HF) and myocardial infarction (MI). The association between sarcopenia and the incidence of outcomes was investigated using Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. The rate advancement period was used to estimate the time period by which CVD is advanced because of sarcopenia. RESULTS Over a median follow-up of 10.7 years, 1957 participants developed CVDs: 373 had a stroke, 307 had an MI and 742 developed HF. Compared with non-sarcopenia, those with sarcopenia had higher risks of CVD (HR 1.89 [95% CI 1.61; 2.21]), HF (HR 2.59 [95% CI 2.12; 3.18]), stroke (HR 1.90 [95% CI 1.38; 2.63]), and MI (HR 1.56 [95% CI 1.04; 2.33]) after adjustment for all covariates. Those with sarcopenia had CVD incidence rates equivalent to those without sarcopenia who were 14.5 years older. Similar results were found for stroke, HF and MI. CONCLUSIONS In people with type 2 diabetes, sarcopenia increased the risk of developing CVD, which might occur earlier than in those without sarcopenia. Therefore, sarcopenia screening and prevention in patients with type 2 diabetes may be useful to prevent the complications of CVD.
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Affiliation(s)
- Jirapitcha Boonpor
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Faculty of Public Health, Chalermphrakiat Sakon Nakhon Province Campus, Kasetsart University, Sakon Nakhon, Thailand
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca, Chile
| | - Stuart R Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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149
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Guo L, Xiao X. Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). Aging Med (Milton) 2024; 7:5-51. [PMID: 38571669 PMCID: PMC10985780 DOI: 10.1002/agm2.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence-based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.
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Affiliation(s)
- Lixin Guo
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xinhua Xiao
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of EndocrinologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
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150
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Pratley R, Guan X, Moro RJ, do Lago R. Chapter 1: The Burden of Heart Failure. Am J Med 2024; 137:S3-S8. [PMID: 38184324 DOI: 10.1016/j.amjmed.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 01/08/2024]
Abstract
Heart failure (HF) affects an estimated 6 million American adults, and the prevalence continues to increase, driven in part by the aging of the population and by increases in the prevalence of diabetes. In recent decades, improvements in the survival of patients with HF have resulted in a growing number of individuals living longer with HF. HF and its comorbidities are associated with substantial impairments in physical functioning, emotional well-being, and quality of life, and also with markedly increased rates of morbidity and mortality. As a result, the management of patients with HF has a substantial economic impact on the health care system, with most costs arising from hospitalization. Clinicians have an important role in helping to reduce the burden of HF through timely diagnosis of HF as well as increasing access to effective treatments to minimize symptoms, delay progression, and reduce hospital admissions. Prevention and early diagnosis of HF will play a fundamental role in efforts to reduce the large and growing burden of HF. Recent advances in pharmacotherapies for HF have the potential to radically change the management of HF, offering the possibility of improved survival and quality of life for patients.
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Affiliation(s)
- Richard Pratley
- AdventHealth Translational Research Institute, Orlando, Fla.
| | - Xuan Guan
- AdventHealth Cardiovascular Institute, Orlando, Fla
| | - Richard J Moro
- Department of Cardiovascular Ultrasound, AdventHealth, Orlando, Fla
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