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Hoang YN, Nguyen TH, Ho DKN, Bai CH, Lin WL, Phan HD, Phan HH, Tran NL, Chang JS. Dietary glycemic index and glycemic load predict longitudinal change in glycemic and cardio-metabolic biomarkers among old diabetic adults living in a resource-poor country. Int J Food Sci Nutr 2024:1-12. [PMID: 38946436 DOI: 10.1080/09637486.2024.2368843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
This study aims to investigate longitudinal associations between the dietary glycemic index (GI) and glycemic load (GL) and changes in glycemic and cardio-metabolic outcomes. A 28-month retrospective cohort study included 110 Vietnamese diabetic patients, collecting their dietary GI and GL values along with blood biochemical data from baseline 24-h dietary recall and medical records. Latent class growth modelling identified three distinct HbA1c trajectories during the follow-up period, with 51% of patients achieving good glycemic control. The adjusted linear mixed-effect model showed that 1 unit increase in logarithms in dietary GL was associated with a 0.14% increase in the log-HbA1c. Among poorly controlled diabetic patients, baseline GL values were positively correlated with increases in HbA1c; GI showed effects on changes in fasting plasma glucose and the triglyceride-glucose (TyG) index. No significant association was observed in patients with good glycemic control.
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Affiliation(s)
- Yen Nhi Hoang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Trong Hung Nguyen
- Department of Adult Nutrition Counselling, National Institute of Nutrition, Hanoi, Vietnam
- Department of Clinical Nutrition and Dietetics, National Hospital of Endocrinology, Hanoi, Vietnam
| | - Dang Khanh Ngan Ho
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ling Lin
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan
| | | | | | | | - Jung-Su Chang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Chinese Taipei Society for the Study of Obesity (CTSSO), Taipei, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
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Garvey WT, Cohen RM, Butera NM, Kazemi EJ, Younes N, Rosin SP, Suratt CE, Ahmann A, Hollander PA, Krakoff J, Martin CL, Seaquist E, Steffes MW, Lachin JM. Association of Baseline Factors With Glycemic Outcomes in GRADE: A Comparative Effectiveness Randomized Clinical Trial. Diabetes Care 2024; 47:562-570. [PMID: 38285957 PMCID: PMC10973909 DOI: 10.2337/dc23-1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/03/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To describe the individual and joint associations of baseline factors with glycemia, and also with differential effectiveness of medications added to metformin. RESEARCH DESIGN AND METHODS Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) participants (with type 2 diabetes diagnosed for <10 years, on metformin, and with HbA1c 6.8-8.5%; N = 5,047) were randomly assigned to a basal insulin (glargine), sulfonylurea (glimepiride), glucagon-like peptide 1 agonist (liraglutide), or dipeptidyl peptidase 4 inhibitor (sitagliptin). The glycemic outcome was HbA1c ≥7.0%, subsequently confirmed. Univariate and multivariate regression and classification and regression tree (CART) analyses were used to assess the association of baseline factors with the glycemic outcome at years 1 and 4. RESULTS In univariate analyses at baseline, younger age (<58 years), Hispanic ethnicity, higher HbA1c, fasting glucose, and triglyceride levels, lower insulin secretion, and relatively greater insulin resistance were associated with the glycemic outcome at years 1 and/or 4. No factors were associated with differential effectiveness of the medications by year 4. In multivariate analyses, treatment group, younger age, and higher baseline HbA1c and fasting glucose were jointly associated with the glycemic outcome by year 4. The superiority of glargine and liraglutide at year 4 persisted after multiple baseline factors were controlled for. CART analyses indicated that failure to maintain HbA1c <7% by year 4 was more likely for younger participants and those with baseline HbA1c ≥7.4%. CONCLUSIONS Several baseline factors were associated with the glycemic outcome but not with differential effectiveness of the four medications. Failure to maintain HbA1c <7% was largely driven by younger age and higher HbA1c at baseline. Factors that predict earlier glycemic deterioration could help in targeting patients for more aggressive management.
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Affiliation(s)
- W. Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Robert M. Cohen
- Division of Endocrinology, Diabetes, and Metabolism, University of Cincinnati College of Medicine and Cincinnati VA Medical Center, Cincinnati, OH
| | - Nicole M. Butera
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Erin J. Kazemi
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Samuel P. Rosin
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Colleen E. Suratt
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Andrew Ahmann
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, OR
| | | | | | - Catherine L. Martin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Elizabeth Seaquist
- Division of Diabetes and Endocrinology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Michael W. Steffes
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - John M. Lachin
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
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Khubchandani J, Banerjee S, Gonzales-Lagos R, Szirony GM. Depression increases the risk of mortality among people living with diabetes: Results from national health and nutrition examination survey, USA. Diabetes Metab Syndr 2023; 17:102892. [PMID: 37898065 DOI: 10.1016/j.dsx.2023.102892] [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: 07/22/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Type 2 Diabetes (T2D) and depression are leading global public health problems associated with profound disability and lower quality of life. Extensive evidence suggests that the two disorders are frequently comorbid. However, long-term effects such as the risk of mortality due to depression among people living with T2D are not well explored. METHODS Data from the National Health and Nutrition Examination Survey, 2005-2010 were linked with mortality files from the National Death Index up to December 31st, 2019. RESULTS A total of 14,920 American adults were included in the study sample; nearly a tenth of them had depression (9.08 %) or T2D (10 %). In adjusted analysis, individuals with T2D were 1.70 times more likely (95 % CI = 1.42-2.03) to die than those without T2D. Among people living with T2D without depression, the risk of mortality was 1.55 times higher, but those with both T2D and depression had a 4.24 times higher risk of mortality. CONCLUSIONS Given the greater risk of morbidity and premature mortality with cooccurring T2D and depression, widespread screening is warranted with a focus on high-risk groups. Integrated and collaborative care models can help address the psychosocial needs of people with T2D and should be widely implemented with the sensitization of clinicians and care teams in primary and specialist care for T2D.
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Affiliation(s)
- Jagdish Khubchandani
- College of Health, Education, and Social Transformation New Mexico State University Las Cruces, NM, 88003, USA.
| | - Srikanta Banerjee
- College of Health SciencesWalden University Minneapolis, MN, 55401, USA.
| | | | - G Michael Szirony
- School of Counseling, Walden University, Minneapolis, MN, 55401, USA.
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Ye F, Chen L, Zheng X. Diabetes and the risk of cirrhosis and HCC: An analysis of the UK Biobank. Hepatol Commun 2023; 7:e0280. [PMID: 37851413 PMCID: PMC10586863 DOI: 10.1097/hc9.0000000000000280] [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] [Received: 06/17/2023] [Accepted: 08/13/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Diabetes increases the risk of cirrhosis and HCC. We aimed to assess such associations given different diabetes statuses. METHODS We included 449,497 participants in the UK Biobank cohort (mean age 56.7±8.0 y; 45.5% male) and assessed the association between preclinical diabetes (prediabetes, having a high risk of diabetes), clinical diabetes (presence, duration, or glycemic control of type 2 diabetes), and incident liver cirrhosis and HCC by the Cox regression. Liver diseases were ascertained through inpatient records and national death registration. Gene-environment interaction was examined using the polygenic risk scores of cirrhosis and HCC. RESULTS Compared with normoglycemia, having <5 years,≥5 years of diabetes showed adjusted HRs (aHRs) of cirrhosis as 2.85 (2.45-3.32) and 3.43 (2.92-4.02), respectively, which was similarly observed in HCC. In diabetes, a level of hemoglobin A1c ≥ 7.5% showed aHRs of 1.37 (1.07-1.76) and 1.89 (1.10-3.25) for cirrhosis and HCC, respectively, compared with hemoglobin A1c < 6.5%. In non-diabetes, prediabetes presented aHRs of 1.41 (1.14-1.73) and 1.80 (1.06-3.04) of cirrhosis and HCC, respectively. Participants with a high risk of diabetes at baseline showed an aHR of 3.31 (2.65-4.13) for cirrhosis and 2.09 (1.15-3.80) for HCC. In those with a high genetic risk of HCC, having an increased risk of diabetes posed a significantly higher risk of HCC (aHR: 1.93, 1.45-2.58, Pinteraction=0.005), compared with those without a high genetic risk of HCC. CONCLUSIONS Not only diabetes but preclinical diabetes, longer diabetes duration, and higher baseline hemoglobin A1c were associated with an increased risk of incident cirrhosis and HCC in the general population.
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Affiliation(s)
- Fangzhou Ye
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Zheng
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan, China
- Hubei Jiangxia Laboratory, Wuhan, China
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Swaray SM, Tetteh J, Djonor SK, Ekem-Ferguson G, Clottey RY, Yacoba A, Yawson AE. Changes in trends and patterns of glycaemic control at Ghana's National Diabetes Management and Research Centre during the era of the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002024. [PMID: 37315063 DOI: 10.1371/journal.pgph.0002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Maintaining optimal glycaemic control (GC) delays the onset and progression of diabetes-related complications, especially microvascular complications. We aimed to establish the trend and pattern of GC, and its associated factors in persons living with diabetes (PLWD), and to examine the influence of COVID-19 on GC. METHODS A retrospective study involving secondary data from 2,593 patients' physical records from the National Diabetes Management and Research Centre (NDMRC) in Accra, extracted from 2015-2021. Growth rate of GC was assessed, and ordinal logistic and Poisson models weighted with Mahalanobis distance matching within propensity caliper were adopted to assess the impact of COVID-19 pandemic on GC. Stata 16.1 was utilized and the significant value set as p≤0.05. RESULTS GC pattern indicated a steady deterioration ranging from 38.6% (95%CI = 34.5-42.9) in 2015 to 69.2% (95%CI = 63.5-74.4) in 2021. The overall growth from 2015-2021 was 8.7%. Being a woman and increasing diastolic pressure significantly increase the likelihood of poor glycaemic control (PGC) by 22% and 25%, respectively compared with their respective counterparts [aOR(95%CI = 1.01-1.46 and 1.25(1.10-1.41), respectively]; whilst lower age increased the risk of PGC throughout the years. We found that risk of PGC during the era of COVID-19 was approximately 1.57(95%CI = 1.08-2.30) times significant, whilst the adjusted prevalence ratio (aPR) of PGC during the era of COVID-19 was approximately 64% significantly higher than the era without COVID-19 (aPR = 1.64, 95%CI = 1.10-2.43). CONCLUSION GC worsened from 2015-2021, especially during the COVID era. Younger age, uncontrolled blood pressure and/or being a woman were associated with PGC. The NDMRC and other centres that provide specialist healthcare in resource-limited settings, must determine the factors that militate against optimal service delivery in the era of the COVID-19 pandemic, and implement measures that would improve resilience in provision of essential care in the face of shocks.
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Affiliation(s)
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - George Ekem-Ferguson
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Psychiatry, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ruth Yawa Clottey
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Atiase Yacoba
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Wang Y, Li C, Liang J, Gao D, Pan Y, Zhang W, Zhang Y, Zheng F, Xie W. Onset age of diabetes and incident dementia: A prospective cohort study. J Affect Disord 2023; 329:493-499. [PMID: 36868384 DOI: 10.1016/j.jad.2023.02.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Relationship between age at diagnosis of diabetes and dementia is lacking. The aim of the study was to investigate whether diabetes onset at a younger age was associated with a higher incidence of dementia. METHODS 466,207 participants free of dementia in the UK biobank (UKB) were included in the analysis. Propensity score matching (PSM) was adopted to match diabetic and non-diabetic participants in different onset age of diabetes groups to evaluate onset age of diabetes and incident dementia. RESULTS Compared with non-diabetic participants, diabetes participants had an adjusted hazard ratio (HR) of 1.87 (95 % confidence interval [CI]: 1.73-2.03) for all-cause dementia, 1.85 (95 % CI: 1.60-2.04) for Alzheimer's disease (AD), and 2.86 (95 % CI: 2.47-3.32) for vascular dementia (VD). Among diabetic participants who reported onset age, the adjusted HRs for incident all-cause dementia, AD, and VD were 1.20 (95 % CI: 1.14-1.25), 1.19 (95 % CI: 1.10-1.29), and 1.19 (95 % CI: 1.10-1.28), respectively, per 10 years decrease in age at diabetes onset. After PSM, strength of association between diabetes and all-cause dementia increased with decreasing onset age of diabetes (≥60 years: HR = 1.47, 95 % CI: 1.25-1.74; 45-59 years: HR = 1.66, 95 % CI: 1.40-1.96; <45 years: HR = 2.92, 95 % CI: 2.13-4.01) after multivariable adjustment. Similarly, diabetic participants with onset age <45 years had greatest HRs for incident AD and VD, compared with their matched controls. LIMITATIONS Our results only reflect the characteristics of UKB participants. CONCLUSIONS Younger age at diabetes onset was significantly associated with a higher risk of dementia in this longitudinal cohort study.
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Affiliation(s)
- Yongqian Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China; PUCRI Heart and Vascular Health Research Centre at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Centre at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Jie Liang
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Darui Gao
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Centre at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yang Pan
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenya Zhang
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Fanfan Zheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China; PUCRI Heart and Vascular Health Research Centre at Peking University Shougang Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China.
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Santos S, Pentzek M, Altiner A, Daubmann A, Drewelow E, Helbig C, Löffler C, Löscher S, Wegscheider K, Abholz HH, Wilm S, Wollny A. HbA1c as a shared treatment goal in type 2 diabetes? A secondary analysis of the DEBATE trial. BMC PRIMARY CARE 2023; 24:115. [PMID: 37173620 PMCID: PMC10182591 DOI: 10.1186/s12875-023-02067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major health problem in the western world. Despite a widespread implementation of integrated care programs there are still patients with poorly controlled T2DM. Shared goal setting within the process of Shared Decision Making (SDM) may increase patient's compliance and adherence to treatment regimen. In our secondary analysis of the cluster-randomized controlled DEBATE trial, we investigated if patients with shared vs. non-shared HbA1c treatment goal, achieve their glycemic goals. METHODS In a German primary care setting, we collected data before intervention at baseline, 6, 12 and 24 months. Patients with T2DM with an HbA1c ≥ 8.0% (64 mmol/mol) at the time of recruitment and complete data at baseline and after 24 months were eligible for the presented analyses. Using a generalized estimating equation analysis, we analysed the association between the achievement of HbA1c goals at 24 months based on their shared vs. non-shared status, age, sex, education, partner status, controlled for baseline HbA1c and insulin therapy. RESULTS From N = 833 recruited patients at baseline, n = 547 (65.7%) from 105 General Practitioners (GPs) were analysed. 53.4% patients were male, 33.1% without a partner, 64.4% had a low educational level, mean age was 64.6 (SD 10.6), 60.7% took insulin at baseline, mean baseline HbA1c was 9.1 (SD 1.0). For 287 patients (52.5%), the GPs reported to use HbA1c as a shared goal, for 260 patients (47.5%) as a non-shared goal. 235 patients (43.0%) reached the HbA1c goal after two years, 312 patients (57.0%) missed it. Multivariable analysis shows that shared vs. non-shared HbA1c goal setting, age, sex, and education are not associated with the achievement of the HbA1c goal. However, patients living without a partner show a higher risk of missing the goal (p = .003; OR 1.89; 95% CI 1.25-2.86). CONCLUSIONS Shared goal setting with T2DM patients targeting on HbA1c-levels had no significant impact on goal achievement. It may be assumed, that shared goal setting on patient-related clinical outcomes within the process of SDM has not been fully captured yet. TRIAL REGISTRATION The trial was registered at ISRCTN registry under the reference ISRCTN70713571.
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Affiliation(s)
- Sara Santos
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Michael Pentzek
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Institute of General Practice and Primary Care, Chair of General Practice II and Patient Centredness in Primary Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christian Helbig
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Susanne Löscher
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Heinz-Harald Abholz
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Anja Wollny
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
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Sanjeevi N, Freeland-Graves JH. Low diet quality is associated with adverse levels of metabolic health markers and clustering of risk factors in adults with type 2 diabetes. J Hum Nutr Diet 2023; 36:31-39. [PMID: 35442546 DOI: 10.1111/jhn.13020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/15/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nutritional recommendations for diabetes management emphasise an overall, healthful diet consistent with the guidelines for the general population. The present study assessed the relationship of diet quality, as measured by Healthy Eating Index-2015 (HEI-2015), with metabolic health markers and risk factor clustering in type 2 diabetes patients using National Health and Nutrition Examination Survey 2011-2016 data. METHODS HEI-2015 diet quality scores were calculated using 24-h dietary recalls. Adults with type 2 diabetes (n = 2220) were assessed for: (1) hyperglycaemia; (2) overweight/obesity; (3) dyslipidaemia; and (4) hypertension. Logistic regression examined associations of diet quality quartiles with odds of hyperglycaemia, overweight/obesity, dyslipidaemia and hypertension, as well as odds of clustering of these risk factors. RESULTS Odds of overweight/obesity and hyperglycaemia were significantly greater for participants in the lowest HEI-2015 quartile compared to those in the highest quartile. Furthermore, individuals in the bottom two HEI-2015 quartiles had increased odds of dyslipidaemia. Those in the lowest quartile also had significantly higher odds of having ≥ 2, ≥ 3 and 4 risk factors (vs. having ≤ 1 risk factor). CONCLUSIONS Low diet quality was related to increased odds of hyperglycaemia, dyslipidaemia, overweight/obesity and risk factor clustering. Findings imply poorer prognosis of diabetes in individuals with low diet quality.
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Affiliation(s)
- Namrata Sanjeevi
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Jeanne H Freeland-Graves
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA
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Jiang W, Zhang J, Yang R, Sun X, Wu H, Zhang J, Liu S, Sun C, Ma L, Han T, Wei W. Association of urinary nitrate with diabetes complication and disease-specific mortality among adults with hyperglycemia. J Clin Endocrinol Metab 2022; 108:1318-1329. [PMID: 36576885 DOI: 10.1210/clinem/dgac741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The hyperglycemia condition disrupts the metabolism of nitrate/nitrite and nitric oxide, and dietary nitrate intake can restore nitric oxide homeostasis. This study aims to examine whether urinary nitrate is associated with diabetes complications and long-term survival among people with hyperglycemia. METHODS A total of 6208 people with hyperglycemia who participated in the National Health and Nutrition Examination Survey from 2005 to 2014 were enrolled. Diabetes complications included congestive heart failure, coronary heart disease, angina, stroke, myocardial infarction, diabetic retinopathy, and nephropathy. Mortality wasobtained from the National Death Index until 2015. Urinary nitrate was measured by ion chromatography coupled with electrospray tandem mass spectrometry, which was log-transformed and categized into tertiles. Logistic regression models and cox proportional hazards models were respectively performed to assess the association of urinary nitrate with the risk of diabetes complications and disease-specific mortalities. RESULTS After adjustment for potential confounders including urinary perchlorate and thiocyanate, compared with the participants in the lowest tertile of nitrate, the participants in the highest tertile had lower risks of congestive heart failure(odd-ratio[OR] = 0.41, 95%CI:0.27-0.60) and diabetic nephropathy(OR = 0.50, 95%CI: 0.41-0.62). Meanwhile, during a total follow-up of 41,463 person-year, the participants in the highest tertile had lower mortality risk of all-cause(hazard-ratio[HR] = 0.78, 95%CI:0.62-0.97), cardiovascular disease(CVD)(HR = 0.56, 95%CI:0.37-0.84) and diabetes(HR = 0.47, 95%CI:0.24-0.90), which showed dose-dependent linear relationships(P for non-linearity > 0.05). Moreover, no association between nitrate and cancer mortality was observed(HR = 1.13, 95%CI:0.71-1.80). CONCLUSIONS Higher urinary nitrate is associated with lower risk of congestive heart failure and diabetic nephropathy, and lower risk of all-cause, CVD, and diabetes mortalities. These findings indicated that inorganic nitrate supplementation can be considered as a supplementary treatment for people with hyperglycemia.
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Affiliation(s)
- Wenbo Jiang
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jia Zhang
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
| | - Ruiming Yang
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
| | - Xinyi Sun
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
| | - Huanyu Wu
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
| | - Jiacheng Zhang
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
| | - Siyao Liu
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
| | - Lifang Ma
- Department of Pharmacology, College of Pharmacy Key Laboratory of Cardiovascular Research, Ministry of Education, Harbin Medical University, Harbin, P. R.China
| | - Tianshu Han
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
| | - Wei Wei
- Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, Harbin, P. R.China
- Department of Geriatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P.R.China
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10
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Socioeconomic disparities in diabetes prevalence and management among the adult population in Bangladesh. PLoS One 2022; 17:e0279228. [PMID: 36538534 PMCID: PMC9767371 DOI: 10.1371/journal.pone.0279228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetes, one of the major metabolic disorders, is rising in Bangladesh. Studies indicate there is inequality in prevalence and care-seeking behavior, which requires further exploration to understand the socioeconomic disparities in the pathophysiology of diabetes. This study examined the latest nationally representative estimates of diabetes prevalence, awareness, and management among adults aged 18 years and above in Bangladesh and its association with socioeconomic status in 2017-18. METHODS We used the 2017-18 Bangladesh Demographic and Health Survey data. Diabetic status of 12,092 adults aged 18 years and above was measured in the survey using fasting plasma glucose levels. We applied multivariate logistic regressions to examine the role of socioeconomic status on diabetes prevalence, awareness, and management, after controlling for relevant covariates. RESULTS Overall, 10% of adults had diabetes in Bangladesh in 2017-18, with the highest prevalence of 16% in the age group 55-64 years. Our analyses found statistically significant disparities by socioeconomic status in the prevalence of diabetes as well as the person's awareness of his/her diabetic condition. However, the effect of socioeconomic status on receiving anti-diabetic medication only approached significance (p = 0.07), and we found no significant association between socioeconomic status and control of diabetes. CONCLUSIONS We expect to see an 'accumulation' of the number of people with diabetes to continue in the coming years. The rising prevalence of diabetes is only the tip of an iceberg; a large number of people with uncontrolled diabetes and a lack of awareness of their condition will lead to increased morbidity and mortality, and that could be the real threat. Immediate measures to increase screening coverage and exploration of poor control of diabetes are required to mitigate the situation.
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11
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Cigolle CT, Blaum CS, Lyu C, Ha J, Kabeto M, Zhong J. Associations of Age at Diagnosis and Duration of Diabetes With Morbidity and Mortality Among Older Adults. JAMA Netw Open 2022; 5:e2232766. [PMID: 36178688 PMCID: PMC9526092 DOI: 10.1001/jamanetworkopen.2022.32766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/31/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Older adults vary widely in age at diagnosis and duration of type 2 diabetes, but treatment often ignores this heterogeneity. Objectives To investigate the associations of diabetes vs no diabetes, age at diagnosis, and diabetes duration with negative health outcomes in people 50 years and older. Design, Setting, and Participants This cohort study included participants in the 1995 through 2018 waves of the Health and Retirement Study (HRS), a population-based, biennial longitudinal health interview survey of older adults in the US. The study sample included adults 50 years or older (n = 36 060) without diabetes at entry. Data were analyzed from June 1, 2021, to July 31, 2022. Exposures The presence of diabetes, specifically the age at diabetes diagnosis, was the main exposure of the study. Age at diagnosis was defined as the age when the respondent first reported diabetes. Adults who developed diabetes were classified into 3 age-at-diagnosis groups: 50 to 59 years, 60 to 69 years, and 70 years and older. Main Outcomes and Measures For each diabetes age-at-diagnosis group, a propensity score-matched control group of respondents who never developed diabetes was constructed. The association of diabetes with the incidence of key outcomes-including heart disease, stroke, disability, cognitive impairment, and all-cause mortality-was estimated and the association of diabetes vs no diabetes among the age-at-diagnosis case and matched control groups was compared. Results A total of 7739 HRS respondents developed diabetes and were included in the analysis (4267 women [55.1%]; mean [SD] age at diagnosis, 67.4 [9.9] years). The age-at-diagnosis groups included 1866 respondents at 50 to 59 years, 2834 at 60 to 69 years, and 3039 at 70 years or older; 28 321 HRS respondents never developed diabetes. Age at diagnosis of 50 to 59 years was significantly associated with incident heart disease (hazard ratio [HR], 1.66 [95% CI, 1.40-1.96]), stroke (HR, 1.64 [95% CI, 1.30-2.07]), disability (HR, 2.08 [95% CI, 1.59-2.72]), cognitive impairment (HR, 1.30 [95% CI, 1.05-1.61]), and mortality (HR, 1.49 [95% CI, 1.29-1.71]) compared with matched controls, even when accounting for diabetes duration. These associations significantly decreased with advancing age at diagnosis. Respondents with diabetes diagnosed at 70 years or older only showed a significant association with the outcome of elevated mortality (HR, 1.08 [95% CI, 1.01-1.17]). Conclusions and Relevance The findings of this cohort study suggest that age at diabetes diagnosis was differentially associated with outcomes and that younger age groups were at elevated risk of heart disease, stroke, disability, cognitive impairment, and all-cause mortality. These findings reinforce the clinical heterogeneity of diabetes and highlight the importance of improving diabetes management in adults with earlier diagnosis.
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Affiliation(s)
- Christine T. Cigolle
- Department of Family Medicine, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center, Ann Arbor, Michigan
| | - Caroline S. Blaum
- Department of Medicine, New York University Langone Health, New York, New York
| | - Chen Lyu
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Jinkyung Ha
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Mohammed Kabeto
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Judy Zhong
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
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12
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Al-Ma'aitah OH, Demant D, Jakimowicz S, Perry L. Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis. J Adv Nurs 2022; 78:2257-2276. [PMID: 35621355 PMCID: PMC9541219 DOI: 10.1111/jan.15255] [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: 05/06/2021] [Revised: 02/05/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Aims To examine the patient‐related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries. Design A systematic review and meta‐analysis. Data Sources A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer‐reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified. Review Methods Extracted data were analysed using Review Manager 5.4. Results The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self‐management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006). Conclusion These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.
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Affiliation(s)
- Odai Hamed Al-Ma'aitah
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Samantha Jakimowicz
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
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13
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Goodman KE, Magder LS, Baghdadi JD, Pineles L, Levine AR, Perencevich EN, Harris AD. Impact of Sex and Metabolic Comorbidities on Coronavirus Disease 2019 (COVID-19) Mortality Risk Across Age Groups: 66 646 Inpatients Across 613 U.S. Hospitals. Clin Infect Dis 2021; 73:e4113-e4123. [PMID: 33337474 PMCID: PMC7799326 DOI: 10.1093/cid/ciaa1787] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The relationship between common patient characteristics, such as sex and metabolic comorbidities, and mortality from coronavirus disease 2019 (COVID-19) remains incompletely understood. Emerging evidence suggests that metabolic risk factors may also vary by age. This study aimed to determine the association between common patient characteristics and mortality across age-groups among COVID-19 inpatients. METHODS We performed a retrospective cohort study of patients discharged from hospitals in the Premier Healthcare Database between April-June 2020. Inpatients were identified using COVID-19 ICD-10-CM diagnosis codes. A priori-defined exposures were sex and present-on-admission hypertension, diabetes, obesity, and interactions between age and these comorbidities. Controlling for additional confounders, we evaluated relationships between these variables and in-hospital mortality in a log-binomial model. RESULTS Among 66 646 (6.5%) admissions with a COVID-19 diagnosis, across 613 U.S. hospitals, 12 388 (18.6%) died in-hospital. In multivariable analysis, male sex was independently associated with 30% higher mortality risk (aRR, 1.30, 95% CI: 1.26-1.34). Diabetes without chronic complications was not a risk factor at any age (aRR 1.01, 95% CI: 0.96-1.06), and hypertension without chronic complications was a risk factor only in 20-39 year-olds (aRR, 1.68, 95% CI: 1.17-2.40). Diabetes with chronic complications, hypertension with chronic complications, and obesity were risk factors in most age-groups, with highest relative risks among 20-39 year-olds (respective aRRs 1.79, 2.33, 1.92; P-values ≤ .002). CONCLUSIONS Hospitalized men with COVID-19 are at increased risk of death across all ages. Hypertension, diabetes with chronic complications, and obesity demonstrated age-dependent effects, with the highest relative risks among adults aged 20-39.
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Affiliation(s)
- Katherine E Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan D Baghdadi
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea R Levine
- Department of Pulmonary & Critical Care Medicine, The University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eli N Perencevich
- Department of Internal Medicine and Epidemiology, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, Maryland, USA
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14
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Sanjeevi N. Mediation of the Relationship of Acculturation With Glycemic Control in Asian Americans With Diabetes. Am J Health Promot 2021; 36:279-287. [PMID: 34787493 DOI: 10.1177/08901171211052562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the role of physical activity and healthcare access in mediating the association of acculturation with cardiometabolic health in Asian American adults with diabetes. DESIGN Cross-sectional study. SETTING National Health and Nutrition Examination Survey (NHANES) 2011-2018. SUBJECTS Non-pregnant Asian American adults with doctor diagnosed diabetes. MEASURES Participants were classified into low, moderate, and high acculturation status. Self-reported leisure-time, work, and transportation-based physical activity were summed for overall physical activity. Health insurance, frequency of healthcare receipt, and glycohemoglobin (HbA1c) check in the past year indicated healthcare access. Cardiometabolic health indicators included HbA1c, total and high density lipoprotein-cholesterol, and systolic and diastolic blood pressure. ANALYSIS Linear and logistic regression estimates, standardized using y-standardization, and assessed mediation of acculturation with cardiometabolic health. RESULTS Low acculturation was significantly related to greater leisure-time inactivity odds [OR (95% CI) = 2.25 (1.05, 4.82)], overall insufficient activity [OR (95% CI) = 2.30 (1.12, 4.74)], and uninsured status [OR (95% CI) = 5.62 (1.55, 20.41)]. Asian Americans with low acculturation had significantly higher log HbA1c than those with high acculturation (β ± SE = .078 ± .038); however, this association was not significant after adjusting for leisure-time activity. Leisure-time activity mediated 48.9% of acculturation and HbA1c association, and the indirect effect was statistically significant [estimate (95% CI) = .021 (.002, 0.047)]. CONCLUSIONS Results suggest that promoting sufficient leisure-time activity could improve glycemic control in least acculturated Asian Americans with diabetes.
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Affiliation(s)
- Namrata Sanjeevi
- Department of Nutritional Sciences, College of Natural Sciences, 12330The University of Texas at Austin, Austin, TX, USA
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15
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Gopalan A, Blatchins MA, Altschuler A, Mishra P, Fakhouri I, Grant RW. Disclosure of New Type 2 Diabetes Diagnoses to Younger Adults: a Qualitative Study. J Gen Intern Med 2021; 36:1622-1628. [PMID: 33501523 PMCID: PMC7837080 DOI: 10.1007/s11606-020-06481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults diagnosed with type 2 diabetes at a younger age are at increased risk for poor outcomes. Yet, little is known about the early experiences of these individuals, starting with communication of the diagnosis. Addressing this knowledge gap is important as this initial interaction may shape subsequent disease-related perceptions and self-management. OBJECTIVE We examined diagnosis disclosure experiences and initial reactions among younger adults with newly diagnosed type 2 diabetes. PARTICIPANTS Purposive sample of adult members of Kaiser Permanente Northern California, an integrated healthcare delivery system, diagnosed with type 2 diabetes before age 45 years. APPROACH We conducted six focus groups between November 2017 and May 2018. Transcribed audio recordings were coded by two coders using thematic analysis. KEY RESULTS Participants (n = 41) were 38.4 (± 5.8) years of age; 10 self-identified as Latinx, 12 as Black, 12 as White, and 7 as multiple or other races. We identified variation in diagnosis disclosure experiences, centered on four key domains: (1) participants' sense of preparedness for diagnosis (ranging from expectant to surprised); (2) disclosure setting (including in-person, via phone, via secure message, or via review of results online); (3) perceived provider tone (from nonchalant, to overly fear-centered, to supportive); and (4) participants' emotional reactions to receiving the diagnosis (including acceptance, denial, guilt, and/or fear, rooted in personal and family experience). CONCLUSIONS For younger adults, the experience of receiving a diabetes diagnosis varies greatly. Given the long-term consequences of inadequately managed diabetes and the need for early disease control, effective initial disclosure represents an opportunity to optimize initial care. Our results suggest several opportunities to improve the type 2 diabetes disclosure experience: (1) providing pre-test counseling, (2) identifying patient-preferred settings for receiving the news, and (3) developing initial care strategies that acknowledge and address the emotional distress triggered by this life-altering, chronic disease diagnosis.
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Affiliation(s)
- Anjali Gopalan
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
| | - Maruta A Blatchins
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Andrea Altschuler
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Pranita Mishra
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Issa Fakhouri
- Kaiser Permanente Northern California Stockton Medical Offices, Stockton, CA, USA
| | - Richard W Grant
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
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16
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Eilat-Tsanani S, Margalit A, Golan LN. Occurrence of comorbidities in newly diagnosed type 2 diabetes patients and their impact after 11 years' follow-up. Sci Rep 2021; 11:11071. [PMID: 34040053 PMCID: PMC8155151 DOI: 10.1038/s41598-021-90379-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/04/2021] [Indexed: 12/30/2022] Open
Abstract
The burden of type 2 diabetes is growing, not only through increased incidence, but also through its comorbidities. Concordant comorbidities for type 2 diabetes, such as cardiovascular diseases, are considered expected outcomes of the disease or disease complications, while discordant comorbidities are not considered to be directly related to type 2 diabetes and are less extensively addressed under diabetes management. Here we show that the combination of concordant and discordant comorbidities appears frequently in persons with diabetes (75%). Persons with combined comorbidities visited family physicians more than persons with discordant, concordant or no comorbidity (17.3 ± 10.2, 11.6 ± 6.5, 8.7 ± 6.8, 6.3 ± 6.6 visits/person/year respectively, p < 0.0001). The risk of death during the study period was highest in persons with combined comorbidities and discordant only comorbidities (HR = 33.4; 95% CI 12.5–89.2 and HR = 33.5; 95% CI 11.7–95.8), emphasizing the contribution of discordant comorbidities to the outcome. Our study is unique as a long-term follow-up of an 11-year cohort of 9725 persons with new-onset type 2 diabetes. The findings highlight the contribution of discordant comorbidity to the burden of the disease. The high prevalence of the combination of both concordant and discordant comorbidities, and their appearance before the onset of type 2 diabetes, indicates a continuum of morbidity.
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Affiliation(s)
- Sophia Eilat-Tsanani
- The Department of Family Medicine, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel. .,Clalit Health Services, Northern Region, Nof Hagalil, Israel. .,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Avital Margalit
- The Department of Family Medicine, Emek Medical Center, Yitzhak Rabin Boulevard 21, 1834111, Afula, Israel.,Clalit Health Services, Northern Region, Nof Hagalil, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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De Silva K, Lim S, Mousa A, Teede H, Forbes A, Demmer RT, Jönsson D, Enticott J. Nutritional markers of undiagnosed type 2 diabetes in adults: Findings of a machine learning analysis with external validation and benchmarking. PLoS One 2021; 16:e0250832. [PMID: 33951067 PMCID: PMC8099133 DOI: 10.1371/journal.pone.0250832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Using a nationally-representative, cross-sectional cohort, we examined nutritional markers of undiagnosed type 2 diabetes in adults via machine learning. METHODS A total of 16429 men and non-pregnant women ≥ 20 years of age were analysed from five consecutive cycles of the National Health and Nutrition Examination Survey. Cohorts from years 2013-2016 (n = 6673) was used for external validation. Undiagnosed type 2 diabetes was determined by a negative response to the question "Have you ever been told by a doctor that you have diabetes?" and a positive glycaemic response to one or more of the three diagnostic tests (HbA1c > 6.4% or FPG >125 mg/dl or 2-hr post-OGTT glucose > 200mg/dl). Following comprehensive literature search, 114 potential nutritional markers were modelled with 13 behavioural and 12 socio-economic variables. We tested three machine learning algorithms on original and resampled training datasets built using three resampling methods. From this, the derived 12 predictive models were validated on internal- and external validation cohorts. Magnitudes of associations were gauged through odds ratios in logistic models and variable importance in others. Models were benchmarked against the ADA diabetes risk test. RESULTS The prevalence of undiagnosed type 2 diabetes was 5.26%. Four best-performing models (AUROC range: 74.9%-75.7%) classified 39 markers of undiagnosed type 2 diabetes; 28 via one or more of the three best-performing non-linear/ensemble models and 11 uniquely by the logistic model. They comprised 14 nutrient-based, 12 anthropometry-based, 9 socio-behavioural, and 4 diet-associated markers. AUROC of all models were on a par with ADA diabetes risk test on both internal and external validation cohorts (p>0.05). CONCLUSIONS Models performed comparably to the chosen benchmark. Novel behavioural markers such as the number of meals not prepared from home were revealed. This approach may be useful in nutritional epidemiology to unravel new associations with type 2 diabetes.
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Affiliation(s)
- Kushan De Silva
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Andrew Forbes
- Biostatistics Unit, Division of Research Methodology, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America.,Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Daniel Jönsson
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden.,Swedish Dental Service of Skane, Lund, Sweden
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
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18
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Seng JJB, Monteiro AY, Kwan YH, Zainudin SB, Tan CS, Thumboo J, Low LL. Population segmentation of type 2 diabetes mellitus patients and its clinical applications - a scoping review. BMC Med Res Methodol 2021; 21:49. [PMID: 33706717 PMCID: PMC7953703 DOI: 10.1186/s12874-021-01209-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Population segmentation permits the division of a heterogeneous population into relatively homogenous subgroups. This scoping review aims to summarize the clinical applications of data driven and expert driven population segmentation among Type 2 diabetes mellitus (T2DM) patients. Methods The literature search was conducted in Medline®, Embase®, Scopus® and PsycInfo®. Articles which utilized expert-based or data-driven population segmentation methodologies for evaluation of outcomes among T2DM patients were included. Population segmentation variables were grouped into five domains (socio-demographic, diabetes related, non-diabetes medical related, psychiatric / psychological and health system related variables). A framework for PopulAtion Segmentation Study design for T2DM patients (PASS-T2DM) was proposed. Results Of 155,124 articles screened, 148 articles were included. Expert driven population segmentation approach was most commonly used, of which judgemental splitting was the main strategy employed (n = 111, 75.0%). Cluster based analyses (n = 37, 25.0%) was the main data driven population segmentation strategies utilized. Socio-demographic (n = 66, 44.6%), diabetes related (n = 54, 36.5%) and non-diabetes medical related (n = 18, 12.2%) were the most used domains. Specifically, patients’ race, age, Hba1c related parameters and depression / anxiety related variables were most frequently used. Health grouping/profiling (n = 71, 48%), assessment of diabetes related complications (n = 57, 38.5%) and non-diabetes metabolic derangements (n = 42, 28.4%) were the most frequent population segmentation objectives of the studies. Conclusions Population segmentation has a wide range of clinical applications for evaluating clinical outcomes among T2DM patients. More studies are required to identify the optimal set of population segmentation framework for T2DM patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01209-w.
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Affiliation(s)
- Jun Jie Benjamin Seng
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore
| | | | - Yu Heng Kwan
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Sueziani Binte Zainudin
- Department of General Medicine (Endocrinology), Sengkang General Hospital, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Julian Thumboo
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Outram Rd, Singapore, 169608, Singapore. .,SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore. .,Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. .,SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore. .,Outram Community Hospital, SingHealth Community Hospitals, 10 Hospital Boulevard, Singapore, 168582, Singapore.
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Zhang K, Reininger B, Lee M, Xiao Q, Bauer C. Individual and Community Social Determinants of Health Associated With Diabetes Management in a Mexican American Population. Front Public Health 2021; 8:633340. [PMID: 33614572 PMCID: PMC7888279 DOI: 10.3389/fpubh.2020.633340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies. Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) at the last follow-up visit compared to the baseline. In addition to age, gender, insurance status, education level and marital status, we also investigated 15 community (census tract) SDOH using the American Community Survey. Because of the high correlation in the community SDOH, we developed the community-level indices representing different domains. Using Bayesian multilevel spatial models that account for the geographic dependency, we were able to simultaneously investigate the individual- and community-level SDOH that may impact HbA1C reduction. Results: After accounting for the diabetes self-management education classes taken by the participants and their length of stay in the program, we found that older age at baseline, being married (compared to being widowed or divorced) and English speaking (compared to Spanish) were significantly associated with greater HbA1C reduction. Moreover, we found that the community level SDOH were also highly associated with HbA1C reduction. With every percentile rank decrease in the socioeconomic advantage index, we estimated an additional 0.018% reduction in HbA1C [95% CI (−0.028, −0.007)]. Besides the socioeconomic advantage index, urban core opportunity and immigrant's cohesion and accessibility indices were also statistically associated with HbA1C reduction. Conclusion: To our knowledge, our study is the first to utilize Bayesian multilevel spatial models and simultaneously investigate both individual- and community-level SDOH in the context of diabetes management. Our findings suggest that community SDOH play an important role in diabetes control and management, and the need to consider community and neighborhood context in future interventions programs to maximize their overall effectiveness.
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Affiliation(s)
- Kehe Zhang
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Belinda Reininger
- Department of Health Promotion and Behavior Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Brownsville Regional Campus, Brownsville, TX, United States
| | - Miryoung Lee
- Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston, Brownsville, TX, United States
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cici Bauer
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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20
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Antonio-Villa NE, Palma-Moreno BG, Rodríguez-Dávila FM, Gómez-Pérez FJ, Aguilar-Salinas CA, Hernández-Jiménez S, García-Ulloa AC, Almeda-Valdes P. Use of an electronic integral monitoring system for patients with diabetes to identify factors associated with an adequate glycemic goal and to measure quality of care. Prim Care Diabetes 2021; 15:162-168. [PMID: 32830095 DOI: 10.1016/j.pcd.2020.07.009] [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: 05/16/2020] [Revised: 06/28/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
AIMS To evaluate the use of the electronic integral monitoring system (SMID) to identify factors associated to glycemic control and its impact in the quality of care in patients with type 2 diabetes (T2D). METHODS T2D patients registered in SMID were analyzed. Biochemical, clinical and lifestyle variables were recorded. Factors associated to HbA1c ≤7% were explored. Quality of care of the clinic was measured according to the National Committee for Quality Assurance Criteria (NCQA) that requires a score of 75 to achieve a good quality of care. RESULTS 511 patients were included. Prescription of basal insulin, SGLT-2 inhibitors and barriers to follow nutritional plan were associated with decreased probability of having adequate glycemic control. Patients in the maintenance stage of motivation had higher probability of having HbA1c ≤7%. According to NCQA evaluation 60 points were achieved. Glucose goals were not met; 35.9% had HbA1c ≥9% and 17% HbA1c <7%. While foot evaluation, smoking approach, blood pressure and lipids goals were accomplished; eye and renal evaluations were borderline. CONCLUSION Glycemic control in patients with long standing T2D and multiple comorbidities is challenging, which directly impacts in the quality of care. Professionals should focus in reinforcing non-pharmacological interventions to optimize glycemic targets.
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Affiliation(s)
- Neftali Eduardo Antonio-Villa
- Program (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico; Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - B Geovani Palma-Moreno
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Fátima M Rodríguez-Dávila
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Francisco J Gómez-Pérez
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; División de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico
| | - Sergio Hernández-Jiménez
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Ana Cristina García-Ulloa
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico; Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico.
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21
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Lim KK, Lee VSY, Tan CS, Kwan YH, Lim ZHX, Wee HL, Østbye T, Low LL. Examining the heterogeneity inexcess risks of coronary heart disease, stroke, dialysis, and lower extremity amputation associated with type 2 diabetes mellitus across demographic subgroups in an Asian population: A population-based matched cohort study. Diabetes Res Clin Pract 2021; 171:108551. [PMID: 33238174 DOI: 10.1016/j.diabres.2020.108551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 01/21/2023]
Abstract
AIMS To examine whether the excess risks of coronary heart disease (CHD), stroke, dialysis, and lower extremity amputation (LEA) associated with type 2 diabetes mellitus (T2DM) differ across age, sex, and ethnicity in Singapore. METHODS Using a 10-year administrative data, we matched individuals with T2DM using nearest neighbour matching, to those without, in 1:2 ratio. To examine whether the excess risks were heterogeneous across age, sex, and ethnicity, we generated interaction terms of age, sex, and ethnicity with T2DM status in Cox proportional hazard (PH) models. RESULTS The main analyses included ~1 million person years, comprising 66,099 and 120,485 individuals with and without T2DM, respectively. The associations of T2DM with CHD and dialysis, split into two time periods to address violation of PH assumption, were higher with older age in short-term but lower with older age in long-term. The association of T2DM with stroke and LEA were lower with older age. The associations of T2DM with CHD and stroke were also consistently higher in women than men. The associations of T2DM with LEA were higher in ethnic Malays than ethnic Chinese. CONCLUSIONS The excess risks of CHD, stroke, dialysis, and LEA associated with T2DM were heterogeneous across some demographic subgroups.
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Affiliation(s)
- Ka Keat Lim
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore; School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, United Kingdom
| | - Vivian Shu Yi Lee
- SingHealth Regional Health System, Singapore Health Services, Singapore, Republic of Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore
| | - Zoey Hui Xian Lim
- SingHealth Regional Health System, Singapore Health Services, Singapore, Republic of Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Truls Østbye
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Republic of Singapore; Post Acute and Continuing Care, SingHealth Community Hospitals, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore; PULSES Centre Grant, SingHealth Regional Health System, Singapore.
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22
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Yang A, Wu H, Lau ESH, Ma RCW, Kong APS, So WY, Luk AOY, Chan JCN, Chow E. Trends in Glucose-Lowering Drug Use, Glycemic Control, and Severe Hypoglycemia in Adults With Diabetes in Hong Kong, 2002-2016. Diabetes Care 2020; 43:2967-2974. [PMID: 33046501 DOI: 10.2337/dc20-0260] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There has been a shift toward new classes of glucose-lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs use, glycemic control, and SH rate among patients with diabetes in Hong Kong, which introduced a territory-wide, team-based diabetes care model since 2000. RESEARCH DESIGN AND METHODS Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLD classes, mean hemoglobin A1c (HbA1c) levels, and SH rates in 763,809 patients with diabetes aged ≥20 years between 2002 and 2016. RESULTS Between 2002 and 2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase 4 inhibitors (DPP-4is) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-53 mmol/mol) increased from 28.6% to 43.4%, while the SH rate declined from 4.2/100 person-years to 1.3/100 person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6% (1.6) (59.5 [19.0] mmol/mol) to 7.2% (1.7) (54.8 [18.9] mmol/mol) (P < 0.001). The 20-44 years age-group had the highest proportion of HbA1c ≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%). CONCLUSIONS In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylureas, and modest rise in DPP-4i use. Persistently poor glycemic control and underuse of GLDs in the youngest group calls for targeted action.
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Affiliation(s)
- Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Wing Yee So
- Hong Kong Hospital Authority Head Office, Hong Kong Special Administrative Region, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China .,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
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23
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Gange WS, Xu BY, Lung K, Toy BC, Seabury SA. Rates of Eye Care and Diabetic Eye Disease among Insured Patients with Newly Diagnosed Type 2 Diabetes. Ophthalmol Retina 2020; 5:160-168. [PMID: 32653554 DOI: 10.1016/j.oret.2020.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine rates of eye examinations and diabetic eye disease in the first 5 years after diagnosis of type 2 diabetes (DM2) among continuously insured adults. DESIGN Retrospective, longitudinal cohort study. PARTICIPANTS Insured patients aged 40 years or older with newly diagnosed DM2 (n = 42 684), and control patients without diabetes matched on age, sex, and race were identified from a nationwide commercial claims database containing data from 2007 to 2015. METHODS All patients were tracked for 6 years: 1 year before and 5 years after the index diabetes diagnosis. Receipt of eye care for individual patients was identified using International Classification of Diseases 9th edition (ICD-9) procedure codes or Current Procedural Terminology (CPT) codes indicating an eye examination, as well as encounters indicating the patient was seen by an ophthalmologist. A diagnosis of diabetic eye disease was determined by using ICD-9 codes. MAIN OUTCOME MEASURES Outcome measures included annual receipt of eye care and development of diabetic eye disease, namely, diabetic retinopathy (DR). Associations between these outcomes and demographic factors were tested with multivariable logistic regression. RESULTS Diabetic patients received more eye examinations than controls in each year, but no more than 40.4% of diabetic patients received an examination in any given year. Patients with Medicare Advantage received fewer eye examinations at 5 years (odds ratio [OR], 0.79; P < 0.01) than those with private insurance but were less likely to develop DR (OR, 0.71; P < 0.01). Hispanic patients had higher rates of DR (OR, 1.60; P < 0.01) and received fewer eye examinations (OR, 0.75; P < 0.01) at 5 years compared with White patients. Men received fewer eye examinations (OR, 0.84; P < 0.01) and were more likely to develop DR at 5 years (OR, 1.17; P < 0.01) than women. Patients with higher education were more likely to receive an eye examination and less likely to develop DR. CONCLUSIONS The majority of diabetic patients do not receive adequate eye care within the 5 years after initial diabetes diagnosis despite having insurance. Efforts should be made to improve adherence to screening guidelines, especially for vulnerable populations.
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Affiliation(s)
- William S Gange
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Khristina Lung
- Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brian C Toy
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Seth A Seabury
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, California
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24
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Gopalan A, Mishra P, Alexeeff SE, Blatchins MA, Kim E, Man A, Karter AJ, Grant RW. Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes. Diabetes Care 2020; 43:975-981. [PMID: 32132007 PMCID: PMC7171948 DOI: 10.2337/dc19-1380] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/29/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The prevalence of type 2 diabetes is increasing among adults under age 45. Onset of type 2 diabetes at a younger age increases an individual's risk for diabetes-related complications. Given the lasting benefits conferred by early glycemic control, we compared glycemic control and initial care between adults with younger onset (21-44 years) and mid-age onset (45-64 years) of type 2 diabetes. RESEARCH DESIGN AND METHODS Using data from a large, integrated health care system, we identified 32,137 adults (aged 21-64 years) with incident diabetes (first HbA1c ≥6.5% [≥48 mmol/mol]). We excluded anyone with evidence of prior type 2 diabetes, gestational diabetes mellitus, or type 1 diabetes. We used generalized linear mixed models, adjusting for demographic and clinical variables, to examine differences in glycemic control and care at 1 year. RESULTS Of identified individuals, 26.4% had younger-onset and 73.6% had mid-age-onset type 2 diabetes. Adults with younger onset had higher initial mean HbA1c values (8.9% [74 mmol/mol]) than adults with onset in mid-age (8.4% [68 mmol/mol]) (P < 0.0001) and lower odds of achieving an HbA1c <7% (<53 mmol/mol) 1 year after the diagnosis (adjusted odds ratio [aOR] 0.70 [95% CI 0.66-0.74]), even after accounting for HbA1c at diagnosis. Adults with younger onset had lower odds of in-person primary care contact (aOR 0.82 [95% CI 0.76-0.89]) than those with onset during mid-age, but they did not differ in telephone contact (1.05 [0.99-1.10]). Adults with younger onset had higher odds of starting metformin (aOR 1.20 [95% CI 1.12-1.29]) but lower odds of adhering to that medication (0.74 [0.69-0.80]). CONCLUSIONS Adults with onset of type 2 diabetes at a younger age were less likely to achieve glycemic control at 1 year following diagnosis, suggesting the need for tailored care approaches to improve outcomes for this high-risk patient population.
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Affiliation(s)
- Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Pranita Mishra
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Maruta A Blatchins
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Eileen Kim
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA
| | - Alan Man
- Kaiser Permanente Northern California, Santa Clara Medical Center, Santa Clara, CA
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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25
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Yu Y, Pan F, Cui W, Tang W, Hu Y. Differences in early-phase insulin secretion and glucose disposition index between aged and middle-aged patients with newly diagnosed type 2 diabetes. Geriatr Gerontol Int 2020; 20:206-211. [PMID: 31923347 DOI: 10.1111/ggi.13861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 01/18/2023]
Abstract
AIM This cross-sectional study aimed to investigate the differences in β-cell function and insulin sensitivity between newly diagnosed aged and middle-aged type 2 diabetes mellitus (T2DM) patients. METHODS A total of 206 newly diagnosed T2DM patients aged ≥60 years (A-DM group) and 206 newly diagnosed sex- and glycated hemoglobin-matched T2DM patients aged <60 years (MA-DM group) were recruited. All patients underwent the 75-g oral glucose tolerance test. Plasma glucose, lipid profiles, liver and renal function, glycated hemoglobin, and insulin were measured. Homeostasis model assessment for insulin resistance, quantitative insulin sensitivity check index, area under the curve of glucose during 0-30 min (GluAUC30) × area under the curve of insulin during 0-30 min (InsAUC30) and β-cell function indexes were calculated. RESULTS The mean age of the total 412 patients (356 men and 56 women) was 59.76 ± 13.32 years. There were no significant differences in GluAUC120 between the two groups (106.89 ± 27.70 in A-DM vs 108.32 ± 27.58 in MA-DM; P = 0.6), but ΔI30/ΔG30, InsAUC30 and GluAUC30 × InsAUC30 levels were significantly higher in the A-DM group than in the MA-DM group (3.55 ± 4.54 vs 2.53 ± 3.83; P = 0.014, and 39.19 ± 32.19 vs 32.71 ± 28.81; P = 0.032, 675.05 ± 475.60 vs 584.56 ± 450.23; P = 0.048, respectively). The glucose disposition index (GDI) of the A-DM group was statistically higher than that of the MA-DM group (0.38 ± 0.40 vs 0.30 ± 0.35; P = 0.018). Age was positively associated with ΔI30/ΔG30 (r = 0.117; P = 0.017) and GDI (r = 0.147; P = 0.003), but had no correlation with InsAUC30, InsAUC120 or GluAUC30 × InsAUC30. After multiple adjustments for confounders, including sex, body mass index, glycated hemoglobin, triglyceride, total cholesterol and high-density lipoprotein cholesterol, age was positively associated with ΔI30/ΔG30, InsAUC30, InsAUC120, GluAUC30 × InsAUC30 and GDI. CONCLUSIONS Aged patients have relatively higher early-phase insulin secretion and GDI than middle-aged patients in newly diagnosed T2DM. Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- Yun Yu
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China.,Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Fenghui Pan
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Wenxia Cui
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Wei Tang
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Hu
- Department of Geriatrics, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
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26
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Seringa J, Marques AP, Moita B, Gaspar C, Raposo JF, Santana R. The impact of diabetes on multiple avoidable admissions: a cross-sectional study. BMC Health Serv Res 2019; 19:1002. [PMID: 31881962 PMCID: PMC6935195 DOI: 10.1186/s12913-019-4840-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Multiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures. Diabetes is one of the conditions consensually classified as an ACSC being considered a major public health concern. The aim of this study was to analyse the impact of diabetes on the occurrence of multiple admissions for ACSC. METHODS We analysed inpatient data of all public Portuguese NHS hospitals from 2013 to 2015 on multiple admissions for ACSC among adults aged 18 or older. Multiple ACSC users were identified if they had two or more admissions for any ACSC during the period of analysis. Two logistic regression models were computed. A baseline model where a logistic regression was performed to assess the association between multiple admissions and the presence of diabetes, adjusting for age and sex. A full model to test if diabetes had no constant association with multiple admissions by any ACSC across age groups. RESULTS Among 301,334 ACSC admissions, 144,209 (47.9%) were classified as multiple admissions and from those, 59,436 had diabetes diagnosis, which corresponded to 23,692 patients. Patients with diabetes were 1.49 times (p < 0,001) more likely to be admitted multiple times for any ACSC than patients without diabetes. Younger adults with diabetes (18-39 years old) were more likely to become multiple users. CONCLUSION Diabetes increases the risk of multiple admissions for ACSC, especially in younger adults. Diabetes presence is associated with a higher resource utilization, which highlights the need for the implementation of adequate management of chronic diseases policies.
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Affiliation(s)
- Joana Seringa
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Ana Patrícia Marques
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Bruno Moita
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Algarve University Hospital Center, Faro, Portugal
| | - Cátia Gaspar
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Filipe Raposo
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Associação Protectora dos Diabéticos de Portugal, Lisbon, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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27
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Generalizing Intensive Blood Pressure Treatment to Adults With Diabetes Mellitus. J Am Coll Cardiol 2019; 72:1214-1223. [PMID: 30189998 DOI: 10.1016/j.jacc.2018.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Controversy over blood pressure (BP) treatment targets for individuals with diabetes is in part due to conflicting perspectives about generalizability of available trial data. OBJECTIVE The authors sought to estimate how results from the largest clinical trial of intensive BP treatment among adults with diabetes would generalize to the U.S. POPULATION METHODS The authors used transportability methods to reweight individual patient data from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial (N = 4,507) of intensive (goal systolic BP <120 mm Hg) versus standard (goal systolic BP <140 mm Hg) treatment to better represent the demographic and clinical risk factors of the U.S. population of adults with diabetes (data from NHANES [National Health and Nutrition Examination Survey] 2005 to 2014, n = 1,943). The primary outcome was the first occurrence of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Analysis used weighted Cox proportional hazards regression models with robust standard errors. RESULTS The ACCORD BP sample had less racial/ethnic diversity and more elevated cardiovascular risk factors than the NHANES participants. Weighted results significantly favored intensive BP treatment, unlike unweighted results (hazard ratio for primary outcome in intensive versus standard treatment in weighted analyses: 0.67, 95% confidence interval: 0.49 to 0.91; in unweighted analyses: hazard ratio: 0.88, 95% confidence interval: 0.73 to 1.07). Over 5 years, the weighted results estimate a number needed to treat of 34, and number needed to harm of 55. CONCLUSIONS After reweighting to better reflect the U.S. adult population with diabetes, intensive BP therapy was associated with significantly lower risk for cardiovascular events. However, data were limited among racial/ethnic minorities and those with lower cardiovascular risk.
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Tan YZ, Cheen MHH, Goh SY, Bee YM, Lim PS, Khee GY, Thumboo J. Trends in medication utilization, glycemic control and outcomes among type 2 diabetes patients in a tertiary referral center in Singapore from 2007 to 2017. J Diabetes 2019; 11:573-581. [PMID: 30556375 DOI: 10.1111/1753-0407.12886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/08/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore. METHODS We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex- and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbA1c of less than 6%, 6% to less than 7%, 7% to less than 8%, 8% to less than 9%, or 9% or more were estimated using logistic regression. Poisson regression was used to estimate standardized rate of severe hypoglycemia. RESULTS From 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P < 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P < 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P < 0.001). The proportion of patients with HbA1c of 8% or more increased (33.7% to 36.0%, P < 0.001). Rates of severe hypoglycemia (5.0 to 8.4 per 100 patient-years, P < 0.001) also rose. CONCLUSION Medication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.
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Affiliation(s)
- Yan Zhi Tan
- Department of Pharmacy, Singapore General Hospital, Singapore
| | | | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Paik Shia Lim
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Giat Yeng Khee
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
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Wang C, Gao Y, Zhu L, Huang M, Wu Y, Xuan J. Treatment Patterns in Patients With Newly Diagnosed Type 2 Diabetes in China: A Retrospective, Longitudinal Database Study. Clin Ther 2019; 41:1440-1452. [PMID: 31155146 DOI: 10.1016/j.clinthera.2019.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The objectives of this study were to examine the patterns of antihyperglycemic drug (AHD) therapy among patients with newly diagnosed type 2 diabetes mellitus (T2DM) in the general Chinese population, stratified by initial hemoglobin (Hb) A1c level, and to assess whether treatment patterns are consistent with the recommendations published in the China Diabetes Society's clinical treatment guideline. METHODS A retrospective database analysis was conducted, and data were obtained from the SuValue database. Prescribing patterns for diabetes treatments were determined from data obtained from the Nanhai District-based electronic medical records database, a subset of the SuValue database. Data from patients newly diagnosed with T2DM who also had at least 2 prescriptions for AHD medications after diagnosis and at least 1 HbA1c test result during the 12 months prior to AHD treatment initiation, between January 1, 2004, and July 22, 2018, were included in the analysis. ANOVA, χ2 test, and Kaplan-Meier survival analysis were used to examine differences between 4 initial-HbA1c groups (<7%, 7%-<8%, 8%-<9%, and ≥9%). FINDINGS A total of 4712 patients were included, with women accounting for 47.8%; the mean age (SD) of the study population was 56.44 (12.57) years. Men were more likely to have had a higher HbA1c level at initial AHD treatment (P < 0.0001). The first-line therapies most frequently prescribed were metformin combination (29.5%), followed by insulin-including treatment (25.9%), and metformin monotherapy (19.2%). Metformin monotherapy (29.5%) was most commonly prescribed in patients with an HbA1c level of <7%; metformin combination (31.7%), in patients with an HbA1c level of 7%-<8%; and insulin-containing treatment, in patients with HbA1c levels of 8%-<9% (28.1%) and ≥9% (38.4%). Insulin-including treatment was more commonly prescribed than was metformin combination in patients with an initial HbA1c level of ≥8% after initial treatment. In third- and fourth-line treatments, patients with an HbA1c level of ≥8% more prevalently were prescribed metformin combination and insulin-including treatment, while metformin combination and "other" treatment were more generally prescribed in patients with an HbA1c level of ≤8%. However, 8.8% of patients with an HbA1c level of <7% were prescribed insulin-including treatment as first-line therapy. In all lines of treatment, the percentages of patients prescribed insulin were increased with initial HbA1c levels. A similar pattern was seen with dipeptidyl peptidase 4 inhibitors after first-line treatment. Overall, the median time to treatment switch was shorter than 3 months. IMPLICATIONS The findings from the present study depict a comprehensive overview of AHD-treatment patterns in patients stratified by HbA1c level. The current treatment practices observed were inconsistent the published guideline, in terms of recommendations on metformin monotherapy and insulin use in first-line therapy.
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Affiliation(s)
- Chunping Wang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Yue Gao
- Shanghai Centennial Scientific Co Ltd., Shanghai, China
| | - Lifeng Zhu
- Shanghai Suvalue Health Scientific Ltd., Shanghai, China
| | - Min Huang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Yin Wu
- Shanghai Suvalue Health Scientific Ltd., Shanghai, China
| | - Jianwei Xuan
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China.
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Lv F, Cai X, Hu D, Pan C, Zhang D, Xu J, Ji L. Characteristics of Newly Diagnosed Type 2 Diabetes in Chinese Older Adults: A National Prospective Cohort Study. J Diabetes Res 2019; 2019:5631620. [PMID: 31828163 PMCID: PMC6885297 DOI: 10.1155/2019/5631620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
AIM To investigate the metabolic profiles of newly diagnosed type 2 diabetes (NEW2D) in Chinese older adults (≥65 years) and assess the proportion of patients who achieved the targeted goals of blood glucose, blood pressure, and blood lipid. METHODS NEW2D study was an observational, longitudinal, prospective cohort study involving patients who were diagnosed with type 2 diabetes (T2D) within the past 6 months and had a follow-up of 12 months. Participants were divided into younger NEW2D group (aged 20-65 years old) and older NEW2D group (aged ≥65 years old) according to age of diabetes onset. The baseline metabolic profiles were compared and the proportion of patients achieving adequate control of blood glucose, blood pressure, and blood lipids in reference to target goals were assessed during treatment. RESULTS The older NEW2D (n = 1362) had a lower BMI, HbA1c%, diastolic blood pressure, triglyceride, low-density lipoprotein cholesterol (LDL-C), and total cholesterol, higher systolic blood pressure, and high-density lipoprotein cholesterol levels at baseline. 47.8%, 66.7%, and 39.4% reached the target of HbA1c < 7.0%, BP < 140/90 mmHg, and LDL - C < 2.6 mmol/L, respectively. After 12 months, the proportion achieving above three targets increased to 70.2%, 76.1%, and 47.5%, respectively. The proportions of patients achieving three combined therapeutic targets doubled from 13.5% to 26.7%. CONCLUSION The older NEW2D patients have special metabolic profiles compared with younger patients. The control of cardiovascular disease risk factors was suboptimal in older adults with type 2 diabetes.
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Affiliation(s)
- Fang Lv
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Dayi Hu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Changyu Pan
- Department of Endocrinology and Metabolism, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Danyi Zhang
- VitalStrategic Research Institute, Shanghai, China
| | - Jie Xu
- VitalStrategic Research Institute, Shanghai, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
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Channanath AM, AlWotayan R, Alkandari H, Davidsson L, Tuomilehto J, Thanaraj TA. Glycaemic control in native Kuwaiti Arab patients with type 2 diabetes. Prim Care Diabetes 2018; 12:526-532. [PMID: 30115526 DOI: 10.1016/j.pcd.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the influence of age at diabetes diagnosis, diabetes duration, BMI, comorbidity with hypertension and medication regimen on glycaemic control in native Kuwaiti Arab patients with T2D. METHODS This cross-sectional study considered 7657 patients from Kuwait Diabetes Registry and analysed data from their laboratory and hospital records. RESULTS HbA1c and prevalence of hypertension increased significantly with diabetes duration. Duration of diabetes (β=0.034; P<0.001) and age at diagnosis (β=-0.03; P<0.001) were independently associated with HbA1c. Inadequate glycaemic control was more likely in patients diagnosed at <60 than in those ≥60 years of age (OR:1.80, 95%-CI:1.39-2.31). Increasing duration of diabetes witnessed decrease in metformin prescription and increase in sulfonylureas prescription; proportion of patients treated with insulin increased from 5.6% to 44.4% in 9 years of diagnosis. Patients with 9-years duration of diabetes or with combination therapy of insulin-metformin-sulfonylureas differed in mean BMI for adequate or inadequate glycaemic control (29.5 versus 31.2kg/m2; P<0.001 and 29.8 versus 33.2; P<0.01, respectively). CONCLUSIONS Only 25.6% of the T2D patients in this ethnic cohort exhibited adequate glycaemic control. The delineated relationship of inadequate glycaemic control with diabetes duration, onset age, obesity and hypertension prevalence has a bearing on diabetes management programs for Arabs.
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Affiliation(s)
- Arshad M Channanath
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Rihab AlWotayan
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Primary Health Care, Ministry of Health, Kuwait
| | - Hessa Alkandari
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Pediatrics, Farwaniya Hospital, Farwaniya, Kuwait
| | - Lena Davidsson
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Jaakko Tuomilehto
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
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Sidorenkov G, van Boven JFM, Hoekstra T, Nijpels G, Hoogenberg K, Denig P. HbA1c response after insulin initiation in patients with type 2 diabetes mellitus in real life practice: Identifying distinct subgroups. Diabetes Obes Metab 2018; 20:1957-1964. [PMID: 29687577 PMCID: PMC6055847 DOI: 10.1111/dom.13332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/06/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
AIMS To identify subgroups of patients with type 2 diabetes mellitus (T2DM) following distinct trajectories of HbA1c after insulin initiation and explore underlying differences in clinical characteristics. MATERIALS AND METHODS A cohort study was conducted in patients with T2DM initiating insulin in 2007-2013 with a follow-up of 2 to 4 years. Data were collected from the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was subgroups with different trajectories of HbA1c patterns after insulin initiation, as identified by latent class growth modeling. Differences between subgroups were tested using one-way ANOVA, Kruskal-Wallis or chi-square tests, where appropriate. RESULTS From 1459 patients, three subgroups with distinct HbA1c patterns were identified. Group 1 (8%) initially showed a moderate decrease followed by an increase in HbA1c 2 years later, despite receiving more comedication. Group 2 (84%) showed a stable decrease. Group 3 (8%) had a high initial level of HbA1c and a rapid decline within the first year, followed by a slow increase thereafter. Group 1 patients were on average 6-7 years younger than patients in groups 2 and 3 and were more likely to receive sulfonylureas than Group 3 patients. Group 3 patients had a shorter diabetes duration and were less well-controlled for HbA1c, systolic blood pressure and LDL-cholesterol at insulin initiation. CONCLUSIONS Most patients showed a stable HbA1c response, but one out of six patients showed either a poor response, or a rapid initial response only after insulin initiation. Response patterns were associated with age, diabetes duration and risk-factor controls at the time of insulin initiation.
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Affiliation(s)
- Grigory Sidorenkov
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of EpidemiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Trynke Hoekstra
- Center for Human Movement SciencesUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of Health Sciences, Faculty of ScienceAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Klaas Hoogenberg
- Department of Internal MedicineMartini HospitalGroningenThe Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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Lee YH, Shin MH, Nam HS, Park KS, Choi SW, Ryu SY, Kweon SS. Effect of Family History of Diabetes on Hemoglobin A1c Levels among Individuals with and without Diabetes: The Dong-gu Study. Yonsei Med J 2018; 59:92-100. [PMID: 29214782 PMCID: PMC5725370 DOI: 10.3349/ymj.2018.59.1.92] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/26/2017] [Accepted: 10/28/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We investigated associations between family history of diabetes (FHD) and hemoglobin A1c (HbA1c) level, among people with and without diabetes. MATERIALS AND METHODS In total, 7031 people without diabetes and 1918 people with diabetes who participated in the Dong-gu Study were included. Data on FHD in first-degree relatives (father, mother, and siblings) were obtained. Elevated HbA1c levels in people without diabetes and high HbA1c levels in people with diabetes were defined as the highest quintiles of HbA1c ≥5.9% and ≥7.9%, respectively. RESULTS In people without diabetes, the odds of elevated HbA1c levels [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.13-1.59] were significantly greater in people with any FHD than in those without. Specifically, the odds of elevated HbA1c levels in people without diabetes with an FHD involving siblings were greater than in those without an FHD involving siblings. Additionally, in people with diabetes, the odds of high HbA1c levels (OR 1.33, 95% CI 1.02-1.72) were greater in people with any FHD than in those without such history. Moreover, people with diabetes with maternal FHD had increased odds of high HbA1c levels. CONCLUSION FHD was associated not only with high HbA1c levels in people with diabetes, but also with elevated HbA1c levels in people without diabetes.
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Affiliation(s)
- Young Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Min Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hae Sung Nam
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyeong Soo Park
- Department of Preventive Medicine, Seonam University College of Medicine, Namwon, Korea
| | - Seong Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - So Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Sun Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
- Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Korea.
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Trends in the management levels of metabolic risk factors in middle-aged and elderly patients with type 2 diabetes mellitus: The Korean National Health and Nutrition Examination Survey 1998-2014. PLoS One 2017; 12:e0189361. [PMID: 29228048 PMCID: PMC5724842 DOI: 10.1371/journal.pone.0189361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022] Open
Abstract
The present study examined the temporal trends in the management of blood pressure, glucose, and lipid levels among middle-aged and elderly patients with type 2 diabetes using data from the Korean National Health and Nutrition Examination Survey (1998–2014). A total of 3,689 patients with diabetes were included and divided into middle-aged (30–64 years old) and elderly (≥65 years old) groups. Demographic and lifestyle data were obtained using a self-reported questionnaire, and trained medical staff obtained fasting blood samples and blood pressure data. Laboratory testing was performed to determine blood glucose, cholesterol, and triglyceride levels. In the multivariable adjusted models, significant decreasing trends in the prevalences of hyperglycemia and hypertension were observed in both age groups during 1998–2014, although no trends were observed for lipid levels. Based on the most recent survey, approximately 50% of patients with diabetes had hyperglycemia, and one-third of patients with diabetes and hypertension did not appropriately manage their blood pressure. In addition, 50% of the patients in both age groups did not manage their lipid profiles, and the management of lipid profiles did not improve in recent years. These results suggest that continuous follow-up is needed to effectively manage metabolic risk factors, especially lipid profiles, among patients with diabetes.
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Li J, Goh CE, Demmer RT, Whitcomb BW, Du P, Liu Z. Association between Serum Folate and Insulin Resistance among U.S. Nondiabetic Adults. Sci Rep 2017; 7:9187. [PMID: 28835661 PMCID: PMC5569086 DOI: 10.1038/s41598-017-09522-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/17/2017] [Indexed: 02/02/2023] Open
Abstract
Recent studies have suggested that epigenetic alterations, particularly DNA methylation, play a crucial role in the pathogenesis of insulin resistance. Folate is a key source of the one-carbon group for DNA methylation, whereas the association and mechanistic linkage between folate status and insulin resistance remains unclear with very limited experimental support. We performed a cross-sectional study of 1530 nondiabetic adults in the 2011–2012 National Health and Nutrition Examination Survey (NHANES). We examined associations between serum folate and insulin resistance using multiple linear regression models adjusted for potential confounders. We detected a significant inverse relationship for serum folate, where a 25% increase in serum folate was associated with a 3.06% (95% CI, −4.72, −1.37) and 2.77% (95% CI, −4.36, −1.77) decline in HOMA-IR and insulin respectively, and a 2.55% (95% CI, 0.93, 4.21) increase in G/I ratio. Our findings demonstrate that serum folate was inversely associated with insulin resistance in U.S. nondiabetic adults.
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Affiliation(s)
- Jinchao Li
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Charlene E Goh
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA
| | - Peng Du
- Department of Mathematics and Statistics, University of Massachusetts, Amherst, MA, USA
| | - Zhenhua Liu
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA. .,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
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Abstract
INTRODUCTION Previous research has found that the percentage of US adults with diabetes achieving a glycated hemoglobin (HbA1c) target of <7.0% with currently available treatments has been fairly constant from 2003 to 2010, remaining at just over 50% [1]. The objective of this study was to compare the most recent data (2011-2014) with earlier data to track progress on HbA1c target achievement, for both the general target of <7.0% and inferred individualized targets based on age and the presence of complications. METHODS Data from 2677 adults with self-reported diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014 were examined to determine the percentage of adults who achieved HbA1c targets of <7% and an individualized target based on age and comorbidities. National estimates are reported by using weights that account for the complex sampling design of the NHANES. RESULTS The percentage of people with diabetes and HbA1c <7.0% slightly declined from 52.2% (95% CI 48.7-55.7%) to 50.9% (95% CI 47.2-54.7%) between the two most recent waves of data. Achievement of individualized targets declined from 69.8% (95% CI 66.5-73.0%) to 63.8% (95% CI 60.1-67.5%). The percentage with HbA1c >9.0% increased from 12.6% (95% CI 10.5-14.8%) to 15.5% (95% CI 12.9-18.2%). Achievement of individualized targets varied by age group and presence of comorbidities, but exhibited similar trends as general target achievement. CONCLUSIONS Despite the development of many new medications to treat diabetes during the past decade, the proportion of patients achieving glycemic control targets has not improved. FUNDING Intarcia Therapeutics.
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Affiliation(s)
| | | | | | - John Yee
- Intarcia Therapeutics, Boston, MA, USA
| | - Steven V Edelman
- Intarcia Therapeutics, Boston, MA, USA
- University of California, San Diego, San Diego, CA, USA
- Taking Control of Your Diabetes, Del Mar, CA, USA
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Kwon Y, Kim KJ, Roh YK, Park YG, Park S, Cho KH. Weight Status and All-Cause Mortality in Older Adults: A Study of Patients With Type 2 Diabetes Undergoing Subtotal Gastrectomy for Cancer. Ann Geriatr Med Res 2017. [DOI: 10.4235/agmr.2017.21.2.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yeongkeun Kwon
- Division of Geriatrics, Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
| | - Kyeong Jin Kim
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yong Kyun Roh
- Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungsoo Park
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Hwan Cho
- Division of Geriatrics, Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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Shamshirgaran SM, Mamaghanian A, Aliasgarzadeh A, Aiminisani N, Iranparvar-Alamdari M, Ataie J. Age differences in diabetes-related complications and glycemic control. BMC Endocr Disord 2017; 17:25. [PMID: 28472985 PMCID: PMC5418847 DOI: 10.1186/s12902-017-0175-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 04/04/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study aimed to examine the associations of age with the presence of complications and glycemic control in the Northwest of Iran. METHODS A total of 649 people with diabetes who were >25 years old and had a caring record in diabetes clinics in two Northwestern provinces of Iran during 2014-15, were recruited in this cross-sectional study. General information including demographic, socioeconomic status and lifestyle factors were collected by trained interviewers. Clinical information was retrieved from clinic's record. Univariate and multivariate logistic regression were performed to assess the predictors of diabetes outcome of interest as well as to clarify the role of age in relation to these outcomes. RESULTS Compared to the age group of ≤49, the middle age group (50-59) and the older age group (60 years of age and older) were less likely to report poor glycemic control (OR fully adjusted = 0.49 95% CI: 0.28-0.86 and (OR = 0.44 95% CI: 0.24-0.80), respectively. Additionally, poor glycemic control was associated with income level, disease duration, hypercholesterolemia, high level of LDL and hypertension. In contrast, age was associated with the highest percentage of complications. People with duration of >7 years of disease record were 6 times more likely to have complications (ORadj = 5.98 95% CI: 2.35-15.22). CONCLUSION Although the prevalence of complications was higher among the older diabetic patients, they had a better glycemic control. The influential factors were variably associated with the two diabetes-related outcomes; therefore, a more comprehensive risk profiles assessment is needed for glycemic control.
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Affiliation(s)
- S. M. Shamshirgaran
- Department of Statistics and Epidemiology, School of Health Sciences Tabriz University of Medical Sciences, Tabriz, Iran
- Injury Epidemiology Prevention Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A. Mamaghanian
- Department of Statistics and Epidemiology, School of Health Sciences Tabriz University of Medical Sciences, Tabriz, Iran
| | - A. Aliasgarzadeh
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - N. Aiminisani
- Department of Statistics and Epidemiology, School of Health Sciences Tabriz University of Medical Sciences, Tabriz, Iran
| | - M. Iranparvar-Alamdari
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - J. Ataie
- Khalkhal Health Center, School of Khalkhal Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
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Wu M, Wen J, Qin Y, Zhao H, Pan X, Su J, Du W, Pan E, Zhang Q, Zhang N, Sheng H, Liu C, Shen C. Familial History of Diabetes is Associated with Poor Glycaemic Control in Type 2 Diabetics: A Cross-sectional Study. Sci Rep 2017; 7:1432. [PMID: 28469277 PMCID: PMC5431173 DOI: 10.1038/s41598-017-01527-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/31/2017] [Indexed: 12/27/2022] Open
Abstract
To investigate the association of familial history (FH) of diabetes with the glycaemic control status of patients with type 2 diabetes (T2D), a cross-sectional study using stratified cluster sampling was conducted with 20,340 diabetic patients in Jiangsu, China. In total, 21.3% of the subjects reported a FH of diabetes. Patients with a FH of diabetes showed a higher risk of poor glycaemic control (59.7%) than those without a diabetic FH (49.8%), with an odds ratio (OR) of 1.366 (P < 0.001). Glycaemic control status did not significantly differ between the T2D patients with parental FH and those with sibling FH. Compared with patients with paternal FH, patients with maternal FH had a higher risk of poor glycaemic control (OR = 1.611, P = 0.013). Stratified analyses showed that a FH of diabetes was significantly associated with poor glycaemic control among T2D patients with a low education level (P < 0.05). In the <60 years old, overweight, and low level of physical activity groups, patients with a maternal history of diabetes showed a higher risk of poor glycaemic control than those without a FH (P < 0.05). In conclusion, FH of diabetes, especially a maternal history, had an independently adverse effect on the glycaemic control of T2D patients.
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Affiliation(s)
- Ming Wu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jinbo Wen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yu Qin
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Hailong Zhao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiaoqun Pan
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jian Su
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Wencong Du
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, 223001, China
| | - Qin Zhang
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, 223001, China
| | - Ning Zhang
- Changshu County Center for Disease Control and Prevention, Suzhou, 215500, China
| | - Hongyan Sheng
- Changshu County Center for Disease Control and Prevention, Suzhou, 215500, China
| | - Chunlan Liu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Lipska KJ, Yao X, Herrin J, McCoy RG, Ross JS, Steinman MA, Inzucchi SE, Gill TM, Krumholz HM, Shah ND. Trends in Drug Utilization, Glycemic Control, and Rates of Severe Hypoglycemia, 2006-2013. Diabetes Care 2017; 40:468-475. [PMID: 27659408 PMCID: PMC5360291 DOI: 10.2337/dc16-0985] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/31/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODS Using claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1) age- and sex-standardized proportion of patients who filled each class of agents; 2) age-, sex-, race-, and region-standardized proportion with hemoglobin A1c (HbA1c) <6%, 6 to <7%, 7 to <8%, 8 to <9%, ≥9%; and 3) age- and sex-standardized rate of severe hypoglycemia among those using medications. Proportions were calculated overall and stratified by age-group (18-44, 45-64, 65-74, and ≥75 years) and number of chronic comorbidities (zero, one, and two or more). RESULTS From 2006 to 2013, use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P < 0.001). The proportion of patients with HbA1c <7% declined (from 56.4 to 54.2%; P < 0.001) and with HbA1c ≥9% increased (9.9 to 12.2%; P < 0.001). Glycemic control varied by age and was poor among 23.3% of the youngest and 6.3% of the oldest patients in 2013. The overall rate of severe hypoglycemia remained the same (1.3 per 100 person-years; P = 0.72), declined modestly among the oldest patients (from 2.9 to 2.3; P < 0.001), and remained high among those with two or more comorbidities (3.2 to 3.5; P = 0.36). CONCLUSIONS During the recent 8-year period, the use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged.
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Affiliation(s)
- Kasia J Lipska
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Xiaoxi Yao
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Rozalina G McCoy
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Joseph S Ross
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health and Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Michael A Steinman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco VA Health Care System, San Francisco, CA
| | - Silvio E Inzucchi
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Thomas M Gill
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health and Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Nilay D Shah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- OptumLabs, Cambridge, MA
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Turi KN, Buchner DM, Grigsby-Toussaint DS. Predicting Risk of Type 2 Diabetes by Using Data on Easy-to-Measure Risk Factors. Prev Chronic Dis 2017; 14:E23. [PMID: 28278129 PMCID: PMC5345963 DOI: 10.5888/pcd14.160244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Statistical models for assessing risk of type 2 diabetes are usually additive with linear terms that use non-nationally representative data. The objective of this study was to use nationally representative data on diabetes risk factors and spline regression models to determine the ability of models with nonlinear and interaction terms to assess the risk of type 2 diabetes. METHODS We used 4 waves of data (2005-2006 to 2011-2012) on adults aged 20 or older from the National Health and Nutrition Examination Survey (n = 5,471) and multivariate adaptive regression splines (MARS) to build risk models in 2015. MARS allowed for interactions among 17 noninvasively measured risk factors for type 2 diabetes. RESULTS A key risk factor for type 2 diabetes was increasing age, especially for those older than 69, followed by a family history of diabetes, with diminished risk among individuals younger than 45. Above age 69, other risk factors superseded age, including systolic and diastolic blood pressure. The additive MARS model with nonlinear terms had an area under curve (AUC) receiver operating characteristic of 0.847, whereas the 2-way interaction MARS model had an AUC of 0.851, a slight improvement. Both models had an 87% accuracy in classifying diabetes status. CONCLUSION Statistical models of type 2 diabetes risk should allow for nonlinear associations; incorporation of interaction terms into the MARS model improved its performance slightly. Robust statistical manipulation of risk factors commonly measured noninvasively in clinical settings might provide useful estimates of type 2 diabetes risk.
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Affiliation(s)
- Kedir N Turi
- Vanderbilt University Medical Center, 215 21st Ave S, Medical Center East, North Tower, Suite 6100, Nashville, TN 37232.
| | - David M Buchner
- University of Illinois-Urbana Champaign, Champaign, Illinois
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Romera I, Gomis R, Crowe S, de Pablos-Velasco P, Aranda U, García A, Kis SG, Naderali E. Empagliflozin in combination with oral agents in young and overweight/obese Type 2 diabetes mellitus patients: A pooled analysis of three randomized trials. J Diabetes Complications 2016; 30:1571-1576. [PMID: 27499456 DOI: 10.1016/j.jdiacomp.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 12/22/2022]
Abstract
AIMS This analysis aimed to evaluate efficacy and safety of empagliflozin in combination therapy in <65 y.o. patients, overweight/obese, and with uncontrolled T2DM. METHODS Pooled analysis from three phase-III trials, in <65 y.o. patients, with BMI 25-35kg/m2, and HbA1c ≥8% at baseline. Patients (N=439) were randomized to placebo (n=138), empagliflozin 10mg (n=160), or empagliflozin 25mg (n=141) once daily (24weeks) as add-on to metformin, to metformin plus sulfonylurea, or to pioglitazone ± metformin. RESULTS At week 24, adjusted mean (SE) changes from baseline in HbA1c were -0.19% (0.07) for placebo vs. -1.10% (0.07) and -1.10% (0.07) for empagliflozin 10 and 25mg, respectively (both p<0.001). Adjusted mean (SE) changes from baseline in weight were -0.33kg (0.21) for placebo vs. -1.94kg (0.19) and -2.14kg (0.20) for empagliflozin 10 and 25mg, respectively (both p<0.001). Adverse events were reported in 57.2% on placebo, 64.4% on empagliflozin 10mg and 59.6% on empagliflozin 25mg. Genital infection AEs were reported in 1.4% on placebo, 3.8% on empagliflozin 10mg, and 5.0% on empagliflozin 25mg. CONCLUSIONS In this specific population, empagliflozin in combination with other oral agents, significantly reduced HbA1c and body weight and was well tolerated.
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Affiliation(s)
- Irene Romera
- Eli Lilly and Company, Avenida de la Industria, 30, 28108 Alcobendas, Madrid, Spain.
| | - Ramon Gomis
- Diabetes and Endocrinology Unit, Hospital Clinic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
| | - Susanne Crowe
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Binger Str. 173, 55218 Ingelheim am Rhein, Germany
| | - Pedro de Pablos-Velasco
- Research Institute of Biomedical and Health Sciences (IUIBS), ULPGC. Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Unai Aranda
- Boehringer Ingelheim España, S.A., Carrer de Prat de la Riba, 50, 08174 Sant Cugat del Vallès, Barcelona, Spain
| | - Arantxa García
- Boehringer Ingelheim España, S.A., Carrer de Prat de la Riba, 50, 08174 Sant Cugat del Vallès, Barcelona, Spain
| | - Sanja Giljanovic Kis
- Eli Lilly (Suisse) SA Representative Office, Ulica grada Vukovara 269 G Zgrada V2/8. kat 10000, Zagreb, Croatia
| | - Ebrahim Naderali
- Eli Lilly and Company, Lilly House, Priestley Rd, Basingstoke RG24 9NL, UK; Faculty of Science, Liverpool Hope University, Hope Park,Liverpool L16 9JD,Reino Unido, Liverpool, UK
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Abstract
Diabetes mellitus is an increasing global health problem. Guidelines for diabetic care recommend management of lifestyle and risk factors (glucose, blood pressure, and cholesterol), as well as regular screening for complications associated with treatment of the conditions related to diabetes. The prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013. According to the diabetes fact sheet 2015, the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013, and 49.5% of those with diabetes were being treated with lipid-lowering medications in 2013, a 1.8-fold increase since 2006. According to the 2014 Korea National Health and Nutrition Examination Survey data, 45.6% of patients with diabetes achieved a hemoglobin A1c level of < 7.0%, 72.8% achieved a blood pressure of < 140/85 mmHg, and 58.0% achieved a low density lipoprotein cholesterol level of < 100 mg/dL. Only 19.7% of patients with diabetes had good control of all three of these parameters. Despite improvements in health promotion efforts, the rates of adherence to medication and risk-factor control are low. Therefore, a systematic approach to managing diabetes, including self-management education, is needed to prevent or delay complications. The government needs to establish a long-term policy to address the growing burden of diabetes.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
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Risk of Developing Diabetes Among Refugees and Immigrants: A Longitudinal Analysis. J Community Health 2016; 41:1274-1281. [DOI: 10.1007/s10900-016-0216-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Fogelman Y, Karkabi K, Goldfracht M. Poor glycemic control as a reason for referral of diabetes patients to specialists in Israel. J Community Hosp Intern Med Perspect 2016; 6:31204. [PMID: 27124172 PMCID: PMC4848427 DOI: 10.3402/jchimp.v6.31204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS/INTRODUCTION Family physicians face the dilemma of when to refer patients with diabetes to specialists. This study examined attitudes of family physicians to referring patients with poor glucose control to diabetes specialists. MATERIALS AND METHODS At continuous medical education courses, family physicians were asked to respond anonymously, as to whether they generally manage the diabetes of their patients, and specifically those with poor glycemic control (HbA1c>9.0%). RESULTS Of 470 respondents, 426 (90%) reported that they generally manage their patients' diabetes; 202 (43%) reported that they manage the diabetes of patients with HbA1c>9.0%. Board certification in family medicine and affiliation to a health maintenance organization, but not sex, age, years of professional experience, or the proportion of patients with diabetes at their clinics, were associated with referral practices. CONCLUSIONS Family medicine residency and organizational support appear to promote treatment by family physicians of patients with poorly controlled diabetes in the primary care setting.
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Affiliation(s)
- Yacov Fogelman
- Department of Family Practice, Leumit Health Services, Tel Aviv-Yafo, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel;
| | - Khaled Karkabi
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Margalit Goldfracht
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Department of Family Medicine, Clalit Health Services, Haifa and Western Galilee District, Israel
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Barrot-de la Puente J, Mata-Cases M, Franch-Nadal J, Mundet-Tudurí X, Casellas A, Fernandez-Real JM, Mauricio D. Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database. Int J Clin Pract 2015; 69:1486-95. [PMID: 26422335 PMCID: PMC5054846 DOI: 10.1111/ijcp.12741] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Older subjects with type 2 diabetes mellitus (T2DM) have differential characteristics compared with middle-aged or younger populations, and require tailored management of the disease. AIMS To evaluate how clinical characteristics, degree of control of glycaemia and cardiovascular risk factors, presence of chronic complications and treatments differ between older T2DM patients and younger adults. METHODS Cross-sectional study using data from a population-based electronic database. We retrieved data from 318,020 patients ≥ 30 years diagnosed with T2DM, attended during 2011 in primary care centres in Catalonia, Spain. We performed descriptive and comparative analyses stratified by gender and age subgroups: ≤ 65, 66-75, 76-85 and >85 years. RESULTS Both men and women across older age subgroups (> 65 years) had longer diabetes duration than younger adults (8.0 vs. 5.6 in men and 8.4 vs. 6.9 years in women; p < 0.001), but better glycaemic control (mean glycated haemoglobin 7.1 vs. 7.7 in men and 7.1 vs. 7.4 in women; p < 0.001), and better combined control of different cardiovascular risk factors (p < 0.001). Moreover, older patients were more likely to achieve glycaemic targets irrespective of having cardiovascular disease. The use of oral antidiabetics decreased with increasing age, and insulin in monotherapy was more frequently prescribed among patients in the older age subgroups. Diabetes-related complications were more frequent in men of all group ages. In the older age subgroups, patients of both sexes had a longer duration of T2DM but better glycaemic control. In this context, the prevalence of diabetic retinopathy decreased unexpectedly with increasing age. CONCLUSION Control of glycaemia and cardiovascular risk factors was better among older T2DM patients. There is a need for prospective studies to quantify the weight of risk factors in each complication to adapt the therapeutic and care approaches in elderly people.
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Affiliation(s)
- J Barrot-de la Puente
- Primary Health Care Center Doctor Jordi Nadal, Gerència d'Àmbit d'Atenció Primària Girona Ciutat, Institut Catala de la Salut, Salt, Spain
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - M Mata-Cases
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center La Mina, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - J Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - X Mundet-Tudurí
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Primary Health Care Center El Carmel, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - A Casellas
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - J M Fernandez-Real
- Department of Endocrinology & Nutrition, Health Sciences Research Institute & Hospital Universitari Josep Trueta, Girona, Spain
- CIBER on Patophisiology, Obesity and Nutrition (CIBERON), Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - D Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
- Department of Endocrinology & Nutrition, Health Sciences Research Institute & Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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A large-scale, observational study to investigate the current status of diabetes complications and their prevention in Japan: research outline and baseline data for type 2 diabetes—JDCP study 1. Diabetol Int 2015. [DOI: 10.1007/s13340-015-0223-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Harris S, Aschner P, Mequanint S, Esler J. Use of Diabetes Registry Data for Comparing Indices of Diabetes Management: A Comparison of 2 Urban Sites in Canada and Colombia. Can J Diabetes 2015; 39:496-501. [PMID: 26255579 DOI: 10.1016/j.jcjd.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/12/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To demonstrate the use of a multinational diabetes registry for comparing indices of diabetes management among countries with differing levels of income, healthcare systems and ethnic backgrounds. METHODS A cross-sectional study was conducted among 1742 people with type 2 diabetes attending diabetes clinics in London, Ontario, Canada, and Bogota, Colombia. The data were extracted from the Global Registry and Surveillance System for Diabetes (GRAND). RESULTS Canadian patients were diagnosed with diabetes at significantly younger ages than Colombian patients (49 years and 53 years, respectively) and were heavier (body mass indices of 33 and 28, respectively). The Colombian patient population had significantly higher mean glycated hemoglobin (A1C) levels (9.4% vs. 8.6%) and fewer patients (22% vs. 26%) at the glycemic target (A1C <7.0%) than Canadian patients. In Colombia, 1 or more diabetes-related complications were present in 51% of the study population compared with 37% in Canada. Newly diagnosed Colombians had higher mean A1C levels (9.1% vs. 8.7%) and low-density lipoprotein-C levels (3.3 mmol/L vs. 2.5 mmol/L) than did newly diagnosed Canadians. CONCLUSIONS A multination diabetes registry collecting standardized data facilitates transnational comparison of diabetes clinical parameters for the purpose of identifying potential gaps in care.
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Affiliation(s)
- Stewart Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Pablo Aschner
- Department of Internal Medicine, Javeriana University School of Medicine, San Ignacio University Hospital, and Colombian Diabetes Association, Bogotá, Colombia
| | - Selam Mequanint
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jim Esler
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Depression in persons with diabetes by age and antidiabetic treatment: a cross-sectional analysis with data from the Hordaland Health Study. PLoS One 2015; 10:e0127161. [PMID: 26010615 PMCID: PMC4444007 DOI: 10.1371/journal.pone.0127161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 04/12/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Persons with diabetes have increased risk of depression, however, studies addressing whether the risk varies by age and type of antidiabetic treatment have yielded conflicting results. The aim of this study was to investigate if the association between diabetes and depression varied by type of antidiabetic treatment in a large community based sample of middle-aged (40-47 years) and older adults (70-72 years). METHODS Data from 21845 participants in the Hordaland Health Study (HUSK) were analyzed in a cross-sectional design. Diabetes was assessed by self-report and classified as un-medicated, treated by oral antidiabetic agents or by insulin. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety and Depression Scale and/or self-reported use of antidepressant agents. Associations between diabetes and depression were estimated using logistic regression. RESULTS Persons in their forties with diabetes had a doubled prevalence of depression (OR: 1.96 (95% C.I.: 1.35, 2.83)) compared to persons without diabetes, while a lower and non-significant association was found among persons in their seventies. Persons in their forties with orally treated diabetes had about three times higher prevalence of depression (OR: 2.92 (95% C.I.: 1.48, 5.77)) after adjustment for gender, BMI, physical activity, alcohol consumption and education, compared to non-diabetic persons in the same age-group. No association between depression and insulin or un-medicated diabetes was found. CONCLUSIONS Clinicians should be aware that persons in their forties with orally treated diabetes are at a marked increased risk of depression.
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Twito O, Frankel M, Nabriski D. Impact of glucose level on morbidity and mortality in elderly with diabetes and pre-diabetes. World J Diabetes 2015; 6:345-351. [PMID: 25789117 PMCID: PMC4360429 DOI: 10.4239/wjd.v6.i2.345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/30/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
The prevalence of type 2 diabetes mellitus (DM) increases with age and reaches 25% in those older than age 65 years. Pre-diabetes status is also very common in the elderly, and is present in about half of those age 75 years and older. Many physicians care for elderly patients with diabetes and pre-diabetes, dealing with the challenge of controlling glucose levels and improving health with minimal adverse events. Over the last decade, research on diabetes among the elderly population has proliferated, adding new information on this topic. This review summarizes the updated medical literature on diabetes and pre-diabetes in the elderly, including the significance of pre-diabetic conditions, new-onset DM in the elderly and long-standing DM. The role of therapeutic intervention and the level of glycemic control for this population are discussed in particular.
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