The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study

Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study

OBJECTIVES

To estimate the burden, trends, and inequalities of type 1 diabetes mellitus (T1DM) among older adults at global, regional, and national level from 1990 to 2019.

DESIGN

Population based study.

POPULATION

Adults aged ≥65 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2019)from 1990 to 2019.

MAIN OUTCOME MEASURES

Primary outcomes were T1DM related age standardised prevalence, mortality, disability adjusted life years (DALYs), and average annual percentage change.

RESULTS

The global age standardised prevalence of T1DM among adults aged ≥65 years increased from 400 (95% uncertainty interval (UI) 332 to 476) per 100 000 population in 1990 to 514 (417 to 624) per 100 000 population in 2019, with an average annual trend of 0.86% (95% confidence interval (CI) 0.79% to 0.93%); while mortality decreased from 4.74 (95% UI 3.44 to 5.9) per 100 000 population to 3.54 (2.91 to 4.59) per 100 000 population, with an average annual trend of -1.00% (95% CI -1.09% to -0.91%), and age standardised DALYs decreased from 113 (95% UI 89 to 137) per 100 000 population to 103 (85 to 127) per 100 000 population, with an average annual trend of -0.33% (95% CI -0.41% to -0.25%). The most significant decrease in DALYs was observed among those aged <79 years: 65-69 (-0.44% per year (95% CI -0.53% to -0.34%)), 70-74 (-0.34% per year (-0.41% to -0.27%)), and 75-79 years (-0.42% per year (-0.58% to -0.26%)). Mortality fell 13 times faster in countries with a high sociodemographic index versus countries with a low-middle sociodemographic index (-2.17% per year (95% CI -2.31% to -2.02%) v -0.16% per year (-0.45% to 0.12%)). While the highest prevalence remained in high income North America, Australasia, and western Europe, the highest DALY rates were found in southern sub-Saharan Africa, Oceania, and the Caribbean. A high fasting plasma glucose level remained the highest risk factor for DALYs among older adults during 1990-2019.

CONCLUSIONS

The life expectancy of older people with T1DM has increased since the 1990s along with a considerable decrease in associated mortality and DALYs. T1DM related mortality and DALYs were lower in women aged ≥65 years, those living in regions with a high sociodemographic index, and those aged <79 years. Management of high fasting plasma glucose remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed.

Quality of life, stress, anxiety and depression and associated factors among people with type 2 diabetes mellitus in Western region Saudi Arabia

Introduction

The objective of this study is to evaluate the quality of life (QoL), depression, anxiety, and stress, along with associated factors among individuals with diabetes in Saudi Arabia.

Methods

This survey was conducted at King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA). The assessment of depression, anxiety, and stress related to Type 2 Diabetes Mellitus (T2DM) was conducted using the DASS-21 questionnaire, while diabetes-related QoL was evaluated using the revised version of the diabetes QoL questionnaire (RV-DQoL13). Data were analyzed using SPSS-26.

Results

A total of 251 subjects were included in the study (165 [65.7%] males and 86 [34.3%] females, mean age 50.1 ± 14.5 years). The individuals with DM had a mean value of QoL of 29.16 ± 9.23, with 46.9% having poor QoL. Furthermore, in dimensions of QoL, almost half of the individuals reported high worry about the disease (49.6%), followed by a high diabetes impact (46.6%) and low life satisfaction (42.9%). The prevalence of depression, anxiety, and stress was 49.4, 71.7, and 49.8%, respectively. A significant correlation was found between depression, anxiety, and stress and DASS-21 scores with QoL (p < 0.001). The regression analysis indicated an association of distinct factors with QoL like age above 41 years (p = 0.004), being married (p < 0.001), being divorced (p = 0.04), higher education (p = 0.007), regular medicine intake (p = 0.01), regular exercise (p = 0.03), lipid profile (p = 0.01), HbA1c (p < 0.001), and DASS-21 scores (p < 0.001). Poor QoL score (TQoL score > 27) was significantly associated with depression, anxiety, and stress (p < 0.001). The participants with higher monthly income, shorter disease duration, regular medicine use, and altered lipid profile, and older subjects had a lower chance of depression, anxiety, and stress.

Conclusion

Approximately half of individuals with T2DM experienced poor QoL, while the prevalence rates for depression, anxiety, and stress were 49.4, 71.7, and 49.8%, respectively. Scores in the domains of impact, worry, and satisfaction were below optimal levels. Several factors were linked to QoL and depression, anxiety, and stress, and an association was observed between DASS-21 scores and QoL.

The Description and Prediction of Incidence, Prevalence, Mortality, Disability-Adjusted Life Years Cases, and Corresponding Age-Standardized Rates for Global Diabetes

OBJECTIVE

Diabetes is a life-long disease that poses a serious threat to safety and health. We aimed to assess the disease burden attributable to diabetes globally and by different subgroups, and to predict future disease burden using statistical models.

METHODS

This study was divided into three stages. Firstly, we evaluated the disease burden attributable to diabetes globally and by different subgroups in 2019. Second, we assessed the trends from 1990 to 2019. We estimated the annual percentage change of disease burden by applying a linear regression model. Finally, the age-period-cohort model was used to predict the disease burden from 2020 to 2044. Sensitivity analysis was performed with time-series models.

RESULTS

In 2019, the number of incidence cases of diabetes globally was 22239396 (95% uncertainty interval (UI): 20599519-24058945). The number of prevalence cases was 459875371 (95% UI 423474244-497980624) the number of deaths cases was 1551170 (95% UI 1445555-1650675) and the number of disability-adjusted life years cases was 70880155 (95% UI 59707574-84174005). The disease burden was lower in females than males and increased with age. The disease burden associated with type 2 diabetes mellitus was greater than that with type 1; the burden also varied across different socio-demographic index regions and different countries. The global disease burden of diabetes increased significantly over the past 30 years and will continue to increase in the future.

CONCLUSION

The disease burden of diabetes contributed significantly to the global disease burden. It is important to improve treatment and diagnosis to halt the growth in disease burden.

Impaired Sensitivity to Thyroid Hormones Is Associated With Elevated Blood Glucose in Coronary Heart Disease

CONTEXT

Thyroid hormones influence glucose homeostasis through central and peripheral regulation. To date, the association between thyroid hormone sensitivity and elevated blood glucose (EBG) in patients with coronary heart disease (CHD) remains unknown. The purpose of this study was to investigate the association between thyroid hormone sensitivity and risk of EBG in patients with CHD, and to further explore their association in different sexes and ages.

METHODS

This large multicenter retrospective study included 30,244 patients with CHD (aged 30-80 years) between 1 January 2014 and 30 September 2020. Parameters representing central and peripheral sensitivity to thyroid hormones were calculated. Central sensitivity to thyroid hormones was assessed by calculating the Thyroid Feedback Quantile-based Index (TFQI), Thyroid-stimulating Hormone Index (TSHI), and Thyrotropin Thyroxine Resistance Index (TT4RI), and Parametric Thyroid Feedback Quantile-based Index (PTFQI); peripheral sensitivity to thyroid hormones was evaluated using the ratio of free triiodothyronine (FT3) /free thyroxine (FT4). Taking normal glucose tolerance (NGT) as a reference, logistic regression was used to analyse the relationship between central and peripheral thyroid hormone sensitivity and EBG in patients with CHD.

RESULTS

Among the 30,244 participants, 15,493 (51.23%) had EBG. The risk of EBG was negatively correlated with TSHI (OR: 0.91; 95%CI: 0.91 to 0.92; P < 0.001), TT4RI (OR: 0.99; 95% CI: 0.99 to 0.99; P<0.001), TFQI (OR: 0.82; 95%CI: 0.80 to 0.84; P <0.001) and PTFQI (OR: 0.76; 95%CI: 0.74 to 0.78; P<0.001). Compared to males and patients aged 60 and below, the OR value for EBG was lower in females and in patients aged over 60 years old. Conversely, EBG risk was positively associated with FT3/FT4 (OR: 1.08; 95% CI: 1.07 to 1.09; P <0.001) and in the sex-categorized subgroups, males had higher OR values than females.

CONCLUSIONS

This study showed that thyroid hormone sensitivity is significantly associated with EBG in patients with CHD. This association is higher in females than in males, and the association in those aged over 60 years old is higher than that in patients aged 60 years and below.

Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study

Background

Dutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers may hinder implementation. The impact of dispensing with protocol and implementation of self-management interventions on patient monitoring and experiences are not known. This study aims to evaluate tailoring of care by understanding experiences of well-organised practices 1) when dispensing with protocol; 2) determining the key conditions for successful implementation of self-management interventions; and furthermore exploring patients’ experiences regarding dispensing with protocol and self-management interventions.

Methods

in this mixed-methods prospective study, practices (n = 49) were invited to participate if they met protocol-related quality targets, and their adult patients with well-controlled type 2 diabetes were invited if they had received protocol-based diabetes care for a minimum of 1 year. For practices, study participation consisted of the opportunity to deliver protocol-free diabetes care, with selection and implementation of self-management interventions. For patients, study participation provided exposure to protocol-free diabetes care and self-management interventions.

Qualitative outcomes (practices: 5 focus groups, 2 individual interviews) included experiences of dispensing with protocol and the implementation process of self-management interventions, operationalised as implementation fidelity. Quantitative outcomes (patients: routine registry data, surveys) consisted of diabetes monitoring completeness, satisfaction, wellbeing and health status at baseline and follow-up (24 months).

Results

Qualitative:

In participating practices (n = 4), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions

A focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity

Quantitative:

In patients (n = 126), likelihood of complete monitoring decreased significantly after two years (OR 0.2 (95% CI 0.1–0.5), p < 0.001)

Satisfaction decreased slightly (− 1.6 (95% CI -2.6;-0.6), p = 0.001)

Non-significant declines were found in wellbeing (− 1.3 (95% CI -5.4; 2.9), p = 0.55) and health status (− 3.0 (95% CI -7.1; 1.2), p = 0.16).

Conclusions

To tailor diabetes care to individual patients within well-organised practices, we recommend dispensing with protocol while maintaining one structural annual monitoring consultation, combined with the well-supported implementation of feasible self-management interventions. Interventions should be selected and delivered with the involvement of patients and should involve population preferences and solid team collaborations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07198-2.

A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study

Background

The combination of diabetes mellitus (DM) and chronic kidney disease (CKD) is associated with a high risk of mortality. Annual assessment of the estimated glomerular filtration rate (eGFR) is recommended for patients with DM. We investigated the effect of variability in annual eGFR values on all-cause mortality in patients with type 2 DM.

Methods

In this retrospective cohort study, we enrolled patients with eGFR data between 01 Aug 2017 and 31 July 2018. We defined the index eGFR as the first available eGFR value within the enrollment year and collected additional annual eGFR data from the previous three years. A total of 3592 patients with type 2 DM were enrolled, including 959 patients with CKD (index eGFR < 60 mL/min/1.73 m²) and 2633 patients without CKD. We assessed eGFR variability by using the standard deviation (SD) of the three annual eGFR and index eGFR values. We divided patients into subgroups according to the median SD of their annual eGFR (7.62 mL/min/1.73 m²). The primary endpoint was all-cause mortality after the index eGFR was assessed.

Results

During a median follow-up of 19 months (interquartile range: 18‒20 months), 127 (3.5%) deaths occurred among all 3592 enrolled patients. The highest mortality risk was observed in the high SD with CKD group, with a hazard ratio (HR) of 2.382 [95% confidence interval (CI) 1.346‒4.215] in comparison to the low SD without CKD group after adjusting for the associated factors. In patients without CKD, a high SD was an independent risk factor for mortality (HR = 2.105, 95% CI 1.256‒3.528). According to the C-index, the mortality prediction ability was better for the index eGFR + SD model than for the index eGFR alone model (0.671 vs. 0.629, P < 0.001).

Conclusion

There was a synergistic effect of eGFR variability with single-measured eGFR for the prediction of mortality in patients with type 2 DM. The SD of the annual eGFR values was also an independent predictor of mortality in patients with an eGFR > 60 mL/min/1.73 m².

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-021-01399-z.

Update on prevention of diabetic foot ulcer

The diabetic foot ulcer is the most important reason for non-traumatic limb amputation. Based on recent data, it has been estimated that up to 34% of type 2 diabetes patients may develop diabetic foot ulcers once in their lifetime. Risk factors for developing foot ulcers are distal sensorimotor peripheral neuropathy, peripheral arterial disease, previous ulcers, and/or amputations. Understanding the factors that place patients with diabetes mellitus at high ulceration risk and the early treatment of risk factors, and continuous education of the patient (and/or caregivers) are essential for the prevention and management of diabetic foot complications. Implementing strategies to prevent these complications is a key aspect of diabetes care, but the most effective strategy in prevention has to be investigated. More evidence from well-designed studies is needed on this topic.

Update on prevention of diabetic foot ulcer

The diabetic foot ulcer is the most important reason for non-traumatic limb amputation. Based on recent data, it has been estimated that up to 34% of type 2 diabetes patients may develop diabetic foot ulcers once in their lifetime. Risk factors for developing foot ulcers are distal sensorimotor peripheral neuropathy, peripheral arterial disease, previous ulcers, and/or amputations. Understanding the factors that place patients with diabetes mellitus at high ulceration risk and the early treatment of risk factors, and continuous education of the patient (and/or caregivers) are essential for the prevention and management of diabetic foot complications. Implementing strategies to prevent these complications is a key aspect of diabetes care, but the most effective strategy in prevention has to be investigated. More evidence from well-designed studies is needed on this topic.

Precision Health Care Elements, Definitions, and Strategies for Patients with Diabetes: A Literature Review

Diabetes is a prevalent disease with a high risk of complications. The number of people with diabetes worldwide was reported to increase every year. However, new integrated individualized health care related to diabetes is insufficiently developed. Purpose: The objective of this study was to conduct a literature review and discover precision health care elements, definitions, and strategies. Methods: This study involved a 2-stage process. The first stage comprised a systematic literature search, evidence evaluation, and article extraction. The second stage involved discovering precision health care elements and defining and developing strategies for the management of patients with diabetes. Results: Of 1337 articles, we selected 35 relevant articles for identifying elements and definitions of precision health care for diabetes, including personalized genetic or lifestyle factors, biodata- or evidence-based practice, glycemic target, patient preferences, glycemic control, interdisciplinary collaboration practice, self-management, and patient priority direct care. Moreover, strategies were developed to apply precision health care for diabetes treatment based on eight elements. Conclusions: We discovered precision health care elements and defined and developed strategies of precision health care for patients with diabetes. precision health care is based on team foundation, personalized glycemic target, and control as well as patient preferences and priority, thus providing references for future research and clinical practice.

Characteristics of blood glucose distribution in a health examination population in Sichuan (2009-2017)

The prevalence of diabetes mellitus and impaired fasting glucose is rapidly increasing in the recent years. Hyperglycemia associated atherosclerosis and other complications are posing a serious threat to human health. The present study aimed to analyze the blood glucose distribution characteristics within a large size of health examination population of Sichuan province, China.This was a retrospective study conducted in 878,019 subjects (483,914 males and 394,105 females) aged more than 18 years old from the Health Examination Center at West China Hospital, Sichuan University during 2009 to 2017. The blood glucose levels were compared in different age groups and different years.The blood glucose levels were significantly increased in recent years. The percentage of cases with high glucose levels was significantly higher in males than that in females since 2009 to 2017. Moreover, the blood glucose levels and the percentage of high glucose levels in aged population were significantly higher than those in younger population every year.The health examination population showed increased percentage of blood glucose levels, and so regular physical examination and glucose control are highly important in aged population.

Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study

AIMS

To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM).

METHODS

A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied.

RESULTS

After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895-0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM.

CONCLUSIONS

This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM.

Program completion and glycemic control in a remote patient monitoring program for diabetes management: Does gender matter?

AIMS

To examine gender differences in program completion and glycemic outcomes for patients with type 2 diabetes (T2D) in a remote patient monitoring (RPM) program for diabetes management.

METHODS

Based on data from an RPM program that enrolled post-discharge T2D patients (n = 1645) in 2014-2017, logistic regression models were estimated to assess gender difference in the likelihood of completing the three-month RPM program; whereas ordinary least squares (OLS) regression models were used to examine gender difference in post-RPM hemoglobin A1c (HbA1c), controlling for demographics, baseline health status, including HbA1c, patient activation scores, and physiological data upload frequency for patients who had completed the program.

RESULTS

Among enrolled participants, men had lower odds of completing the three-month RPM program than women (adjusted odds ratio, 0.61; 95% confidence interval [CI], 0.39-0.95). However, among those who completed the program, men had lower post-RPM HbA1c than women (-0.18; 95% CI, -0.33, -0.03) after controlling for baseline HbA1c and other covariates.

CONCLUSIONS

While female patients with T2D were more likely to complete the RPM program, they showed a higher glycemic level at the end of the program compared to male patients. To close gender disparities in health, interventions through telemedicine tailored towards women's diabetes outcomes and men's engagement level are warranted.

Social inequality in lifestyle, motivation to change lifestyle and received health advice in individuals with diabetes: A nationwide study

Aims: The aim was to investigate the association between socioeconomic position (SEP) and physical activity, alcohol consumption and smoking, motivation to change lifestyle and health advices from general practitioners (GPs) in individuals with diabetes. Methods: Data were provided by the Danish National Health Survey 2013 and 7504 adults (⩾ 40 years) with diabetes were included. Educational level was used as SEP indicator and categorized into low, middle and high SEP. Dependent variables included physical activity, alcohol consumption, smoking, motivation to change lifestyle and GP lifestyle advices. Multiple logistic regression analyses adjusted for age, body mass index and ethnic background were performed. Results: Higher SEP were associated with reduced odds of being physically inactive (middle SEP odds ratio (OR) men 0.58 (95% confidence intervals 0.47–0.72) and women 0.59 (0.47–0.75)) and non-smoking (middle SEP OR men 0.74 (0.59–0.93) and high SEP OR women 0.54 (0.38–0.77)) compared to participants with a low SEP. Alcohol consumption above the recommended maximum was associated with high SEP in men, OR 1.83 (1.30–2.61). Elevated SEP was associated with a motivation to increase physical activity levels (middle SEP OR men 1.45 (1.19–1.76) and women 1.35 (1.09–1.67)), high SEP was associated with none advice from GPs regarding smoking cessation among women, OR 0.47 (0.25–0.89). Conclusions: Socioeconomic position was strongly associated with lifestyle in individuals with diabetes. The most pronounced inequalities were found in physical activity levels, smoking status and the motivation to become more physically active. Municipalities and GPs may need a greater focus on SEP in interventions to change lifestyle in individuals with diabetes.

Changes in HbA1c during the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes

To analyze the association between change in HbA_1c during the first 6 years after diagnosis of Type 2 diabetes mellitus (Type 2 DM) and incident micro- and macrovascular morbidity and mortality during 13 years thereafter. This is an observational study of the participants in the intervention arm of the randomized controlled trial Diabetes Care in General Practice (DCGP) in Denmark. 494 newly diagnosed persons with Type 2 DM aged 40 years and over with three or more measurements of HbA_1c during six years of intervention were included in the analyses. Based on a regression line, fitted through the HbA_1c-measurements from 1 to 6 years after diabetes diagnosis, glycaemic control was characterized by the one-year level of HbA_1c after diagnosis, and the slope of the regression line. Outcomes were incident diabetes-related morbidity and mortality from 6 to 19 years after diabetes diagnosis. The association between change in HbA_1c (the slope of the regression line) and clinical outcomes were assessed in adjusted Cox regression models. The median HbA_1c level at year one was 60 (IQR: 52–71) mmol/mol or (7.65 (IQR: 6.91–8.62) %). Higher HbA_1c levels one year after diagnosis were associated with a higher risk of later diabetes-related morbidity and mortality. An increase in HbA_1c during the first 6 years after diabetes diagnosis was associated with later microvascular complications (HR per 1.1 mmol/mol or 0.1% point increase in HbA_1c per year; 95% CI) = 1.14; 1.05–1.24). Change in HbA_1c did not predict the aggregate outcome ‘any diabetes-related endpoint, all-cause mortality, diabetes-related mortality, myocardial infarction, stroke, or peripheral vascular diseases. We conclude that suboptimal development of glycaemic control during the first 6 years after diabetes diagnosis was an independent risk factor for microvascular complications during the succeeding 13-year follow-up, but not for mortality or macrovascular complications.

Prevalence and predictors of depression, anxiety, and stress symptoms among patients with type II diabetes attending primary healthcare centers in the western region of Saudi Arabia: a cross-sectional study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent health problem, not only globally, but also in Saudi Arabia. A growing body of literature suggests a bi-directional association between T2DM and various mental health disorders. This study aimed to investigate the prevalence and predictors of depression, anxiety, and stress among T2DM patients in the western region of Saudi Arabia.

METHODS

Between May and August 2018, a cross-sectional study was conducted among adult patients with T2DM in five public primary care centers in the western region of Saudi Arabia. Sociodemographic characteristics and symptoms of depression, anxiety, and stress were measured using the self-administered, previously validated Depression, Anxiety, and Stress Scale (DASS-21) questionnaire. Simple descriptive statistics were used. Forward binary logistic regression was used to identify predictors of depression, anxiety, and stress.

RESULTS

A total of 450 adults with T2DM were included (56.9% men; 43.1% women). The prevalence of depression, anxiety, and stress was 33.8%, 38.3%, and 25.5%, respectively. Major predictors of psychological distress were age, sex, the presence of comorbidities, duration since T2DM diagnosis, and serum level of hemoglobin A1c. Compliance with diabetes management measures and older age were the only protective factors.

CONCLUSION

Patients with T2DM had significantly high rates of depression, anxiety, and stress. We recommend periodic screening of patients with T2DM for psychological distress using easy and inexpensive validated screening tools like the DASS-21 questionnaire. Further larger-scale studies are needed to investigate the causes and outcomes of these higher rates of psychological distress among Saudi patients with diabetes.

The impact of cancer on diabetes outcomes

BACKGROUND

Survival from many cancer types is steadily increasing, and as a result, a growing number of cancer patients will live with other chronic diseases, of which diabetes is one of the most prevalent. This study aims to describe the impact of cancer on health outcomes in patients with type 2 diabetes and to compare the effectiveness of a multifactorial intervention in diabetes patients with and without cancer.

METHODS

The randomized controlled trial Diabetes Care in General Practice (DCGP) included 1381 patients newly diagnosed with type 2 diabetes. Patients were randomized to either six years of structured personal diabetes care or routine care. In a post hoc analysis, we followed patients for 19 years in Danish national registries for the occurrence of diabetes-related outcomes. We used Cox regression models to estimate hazard ratios for outcomes.

RESULTS

At diagnosis 48 patients had cancer, and 243 patients were diagnosed with cancer during follow up. Patients with diabetes and cancer had excess all-cause mortality (HR 3.33; 95%CI 2.72-4.06), as well as an increased incidence of myocardial infarction (HR 1.76; 95%CI 1.29-2.39) and any diabetes-related outcome (HR 1.36; 95%CI 1.07-1.71). The intervention reduced the risk of both these endpoints in patients without cancer. Furthermore, there was no statistically significant difference in the effectiveness of the intervention among patients with and without cancer.

CONCLUSIONS

Diabetes patients with cancer had an increased risk of myocardial infarction and any diabetes-related outcome. The observed positive effect of structured personal diabetes care on clinical outcomes did not differ between patients with and without cancer. Attention to and prevention of diabetes complications in patients with both type 2 diabetes and cancer is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01074762 (February 24, 2010).

The effect of structured personal care on RNA oxidation: A 19-year follow-up of the randomized trial Diabetes Care in General Practice (DCGP)

AIMS

The urinary marker of RNA oxidation, 8‑oxo‑7,8‑dihydroguanosine (8-oxoGuo), but not the corresponding marker of DNA oxidation, 8‑oxo‑7,8‑dihydro‑2'‑deoxyguanosine (8-oxodG), is a prognostic biomarker in patients with type 2 diabetes (T2D). The aim of the present study was to investigate the effect of structured personal care (individualized multifactorial treatment) versus standard care on RNA oxidation level in patients with T2D and to assess if the effect of structured personal care on all-cause and diabetes-related mortality was modified by RNA oxidation level.

METHODS

Urine samples were analyzed for 8-oxoGuo/8-oxodG from 1381 newly diagnosed T2D patients from the cluster randomized trial Diabetes Care in General Practice cohort, and 970 patients were reexamined after six years of intervention.

RESULTS

The yearly variation in RNA oxidation levels were not significantly different between the structured personal care group and standard care group. The effect of treatment on all-cause and diabetes-related mortality was not modified by the level of RNA oxidation. No changes in DNA oxidation were seen.

CONCLUSIONS

Structured personal care does not influence RNA oxidation level nor is it better for patients with high RNA oxidation level. Thus, structured personal care may not impact the disease-related aspects identified by RNA oxidation level in T2D patients.

Risk factors associated with outcomes of peritoneal dialysis in Taiwan: An analysis using a competing risk model

Peritoneal dialysis (PD) is one option for renal replacement therapy in patients with end-stage renal disease (ESRD). Maintenance of the PD catheter is an important issue for patient outcomes and quality of life. The aim of this retrospective cohort study is to clarify the risk factors of technique failure and outcomes at a single institute in Taiwan.The study enrolled ESRD patients who had received PD catheters in a tertiary hospital in northern Taiwan. Using a competing risks regression model, we reviewed clinical data and analyzed them in terms of the time to technical failure and clinical outcomes, including PD-related peritonitis and mortality.A total of 514 patients receiving PD between 2001 and 2013 were enrolled in the study. According to the multivariate analysis model, we found that diabetes mellitus was a risk factor for PD-related peritonitis (subdistribution hazard ratio [SHR] 1.47, 95% confidence interval [CI] 1.06-2.04, P = .021). Female gender and higher serum albumin levels were associated with lower risks of technique failure (SHR 0.67, 95% CI 0.48-0.94, P = .02; SHR 0.75, 95% CI 0.58-0.96, P = .023, respectively), but Gram-negative and polymicrobial infection increased the technique failure rate (SHR 1.68, 95% CI 1.08-2.61, P = .021; SHR 1.93, 95% CI 1.11-3.36, P = .02, respectively). Female gender was a risk factor associated with overall mortality (SHR 6.4, 95% CI 1.42-28.81, P = .016). Higher weekly urea clearance (Kt/V) and weekly creatinine clearance (WCCr) were associated with a lower risk of mortality (SHR 0.1, 95% CI 0.01-0.89, P = .04; SHR 0.97, 95% CI 0.96-0.99, P = .004, respectively).Diabetes mellitus is a risk factor contributing to PD-related peritonitis. Male patients and lower serum albumin levels were associated with higher rates of technique failure. Female gender, lower Kt/V, and WCCr are risk factors for overall mortality in PD patients.

17β-Estradiol Regulates Glucose Metabolism and Insulin Secretion in Rat Islet β Cells Through GPER and Akt/mTOR/GLUT2 Pathway

Aims: To explore the molecular mechanism by which 17β-estradiol (estrogen 2, E2) regulates glucose transporter 2 (GLUT2) and insulin secretion in islet β cells through G protein-coupled estrogen receptor (GPER) via Akt/mTOR pathway. Methods: SPF-grade SD male rats were used to establish an in vivo type 2 diabetes model treated with E2. Rat insulinoma cells (INS-1) were cultured in normal or high glucose media with or without E2. Immunofluorescence double staining was used to detect GPER, GLUT2, insulin, and glucagon immunolocalization in rat islet tissues. Western blot was used to detect GPER, Akt, mTOR, and GLUT2 protein immunocontent. Real-time PCR detected Slc2a2 and glucose kinase (GK) content, and ELISA was used to detect insulin levels. Glucose uptake, GK activity and pyruvate dehydrogenase (PDH) activity were analyzed with glucose detection, GK activity and PDH activity assay kit. Results: Immunofluorescence double staining confocal indicated that E2 treatment up-regulated expression levels of GPER, GLUT2, and insulin, while down-regulated glucagon. Western blot results revealed E2 increased GPER, Akt/mTOR pathway, and GLUT2 protein immunocontent. Real-time PCR showed E2 elevated Slc2a2, GK content. Moreover, E2 improved insulin secretion, glucose uptake, GK activity, and PDH activity. Conclusion: Our findings indicated that exogenous E2 up-regulated GPER via the Akt/mTOR pathway to increase GLUT2 protein content and insulin secretion in islet β cells.

Sex differences and risk factors for diabetes mellitus - an international study from 193 countries

Background

Increases in overweight and obesity among youths have resulted in the diagnosis of Type 2 diabetes mellitus (T2DM) at earlier ages. The impact of lifestyle-related factors has been implicated; however, its relation to morbidity and mortality and sex differences remain unclear. We aimed to document the changes in risk factors and sex differences associated with T2DM-related morbidity and mortality during 1995–2015.

Method

We used mortality rates and morbidity estimates from the Global Burden of Diseases Study 2016 using Disability-Adjusted Life Years (DALY). Multiple linear regression analyses were used to determine associations between T2DM-related mortality and related risk factors. DALYs were grouped by country income level, and were stratified by sex.

Results

Increases in mortality were observed for both sexes, and females tended to have higher mortality rates per 100,000 persons. Body mass index (BMI) continued to be the leading risk factor for T2DM-related mortality, and increases in BMI were more common in low- and middle-income countries (LIC and MIC). Low physical activity was strongly associated with mortality rates, followed by dietary risks and smoking (2.4; 1.4; 0.8 per 100,000 persons, respectively). Similar patterns were observed after adjustments for income level, sex, and age. DALYs continued to show increasing trends across all income levels during 1995–2015 (high-income (HIC):16%; MIC: 36%; LIC: 12%). Stratification by sex showed similar results; males had fewer T2DM DALYs than females, though a greater increase was observed among males.

Conclusion

Overall, T2DM related mortality was higher among females. Compared to in HIC, there appeared to be a considerable increase in the burden of T2DM in MIC and LIC, where BMI is the leading risk factor for T2DM-related mortality. Prevention programs should emphasize related risk factors according to the existing standard of care.

Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study) : results from the MADIABETES cohort

OBJECTIVE

To estimate the prevalence of depression in patients diagnosed with type 2 diabetes mellitus (T2DM), and to identify sociodemographic, clinical and psychological factors associated with depression in this population. Additionally, we examine the annual incidence rate of depression among patients with T2DM.

METHODS

We performed a large prospective cohort study of patients with T2DM from the Madrid Diabetes Study. The first recruitment drive included 3443 patients. The second recruitment drive included 727 new patients. Data have been collected since 2007 (baseline visit) and annually during the follow-up period (since 2008).

RESULTS

Depression was prevalent in 20.03% of patients (n=592; 95% CI 18.6% to 21.5%) and was associated with previous personal history of depression (OR 6.482; 95% CI 5.138 to 8.178), mental health status below mean (OR 1.423; 95% CI 1.452 to 2.577), neuropathy (OR 1.951; 95% CI 1.423 to 2.674), fair or poor self-reported health status (OR 1.509; 95% CI 1.209 to 1.882), treatment with oral antidiabetic agents plus insulin (OR 1.802; 95% CI 1.364 to 2.380), female gender (OR 1.333; 95% CI 1.009 to 1.761) and blood cholesterol level (OR 1.005; 95% CI 1.002 to 1.009). The variables inversely associated with depression were: being in employment (OR 0.595; 95% CI 0.397 to 0.894), low physical activity (OR 0.552; 95% CI 0.408 to 0.746), systolic blood pressure (OR 0.982; 95% CI 0.971 to 0.992) and social support (OR 0.978; 95% CI 0.963 to 0.993). In patients without depression at baseline, the incidence of depression after 1 year of follow-up was 1.20% (95% CI 1.11% to 2.81%).

CONCLUSIONS

Depression is very prevalent among patients with T2DM and is associated with several key diabetes-related outcomes. Our results suggest that previous mental status, self-reported health status, gender and several diabetes-related complications are associated with differences in the degree of depression. These findings should alert practitioners to the importance of detecting depression in patients with T2DM.

Follow-up of blood glucose distribution characteristics in a health examination population in Chengdu from 2010 to 2016

The worldwide prevalence and incidence of diabetes and obesity are increasing in pandemic proportions. Thus, regular health examination is an important way for early detection of diabetes and glucose intolerance. The present study aims to detect the blood glucose distribution characteristics of the participants in the Health Examination Center at West China Hospital, Sichuan University from 2010 to 2016.A prospective cohort included 9168 Chinese participants, aged 18 years or more, who had available information on fasting blood glucose concentrations at the start of the study (2010). Examination surveys were conducted every year from 2010 to 2016. Cases having serum level of fasting blood glucose between 2.2 and 6.1 mmol/L were considered as normality, while serum level of fasting blood glucose < 2.2 or higher than 6.2 mmol/L were considered as abnormality.The percentage of participants having normal level of glucose was gradually reduced both in males and females from 2010 to 2016, by which the percentage of males having normal level of glucose was significantly lower than that in females. Moreover, the mean level of glucose was significantly increased from 2010 to 2016 both in males and females overall, and the mean level of glucose was higher in males compared with that in females every year. Furthermore, we showed that the level of glucose was gradually increased year by year in each age group, and the level of glucose was higher in aged cases compared with the young population.The study population in the current study showed higher levels of glucose with ages increasing, and males indicated higher expression of glucose than that in females. Some preventive action may be adopted early and more attention can be paid to this health-examination population.

Sex Differences in Outcomes after Stroke in Patients with Diabetes in Ontario, Canada

BACKGROUND

Outcomes after stroke in those with diabetes are not well characterized, especially by sex and age. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes.

METHODS

Using population-based demographic and administrative health-care databases in Ontario, Canada, all patients with diabetes hospitalized with index ischemic stroke between April 1, 2002, and March 31, 2012, were followed for death, stroke, and myocardial infarction (MI). The Kaplan-Meier survival analysis and Fine-Gray competing risk models estimated hazards of outcomes by sex and age, unadjusted and adjusted for demographics and vascular risk factors.

RESULTS

Among 25,495 diabetic patients with index ischemic stroke, the incidence of death was higher in women than in men (14.08 per 100 person-years [95% confidence interval [CI], 13.73-14.44] versus 11.89 [11.60-12.19]) but was lower after adjustment for age and other risk factors (adjusted hazard ratio [HR], .95 [.92-.99]). Recurrent stroke incidence was similar by sex, but men were more likely to be readmitted for MI (1.99 per 100 person-years [1.89-2.10] versus 1.58 [1.49-1.68] among females). In multivariable models, females had a lower risk of readmission for any event (HR, .96 [95% CI, .93-.99]).

CONCLUSIONS

In this large, population-based, retrospective study among diabetic patients with index stroke, women had a higher unadjusted death rate but lower unadjusted incidence of MI. In adjusted models, females had a lower death rate compared with males, although the increased risk of MI among males persisted. These findings confirm and quantify sex differences in outcomes after stroke in patients with diabetes.

Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP)

BACKGROUND

We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes.

METHODS

The Diabetes Care in General Practice (DCGP) study is a cluster-randomized trial involving a population-based sample of 1381 patients with newly diagnosed type 2-diabetes mellitus. We investigated how education, employment, cohabitation status and residence influenced the effectiveness of 6 years of intervention with structured personal diabetes care, resembling present day recommendations. Outcomes were incidence of any diabetes-related endpoint and death during 19 years after diagnosis, and cardiovascular risk factors, behaviour, attitudes and process-of-care variables 6 years after diagnosis.

RESULTS

Structured personal care reduced the risk of any diabetes-related endpoint and the effect of the intervention was modified by geographical area (interaction p = 0.034) with HR of 0.71 (95%CI: 0.60-0.85) and of 1.07 (95%CI: 0.77-1.48), for patients in urban and rural areas, respectively. Otherwise, there was no effect modification of education, employment and civil status on the intervention for the final endpoints. There were no noticeable socio-demographic differences in the effect of the intervention on cardiovascular risk factors, behaviour, attitudes, and process-of-care.

CONCLUSION

Structured personal care reduced the aggregate outcome of any diabetes-related endpoint and independent of socio-demographic factors similar effect on cardiovascular risk factors, behaviour, attitudes and process of care, but the intervention did not change the existing inequity in mortality and morbidity. Residence modified the uptake of the intervention with patients living in urban areas having more to gain of the intervention than rural patients, further investigations is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov registration no. NCT01074762 (February 24, 2010).

Quality of Diabetes Care for Individuals with Comorbid Chronic Psychotic Illness: A Sex-Based Analysis

BACKGROUND

Diabetes is common among individuals with chronic psychotic illness, yet they receive lower quality of diabetes care than those without psychosis. Men usually receive higher quality diabetes care than women, but whether this holds true in chronic psychotic illness populations is unknown. We aimed to determine whether quality of diabetes care differs between men and women with chronic psychotic illness.

METHODS

This population-based cohort study used Ontario health administrative data to compare women and men with comorbid chronic psychotic illness and diabetes mellitus (2011-2013). The primary outcome was adherence to diabetes monitoring guidelines, defined as ≥1 retinal exam, ≥4 hemoglobin A1c (HbA1c) tests, and ≥1 dyslipidemia test during a 2-year period. Logistic regression models compared women to men to generate adjusted odds ratios (aOR) and confidence intervals (95% CI), adjusting for potential confounding variables.

RESULTS

Women with chronic psychotic illness (n = 13,972) were slightly more likely to receive guideline-adherent diabetes monitoring than men (n = 12,287) (25.2% vs. 23.0%; aOR 1.20, 95% CI 1.10-1.30), including a greater likelihood of receiving ≥1 retinal exam (aOR 1.13, 95% CI 1.08-1.19) and ≥4 HbA1c tests (aOR 1.06, 95% CI 1.01-1.12). There was no difference in receipt of ≥1 dyslipidemia test (aOR 1.04, 95% CI 0.99-1.11).

CONCLUSIONS

Quality of diabetes monitoring is similarly poor in women and men with chronic psychotic illness, with women receiving only marginally more optimal monitoring than men. This differs from patterns in the general population, and could have implications when designing and implementing interventions to improve diabetes care in women and men with chronic psychotic illness.

Analysis of blood glucose distribution characteristics in a health examination population in Chengdu (2007-2015)

With socioeconomic growth and cultural changes in China, the level of blood glucose may have changed in recent years. This study aims to detect the blood glucose distribution characteristics with a large size of health examination population.A total of 641,311 cases (360,259 males and 281,052 females) more than 18 years old during 2007 to 2015 were recruited from the Health Examination Center at West China hospital, Sichuan University.The percentage of cases with abnormal glucose level and the mean level of glucose were significantly increased since 2007 to 2015 overall. The percentage of cases with abnormal glucose level in males was significantly higher than that in females every year, and the percentage of cases with abnormal glucose level in aged population was higher than the young population. In addition, the mean level of glucose was higher in aged population with normal level of glucose than the young population with normal level of glucose, and the mean level of glucose was higher in males with normal level of glucose than the females with normal level of glucose.The population showed an increased level of blood glucose. Some preventive action may be adopted early and more attention can be paid to them.

Diabetes mortality in Serbia, 1991-2015 (a nationwide study): A joinpoint regression analysis

PURPOSE

The aim of this study was to analyze the mortality trends of diabetes mellitus in Serbia (excluding the Autonomous Province of Kosovo and Metohia).

METHODS

A population-based cross sectional study analyzing diabetes mortality in Serbia in the period 1991-2015 was carried out based on official data. The age-standardized mortality rates (per 100,000) were calculated by direct standardization, using the European Standard Population. Average annual percentage of change (AAPC) and the corresponding 95% confidence interval (CI) were computed using the joinpoint regression analysis.

RESULTS

More than 63,000 (about 27,000 of men and 36,000 of women) diabetes deaths occurred in Serbia from 1991 to 2015. Death rates from diabetes were almost equal in men and in women (about 24.0 per 100,000) and places Serbia among the countries with the highest diabetes mortality rates in Europe. Since 1991, mortality from diabetes in men significantly increased by +1.2% per year (95% CI 0.7-1.7), but non-significantly increased in women by +0.2% per year (95% CI -0.4 to 0.7). Increased trends in diabetes type 1 mortality rates were significant in both genders in Serbia. Trends in mortality for diabetes type 2 showed a significant decrease in both genders since 2010.

CONCLUSION

Given that diabetes mortality trends showed different patterns during the studied period, our results imply that further observation of trend is needed.

Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus

Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications.

Analysis of Blood Glucose Distribution Characteristics and Its Risk Factors among a Health Examination Population in Wuhu (China)

Background: Diabetes mellitus (DM) and Impaired Fasting Glucose (IFG) represent serious threats to human health, and as a result, this study was aimed at understanding the blood glucose distribution characteristics and the risk factors among a large health examination population in China. Methods: An investigation with physical and biochemical examinations and questionnaires was conducted in the physical examination center from 2011 to 2014 and as a result 175,122 physical examination attendees were enrolled in this study. Multivariate logistic regression was used to explore the factors influencing blood sugar levels. Results: The rates of IFG and DM were 6.0% and 3.8%. Prevalence were 7.6%/5.1% in males and 5.1%/2.8% in females for IFG and DM, respectively. The prevalence of IFG and DM were thus higher in males than in females. In the normal group, except high density lipoprotein (HDL) that was significantly higher than in the IFG and DM group, the other indexes (age, body mass index (BMI), glucose (Glu), total cholesterol (TC) and total glycerides (TG) were lower than those in the IFG and DM group. The proportion of IFG and DM also increased with the increases in proportion of abnormal blood pressure, smoking and alcohol consumption. Multivariate logistic regression analysis showed that increasing age, high BMI, high TC, high TG and low HDL increased the risk of diabetes, while in males, in addition to the above factors, the smoking and drinking factors also increased the risk of diabetes. After the age of 65, the blood glucose level reached a peak in males, while in females, the increasing trends was on the rise. The inflexion age of the fast rise was younger in males than in females. Conclusion: The study population showed a high prevalence of DM and IFG among the adults. Regular physical examination for the early detection of diabetes is recommended in the high-risk population.