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Nasution DLI, Furuta M, Li H, Zakaria MN, Takeshita T, Peres MA, Yamashita Y. Longitudinal association between periodontal condition and glycaemic status in middle-aged adults: A cross-lagged panel analysis. J Clin Periodontol 2023; 50:1042-1050. [PMID: 36935202 DOI: 10.1111/jcpe.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/08/2023] [Accepted: 03/13/2023] [Indexed: 03/21/2023]
Abstract
AIM To investigate the existence of a bidirectional temporal relationship between periodontal condition and glycaemic status. MATERIALS AND METHODS This longitudinal study included 2198 participants with mean age 43.4 ± 7.7 years, who underwent dental examinations in Yokohama, Japan, at two time points, 2003-2004 and 2008-2009, at an interval of 5 years. Periodontal condition was assessed by the mean value of probing pocket depth (PPD) and clinical attachment level (CAL). Glycaemic status was assessed by fasting glucose and glycated haemoglobin (HbA1c). RESULTS The cross-lagged panel models showed the effect of HbA1c at baseline on mean PPD at follow-up (β = 0.044, p = .039). There was a marginal effect of fasting glucose on the mean PPD (β = 0.037, p = .059). It was similar to the effect of fasting glucose or HbAlc on mean CAL. However, in the opposite direction, no effect of mean PPD or CAL at baseline on fasting glucose or HbAlc at follow-up was identified. CONCLUSIONS This study demonstrated a unidirectional relationship between glycaemic status and periodontal condition. The study population, however, had mostly mild periodontitis. Future studies are needed to investigate the effect of periodontal condition on glycaemic status in patients with severe periodontitis.
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Affiliation(s)
- Dewi L I Nasution
- Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
- Department of Periodontology, Faculty of Dentistry, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Michiko Furuta
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
| | - Huihua Li
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
| | - Myrna Nurlatifah Zakaria
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Operative Dentistry and Endodontology, Faculty of Dentistry, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
| | - Toru Takeshita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
- OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Dykun I, Bayturan O, Carlo J, Nissen SE, Kapadia SR, Tuzcu EM, Nicholls SJ, Puri R. HbA1c, Coronary atheroma progression and cardiovascular outcomes. Am J Prev Cardiol 2022; 9:100317. [PMID: 35112095 PMCID: PMC8790601 DOI: 10.1016/j.ajpc.2022.100317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background and aims We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. Methods We performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. Results Among 3,312 patients (mean age 58.6±9years, 28.4%women) average on-treatment HbA1c was 6.2±1.1%. Overall, there was no net significant annualized change in PAV (0.12±0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p < 0.001]. On-treatment HbA1c levels were independently associated with MACE [hazard ratio (95% confidence interval): 1.13(1.04, 1.23), p = 0.005]. Conclusions Independent of achieved cardiovascular risk factor control, greater HbA1c levels significantly associate with coronary atheroma progression rates and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.
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Gauci S, Young LM, White DJ, Reddan JM, Lassemillante AC, Meyer D, Pipingas A, Scholey A. Diet May Moderate the Relationship Between Arterial Stiffness and Cognitive Performance in Older Adults. J Alzheimers Dis 2021; 85:815-828. [PMID: 34864661 PMCID: PMC8842781 DOI: 10.3233/jad-210567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cognitive decline is influenced by various factors including diet, cardiovascular disease, and glucose control. However, the combined effect of these risk factors on cognitive performance is yet to be fully understood. OBJECTIVE The current study aimed to explore the inter-relationship between these risk factors and cognitive performance in older adults at risk of future cognitive decline. METHODS The sample comprised 163 (Age: M = 65.23 years, SD = 6.50) participants. Food Frequency Questionnaire data was used to score diet quality and adherence to the Western Style Diet (WSD) and Prudent Style Diet (PSD). Glucose control was gauged by serum levels of glycated hemoglobin (HbA1c) and arterial stiffness was measured using carotid to femoral pulse wave velocity. Cognitive performance was assessed using two subtests of the Swinburne University Computerized Cognitive Assessment Battery (SUCCAB) and Rey's Verbal Learning Test (RVLT). RESULTS Diet quality, adherence to the WSD or PSD, and glucose control were not significantly related to cognitive outcomes. However, a significant negative association was found between arterial stiffness and the spatial working memory subtest of SUCCAB (β= -0.21, p < 0.05). Arterial stiffness also significantly interacted with the PSD to impact total recall (F change (1,134) = 5.37, p < 0.05) and the composite score of RVLT (F change (1,134) = 4.03, p < 0.05). CONCLUSION In this sample of older adults at risk of cognitive decline, diet alone was not found to predict cognitive performance; however, it was found to moderate the relationship between arterial stiffness and cognition.
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Affiliation(s)
- Sarah Gauci
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia.,Heart and Mind Research, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Lauren M Young
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia.,Food and Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - David J White
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Jeffery M Reddan
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Annie-Claude Lassemillante
- Department of Nursing and Allied Health, Faculty of Health, Arts and Design, Swinburne University, Melbourne, VIC, Australia
| | - Denny Meyer
- Department of Health Science and Biostatistics, Centre for Mental Health, Swinburne University, Melbourne, VIC, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia.,Nutrition Dietetics and Food, School of Clinical Sciences, Monash University, Melbourne, Australia
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Choi YM, Hwang KR, Oh SH, Lee D, Chae SJ, Yoon SH, Kim JJ. Progression to prediabetes or diabetes in young Korean women with polycystic ovary syndrome: A longitudinal observational study. Clin Endocrinol (Oxf) 2021; 94:837-844. [PMID: 33440048 DOI: 10.1111/cen.14416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate changes in glycaemic status in women with polycystic ovary syndrome (PCOS). DESIGN Longitudinal observational study. PATIENTS Women with PCOS who underwent baseline and follow-up screening tests for diabetes (n = 262). Four patients with type 2 diabetes (T2DM) at baseline and 6 patients who were taking drugs at the final follow-up were excluded. MEASUREMENTS Changes in glycaemic classification based on fasting glucose, haemoglobin A1c and oral glucose tolerance test. RESULTS The median length of follow-up was 2.9 years. The mean age and body mass index in the normoglycaemia group (n = 202) were 23.0 years and 21.6 kg/m2 , while it was 23.6 years and 22.9 kg/m2 in the prediabetes group (n = 50). In the normoglycaemia group, 38 (18.8%) and 2 (1.0%) developed prediabetes and T2DM, respectively. In the prediabetes group, 22 (44.0%) remained in the same category, 6 (12.0%) developed T2DM, while 22 (44.0%) achieved normoglycaemia. The incidence rate of T2DM was 9.3 per 1,000 person-years, which was significantly higher than that of the female population of similar age, and the incidence was higher in women with fasting glucose ≥ 5.6 mmol/L at baseline than in women with < 5.6 mmol/L. CONCLUSIONS About 20% of normoglycaemic women had developed prediabetes or T2DM after a median time of 2.9 years. Meanwhile, nearly half of prediabetes women achieved normoglycaemia. Higher baseline fasting glucose levels were associated with an increased incidence of T2DM. Our results are the first to evaluate glycaemic status changes using all three parameters in patients with PCOS.
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Affiliation(s)
- Young Min Choi
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - So Hee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Dayong Lee
- Department of Obstetrics and Gynecology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Soo Jin Chae
- Department of Obstetrics and Gynecology, IORA Fertility Clinic, Suwon, Korea
| | - Sang Ho Yoon
- Department of Obstetrics and Gynecology, School of Medicine, Dongguk University, Seoul, Korea
| | - Jin Ju Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Jiao S, Huang J, Chen Y, Song Y, Gong T, Lu J, Guo T, Zhang J, Zhang C, Chen M. Impacts of Glycemic Control on Intracranial Plaque in Patients with Type 2 Diabetes Mellitus: A Vessel Wall MRI Study. AJNR Am J Neuroradiol 2020; 42:75-81. [PMID: 33272948 DOI: 10.3174/ajnr.a6878] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The relationship between glycemic control in patients with type 2 diabetes mellitus and intracranial atherosclerotic plaque features has remained understudied. This study aimed to investigate the association of type 2 diabetes mellitus and glycemic control with the characteristics of intracranial plaques using vessel wall MR imaging. MATERIALS AND METHODS In total, 311 patients (217 [69.8%] men; mean age, 63.24 ± 11.44 years) with intracranial atherosclerotic plaques detected on vessel wall MR imaging were enrolled and divided into 3 groups according to type 2 diabetes mellitus and glycemic control statuses: the non-type 2 diabetes mellitus group, the type 2 diabetes mellitus with good glycemic control group, and the type 2 diabetes mellitus with poor glycemic control group. The imaging features of intracranial plaque were analyzed and compared among the groups. The clinical risk factors for atherosclerosis were also analyzed using logistic regression analysis. RESULTS The plaque length and thickness were significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus group. The prevalence of strongly enhanced plaques was significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus and type 2 diabetes mellitus with good glycemic control groups (92.9%, 63.4%, and 72.7%, respectively; P < .001). Multivariate logistic regression analysis showed a significant association of poor glycemic control with the plaque length (OR = 1.966; 95% CI, 1.170-3.303; P = .011), plaque thickness (OR = 1.981; 95% CI, 1.174-3.340; P = .010), and strongly enhanced plaque (OR = 5.448; 95% CI, 2.385-12.444; P < .001). CONCLUSIONS Poor glycemic control, compared with the history of diabetes, might have a greater impact on the burden and vulnerability of intracranial atherosclerotic plaques.
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Affiliation(s)
- S Jiao
- From the Departments of Radiology (S.J., J.H., Y.S., T. Guo, J.Z., C.Z., M.C.)
| | - J Huang
- From the Departments of Radiology (S.J., J.H., Y.S., T. Guo, J.Z., C.Z., M.C.)
| | | | - Y Song
- From the Departments of Radiology (S.J., J.H., Y.S., T. Guo, J.Z., C.Z., M.C.)
| | | | - J Lu
- Neurosurgery (J.L.), Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China, Beijing, China
| | - T Guo
- From the Departments of Radiology (S.J., J.H., Y.S., T. Guo, J.Z., C.Z., M.C.)
| | - J Zhang
- From the Departments of Radiology (S.J., J.H., Y.S., T. Guo, J.Z., C.Z., M.C.)
| | - C Zhang
- From the Departments of Radiology (S.J., J.H., Y.S., T. Guo, J.Z., C.Z., M.C.)
| | - M Chen
- From the Departments of Radiology (S.J., J.H., Y.S., T. Guo, J.Z., C.Z., M.C.)
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Singh D, Bafadhel M, Brightling CE, Sciurba FC, Curtis JL, Martinez FJ, Pasquale CB, Merrill DD, Metzdorf N, Petruzzelli S, Tal-Singer R, Compton C, Rennard S. Blood Eosinophil Counts in Clinical Trials for Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 202:660-671. [PMID: 32186896 PMCID: PMC7462391 DOI: 10.1164/rccm.201912-2384pp] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/17/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Dave Singh
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester University National Health Service Hospital Trust, Manchester, United Kingdom
| | - Mona Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher E. Brightling
- Institute for Lung Health, National Institute for Health Research Leicester Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, United Kingdom
| | - Frank C. Sciurba
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jeffrey L. Curtis
- Pulmonary and Critical Care Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Fernando J. Martinez
- Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Cara B. Pasquale
- COPD Patient-Powered Research Network, COPD Foundation, Washington, DC
| | - Debora D. Merrill
- COPD Biomarkers Qualification Consortium, COPD Foundation, Miami, Florida
| | - Norbert Metzdorf
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Ruth Tal-Singer
- COPD Biomarkers Qualification Consortium, COPD Foundation, Miami, Florida
| | - Christopher Compton
- Global Medical Affairs, Speciality and Primary Care, GlaxoSmithKline, Middlesex, United Kingdom
| | - Stephen Rennard
- Biopharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
- University of Nebraska Medical Center, Omaha, Nebraska; and
| | - on behalf of the COPD Foundation Eosinophil Working Group
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester University National Health Service Hospital Trust, Manchester, United Kingdom
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute for Lung Health, National Institute for Health Research Leicester Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, United Kingdom
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Pulmonary and Critical Care Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
- Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
- COPD Patient-Powered Research Network, COPD Foundation, Washington, DC
- COPD Biomarkers Qualification Consortium, COPD Foundation, Miami, Florida
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
- Global Clinical Development, Chiesi Farmaceutici, Parma, Italy
- Global Medical Affairs, Speciality and Primary Care, GlaxoSmithKline, Middlesex, United Kingdom
- Biopharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
- University of Nebraska Medical Center, Omaha, Nebraska; and
- Research and Development, AstraZeneca, Gaithersburg, Maryland
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Mazarello Paes V, Barrett JK, Taylor‐Robinson DC, Chesters H, Charalampopoulos D, Dunger DB, Viner RM, Stephenson TJ. Effect of early glycemic control on HbA1c tracking and development of vascular complications after 5 years of childhood onset type 1 diabetes: Systematic review and meta-analysis. Pediatr Diabetes 2019; 20:494-509. [PMID: 30932298 PMCID: PMC6701989 DOI: 10.1111/pedi.12850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/25/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE A systematic review and meta-analysis was conducted to investigate if glycemic control measured by glycated hemoglobin (HbA1c) levels near diagnosis are predictive of future glycemic outcomes and vascular complications in childhood onset type 1 diabetes (T1D). METHODS Evidence was gathered using electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus, and Cochrane Library up to February 2017) and snowballing techniques. Studies investigating the association between the exposure "early glycemic control" and main outcome: "tracking of early control" and secondary outcome: risk of future complications; in children and young people aged 0 to 19 years at baseline; were systematically double-reviewed, quality assessed, and outcome data extracted for synthesis and meta-analysis. FINDINGS Five studies (N = 4227 participants) were eligible. HbA1c levels were sub-optimal throughout the study period but tended to stabilize in a "track" by 6 months after T1D diagnosis. The group with low HbA1c <53 mmol/mol (<7%) at baseline had lower long-term HbA1c levels than the higher HbA1c group. The estimated standardized mean difference between the sub groups showed a reduction of HbA1c levels on average by 1.6% (range -0.95% to -2.28%) from baseline. Only one study investigated the association between early glycemic control and development of vascular complications in childhood onset T1D. INTERPRETATIONS Glycemic control after the first few months of childhood onset T1D, remains stable but sub-optimal for a decade. The low and high HbA1c levels at baseline seem to "track" in their respective tracks during the 10-year follow-up, however, the initial difference between groups narrows over time. PROSPERO CRD42015024546 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024546.
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Affiliation(s)
- Veena Mazarello Paes
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | | | | | - Heather Chesters
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | | | - David B. Dunger
- Department of PaediatricsUniversity of CambridgeCambridgeUK,Wellcome Trust/MRC Institute of Metabolic Sciences, University of CambridgeCambridgeUK
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Raymond LW, Roy DM, Mullinax SL, Yanni A, Pentek KC, Isaacs SE. Preventing Diabetes in the Workplace. J Occup Environ Med 2019; 61:e308-e311. [DOI: 10.1097/jom.0000000000001611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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9
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Hernandez I, He M, Chen N, Brooks MM, Saba S, Gellad WF. Trajectories of Oral Anticoagulation Adherence Among Medicare Beneficiaries Newly Diagnosed With Atrial Fibrillation. J Am Heart Assoc 2019; 8:e011427. [PMID: 31189392 PMCID: PMC6645643 DOI: 10.1161/jaha.118.011427] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Only 50% of atrial fibrillation (AF) patients recommended for oral anticoagulation (OAC) use these medications, and less than half of them adhere to OAC. In a cohort of Medicare beneficiaries newly diagnosed with AF, we identified groups of patients with similar trajectories of OAC use and adherence, and evaluated patient characteristics affecting group membership. Methods and Results We selected continuously enrolled Medicare Part D beneficiaries with first AF diagnosis in 2014 to 2015 (n=34 898). We calculated the proportion of days covered with OAC over the first 12 months after diagnosis and identified OAC adherence trajectories using group‐based trajectory models. We constructed multinomial logistic regression models to evaluate how demographics, system‐level factors, and clinical characteristics were associated with group membership. We identified 4 trajectories of OAC adherence: patients who never used OAC (43.8%), late OAC initiators (7.6%), early OAC discontinuers (8.9%), and continuously adherent patients (40.1%). Predictors such as sex, black race, residence in the South, or HAS‐BLED score were associated with not only OAC use, but also the timing of initiation and the likelihood of discontinuation. For example, HAS‐BLED score ≥4 was associated with a higher likelihood of not using OAC (odds ratio 1.35; 95% CI, 1.14–1.62), of late initiation (1.55; 95% CI, 1.11–2.05), and of early discontinuation (odds ratio 1.35; 95% CI, 1.01–1.84). Conclusions We identified 4 distinct trajectories of OAC adherence after first AF diagnosis, with <45% of newly diagnosed AF patients belonging to the trajectory group characterized by continuous OAC adherence. Trajectories were associated not only with demographic and clinical characteristics but also with regional factors.
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Affiliation(s)
- Inmaculada Hernandez
- 1 Department of Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh PA
| | - Meiqi He
- 1 Department of Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh PA
| | - Nemin Chen
- 1 Department of Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh PA.,2 Department of Epidemiology Graduate School of Public Health University of Pittsburgh PA
| | - Maria M Brooks
- 2 Department of Epidemiology Graduate School of Public Health University of Pittsburgh PA
| | - Samir Saba
- 3 Heart and Vascular Institute University of Pittsburgh Medical Centre Pittsburgh PA
| | - Walid F Gellad
- 4 Department of General Internal Medicine School of Medicine University of Pittsburgh PA.,5 VA Pittsburgh Healthcare System Pittsburgh PA
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10
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Simcoe T, Catillon M, Gertler P. Who benefits most in disease management programs: Improving target efficiency. HEALTH ECONOMICS 2019; 28:189-203. [PMID: 30345722 DOI: 10.1002/hec.3836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 08/10/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
Disease management programs aim to reduce cost by improving the quality of care for chronic diseases. Evidence of their effectiveness is mixed. Reducing health care spending sufficiently to cover program costs has proved particularly challenging. This study uses a difference in differences design to examine the impact of a diabetes disease management program for high risk patients on preventive tests, health outcomes, and cost of care. Heterogeneity is examined along the dimensions of severity (measured using the proxy of poor glycemic control) and preventive testing received in the baseline year. Although disease management programs tend to focus on the sickest, the impact of this program concentrates in the group of people who had not received recommended tests in the preintervention period. If confirmed, such findings are practically important to improve cost-effectiveness in disease management programs by targeting relevant subgroups defined both based on severity and on (missing) test information.
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Affiliation(s)
- Timothy Simcoe
- Questrom School of Business and NBER, Boston University, Boston, Massachusetts
| | | | - Paul Gertler
- Haas School of Business and NBER, University of California at Berkeley, Berkeley, California
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11
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Macmillan AK, Mackie H, Hosking JE, Witten K, Smith M, Field A, Woodward A, Hoskins R, Stewart J, van der Werf B, Baas P. Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design. BMC Public Health 2018; 18:850. [PMID: 29986679 PMCID: PMC6038249 DOI: 10.1186/s12889-018-5758-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving a shift from car use to walking, cycling and public transport in cities is a crucial part of healthier, more environmentally sustainable human habitats. Creating supportive active travel environments is an important precursor to this shift. The longevity of urban infrastructure necessitates retrofitting existing suburban neighbourhoods. Previous studies of the effects of street changes have generally relied on natural experiments, have included few outcomes, and have seldom attempted to understand the equity impacts of such interventions. METHODS In this paper we describe the design of Te Ara Mua - Future Streets, a mixed-methods, controlled before-after intervention study to assess the effect of retrofitting street changes at the suburb scale on multiple health, social and environmental outcomes. The study has a particular focus on identifying factors that improve walking and cycling to local destinations in low-income neighbourhoods and on reducing social and health inequities experienced by Māori (Indigenous New Zealanders) and Pacific people. Qualitative system dynamics modelling was used to develop a causal theory for the relationships between active travel, and walking and cycling infrastructure. On this basis we selected outcomes of interest. Together with the transport funder, we triangulated best evidence from the literature, transport policy makers, urban design professionals and community knowledge to develop interventions that were contextually and culturally appropriate. Using a combination of direct observation and random sample face to face surveys, we are measuring outcomes in these domains of wellbeing: road-user behaviour, changes to travel mode for short trips, physical activity, air quality, road traffic injuries, greenhouse gas emissions, and perceptions of neighbourhood social connection, safety, and walking and cycling infrastructure . DISCUSSION While building on previous natural experiments, Te Ara Mua - Future Streets is unique in testing an intervention designed by the research team, community and transport investors together; including a wide range of objective outcome measures; and having an equity focus. When undertaking integrated intervention studies of this kind, a careful balance is needed between epidemiological imperatives, the constraints of transport funding and implementation and community priorities, while retaining the ability to contribute new evidence for healthy, equitable transport policy. The study was retrospectively registered as a clinical trial on 21 June 2018 in the ISCRTN registry: ISRCTN89845334 http://www.isrctn.com/ISRCTN89845334.
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Affiliation(s)
- A. K. Macmillan
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9054 New Zealand
| | - H. Mackie
- Mackie Research, Ltd, Auckland, New Zealand
| | - J. E. Hosking
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - K. Witten
- SHORE Whariki, Massey University, Auckland, New Zealand
| | - M. Smith
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - A. Field
- Dovetail Research Ltd, Auckland, New Zealand
| | - A. Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - R. Hoskins
- DesignTribe Architects, Auckland, New Zealand
| | - J. Stewart
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - B. van der Werf
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - P. Baas
- TERNZ Transport Research, Auckland, New Zealand
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12
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Tarnowski M, Duda-Sobczak A, Lipski J, Zozulinska-Ziolkiewicz D, Wyganowska-Swiatkowska M. Tobacco smoking decreases clinical symptoms of gingivitis in patients with type 1 diabetes-a cross-sectional study. Oral Dis 2018; 24:1336-1342. [PMID: 29757485 DOI: 10.1111/odi.12889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Periodontal disease may develop on the background of microvascular complications of diabetes. However, some modifying factors, such as tobacco smoking, should be taken into consideration when assessing risk of development of chronic complications. The aim of the study was the clinical assessment of the periodontal status in patients with type 1 diabetes according to tobacco smoking. SUBJECTS AND METHODS A total of 362 subjects aged 29 (IQR 22-35) years, type 1 diabetes duration 12 (8-18) years, hemoglobin A1c, HbA1c 8.0 (7.2-9.1)% were included. We used Gingival Index, Approximal Plaque Index, and Sulcus Bleeding Index to assess periodontal health. Patients were divided into two subgroups according to current cigarette smoking. RESULTS No differences in age, diabetes duration, and chronic complications were found between subgroups. A better metabolic control of diabetes expressed by lower HbA1c (p = 0.00001) and triglyceride levels (p = 0.004) was shown in nonsmokers. Smokers presented significantly lower gingival bleeding, p = 0.009. HbA1c correlated with API in study group (Rs = 0.16; p = 0.002) and in nonsmokers subgroup (Rs = 0.2;p = 0.004), however, not in smoker's subgroup. In multivariable regression analysis, smoking cigarettes (β = -0.26; p = 0.0002), hs-CRP (β = 0.15; p = 0.03) and age (β = -0.19; p = 0.007) occurred to be independent predictors of SBI after adjustment for confounding variables (R2 = 0.13; p = 0.001). CONCLUSIONS Patients with type 1 diabetes smoking cigarettes presented lower gingival sulcus bleeding and worse metabolic control of diabetes than nonsmoking patients.
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Affiliation(s)
- Mateusz Tarnowski
- Department of Dental Surgery and Periodontology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Duda-Sobczak
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jakub Lipski
- Department of Dental Surgery and Periodontology, Poznan University of Medical Sciences, Poznan, Poland
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13
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Mburu JW, Kingwara L, Ester M, Andrew N. Use of classification and regression tree (CART), to identify hemoglobin A1C (HbA 1C) cut-off thresholds predictive of poor tuberculosis treatment outcomes and associated risk factors. J Clin Tuberc Other Mycobact Dis 2018; 11:10-16. [PMID: 31720385 PMCID: PMC6830151 DOI: 10.1016/j.jctube.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background Rifampin-based therapy potentially exacerbates glycemic control among TB patients who are already at high risk of hyperglycemia. This impacts negatively to the optimal care of TB- diabetes mellitus co-affected patients. Classification and regression tree (CART), a machine-learning algorithm impervious to statistical assumptions is one of the ideal tools for clinical decision-making that can be used to identify hemoglobin A1C (HbA1C) cut-off thresholds predictive of poor TB treatment outcomes in such populations. Methods 340TB smear positive patients attending two peri-urban clinics were recruited and prospectively followed up for six months. Baseline HbA1C and random blood glucose (RBG) levels were determined. CART was then used to identify cut-off thresholds and rank outcome predictors at end of therapy by determining Risk ratios (RR) and 95% confidence interval (CI) of each predictor threshold. Fractal geometry law explained effect of weight, while U-shaped curve explained effect of HbA1C on these clinical outcomes. Results Of the 340 patients enrolled: 84%were cured, 7% completed therapy and 9% had unfavorable outcomes out of which 4% (n = 32) had microbiologic failure. Using CART HbA1C identified thresholds were >2.95%, 2.95–4.55% and >4.55%, containing 8/11 (73%), 111/114 (97%) and 189/215 (88%) of patients who experienced favorable outcomes. RR for favorable outcome in patients with weight <53.25 Kg compared to >53.25 Kg was 0.61 (95% CI, 0.45–0.88) among patients with HbA1C >4.55%. Simulation of the CART model with 13 patients data failed therapy revealed that 8/11 (73%) of patients with HbA1C <2.95%, 111/114 (97%) with HbA1C between 2.95% and 4.55% and 189/215 (88%) of patients with HbA1c >4.55% experienced microbiologic failure. Conclusion Using fractal geometry relationships to drug pharmacokinetics, low weight has profound influence on failure of anti-tuberculosis treatment among patients at risk for diabetes mellitus.
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Affiliation(s)
- Josephine W Mburu
- National Reference Tuberculosis Laboratory, MOH, Kenya.,Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
| | | | - Magiri Ester
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
| | - Nyerere Andrew
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
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14
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Jung JY, Oh CM, Ryoo JH, Choi JM, Choi YJ, Ham WT, Park SK. The influence of prehypertension, hypertension, and glycated hemoglobin on the development of type 2 diabetes mellitus in prediabetes: the Korean Genome and Epidemiology Study (KoGES). Endocrine 2018; 59:593-601. [PMID: 29380232 DOI: 10.1007/s12020-018-1530-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/10/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND It has been reported that elevated blood pressure (BP) was significantly associated with the increased risk for type 2 diabetes mellitus (T2DM). However, there is still limited information about the influence of BP on the risk for T2DM across the level of glycated hemoglobin (HbA1c). METHOD In a cohort of the Korean Genome and Epidemiology Study (KoGES), 2830 non-diabetic Korean adults with prediabetes defined by HbA1c level of 5.7-6.4% were followed-up for 10 years. Multivariate cox proportional hazards assumption was used to assess the risk for T2DM according to the baseline BP categories (normal, prehypertension and hypertension) and HbA1c level (low: 5.7-5.9% and high: 6.0-6.4%). RESULTS The risk for T2DM significantly increased proportionally to BP categories (adjusted HR; reference in normal BP, 1.32 [1.10-1.59] in prehypertension and 1.61 [1.35-1.92] in hypertension). Subgroup analysis indicated that individuals with high HbA1c had the higher risk for T2DM than individuals with low HbA1c regardless of BP. Additionally, combined presence of hypertension and high HbA1c had the highest risk for T2DM (adjusted HR: 3.82 [3.00-4.87]). In each systolic and diastolic BP level, the risk for T2DM significantly increased from systolic BP ≥ 130 mmHg (adjusted HRs: 1.39 ([1.15-1.71]) and diastolic BP ≥ 80 mmHg (adjusted HRs: 1.30 ([1.07-1.58]). CONCLUSION BP and HbA1c may be useful tools in identifying individuals with prediabetes more potentially predisposed to T2DM. Prospective studies should be considered to examine whether controlling BP actually lowers the risk for T2DM.
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Affiliation(s)
- Ju Young Jung
- Total healthcare center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Joong-Myung Choi
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young-Jun Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Taek Ham
- Department of Social Physical Education, Sangji Youngseo College, Wonju, Republic of Korea
| | - Sung Keun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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15
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Mazarello Paes V, Charalampopoulos D, Edge J, Taylor-Robinson D, Stephenson T, Amin R. Predictors of glycemic control in the first year of diagnosis of childhood onset type 1 diabetes: A systematic review of quantitative evidence. Pediatr Diabetes 2018; 19:18-26. [PMID: 28488346 DOI: 10.1111/pedi.12530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/28/2017] [Accepted: 03/28/2017] [Indexed: 12/14/2022] Open
Abstract
Early glycemic control is associated with reduced future vascular complications risk in type 1 diabetes (T1D). The aim of this study was to systematically review evidence on the predictors of glycemic control within 12 months of diagnosis of childhood onset T1D. Inclusion criteria for the electronic search were: interventional and observational studies that assessed and quantified an association between the predictor and glycemic control within 12 months of diagnosis of childhood onset T1D. A total of 17 915 articles were identified from 6 databases and 20 studies were finally included in the analysis. Harvest plots and narrative synthesis were used to summarize data from intervention (n = 0), prospective/retrospective cohort (n = 15), and cross-sectional (n = 5) studies. Significant predictors of poorer glycemic control 0 to 3 months after diagnosis were older age and female gender. Non-white ethnicity, diabetes autoantibody positivity, measures of deprivation, and non-private health insurance were potential predictors. Predictors of poorer glycemic control 4 to 12 months after diagnosis were: older age, non-white ethnicity, a single parent family, high hemoglobin A1c (HbA1c) levels at diagnosis, longer T1D duration, and non-intensive insulin therapy. Potential predictors included: family with health issues, clinical factors, and comorbidities at diagnosis. Most significant predictors of poor glycemic control within 12 months of diagnosis of childhood onset T1D are non-modifiable. These factors need to be recognized and addressed through individualized and multidisciplinary diabetes care. Further research is required to confirm the association of potential predictors with early glycemic control.
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Affiliation(s)
- Veena Mazarello Paes
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Dimitrios Charalampopoulos
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Julie Edge
- Department of Paediatric Endocrinology and Diabetes, University of Oxford, Oxford, UK
| | - David Taylor-Robinson
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Terence Stephenson
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rakesh Amin
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK
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16
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Landis SH, Suruki R, Hilton E, Compton C, Galwey NW. Stability of Blood Eosinophil Count in Patients with COPD in the UK Clinical Practice Research Datalink. COPD 2017; 14:382-388. [PMID: 28569614 DOI: 10.1080/15412555.2017.1313827] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Blood eosinophil counts may be predictive of corticosteroid response in chronic obstructive pulmonary disease (COPD) patients. However, little is known about measurement stability, which is important for understanding the utility of blood eosinophil counts as a potential biomarker. We evaluated the stability of blood eosinophil counts over 1 year in a population-based cohort of patients with COPD in primary care. Patients were aged ≥ 40 years with forced expiratory volume in 1 second/forced vital capacity < 0.7 and ≥ 1 blood eosinophil measurement taken during a period of stable disease within 6 months of a COPD diagnosis code recorded between January 1, 2010 and December 31, 2012. Generalized linear mixed models were fitted to log-transformed data to estimate the between-(s2between) and within-patient (s2within) variance in eosinophil count; an intra-class correlation coefficient Ri was calculated (s2between/[s2between + s2within]). A sensitivity analysis was performed from which patients who were prescribed systemic corticosteroids or antibiotics at any time during follow-up were excluded. All models were adjusted for age, gender, smoking status, and asthma history. Overall, 27,557 patients were included in the full cohort (51.5% male, mean age [standard deviation] 71.1 [10.6] years) and 54% of patients had ≥ 2 eosinophil measurements (median 2 [interquartile range 1]) during follow-up. For the full cohort, Ri = 0.64, and in the sensitivity analysis subgroup, Ri = 0.70, mainly due to a decrease in s2within. For patients with COPD in primary care, eosinophil measurements demonstrated reasonable repeatability over 1 year, which increased after exclusion of patients who were prescribed systemic corticosteroids or antibiotics.
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Affiliation(s)
| | - Robert Suruki
- b Real World Evidence , GlaxoSmithKline , Research Triangle Park , North Carolina , USA
| | - Emma Hilton
- c Respiratory Medical Franchise , GlaxoSmithKline , Uxbridge , UK
| | - Chris Compton
- c Respiratory Medical Franchise , GlaxoSmithKline , Uxbridge , UK
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17
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Impact of demographics and disease progression on the relationship between glucose and HbA1c. Eur J Pharm Sci 2017; 104:417-423. [PMID: 28412484 DOI: 10.1016/j.ejps.2017.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 11/20/2022]
Abstract
CONTEXT Several studies have shown that the relationship between mean plasma glucose (MPG) and glycated haemoglobin (HbA1c) may vary across populations. Especially race has previously been referred to shift the regression line that links MPG to HbA1c at steady-state (Herman & Cohen, 2012). OBJECTIVE To assess the influence of demographic and disease progression-related covariates on the intercept of the estimated linear MPG-HbA1c relationship in a longitudinal model. DATA Longitudinal patient-level data from 16 late-phase trials in type 2 diabetes with a total of 8927 subjects was used to study covariates for the relationship between MPG and HbA1c. The analysed covariates included age group, BMI, gender, race, diabetes duration, and pre-trial treatment. Differences between trials were taken into account by estimating a trial-to-trial variability component. PARTICIPANTS Participants included 47% females and 20% above 65years. 77% were Caucasian, 9% were Asian, 5% were Black and the remaining 9% were analysed together as other races. ANALYSIS Estimates of the change in the intercept of the MPG-HbA1c relationship due to the mentioned covariates were determined using a longitudinal model. RESULTS The analysis showed that pre-trial treatment with insulin had the most pronounced impact associated with a 0.34% higher HbA1c at a given MPG. However, race, diabetes duration and age group also had an impact on the MPG-HbA1c relationship. CONCLUSION Our analysis shows that the relationship between MPG and HbA1c is relatively insensitive to covariates, but shows small variations across populations, which may be relevant to take into account when predicting HbA1c response based on MPG measurements in clinical trials.
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18
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Kar D, Gillies C, Zaccardi F, Webb D, Seidu S, Tesfaye S, Davies M, Khunti K. Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol 2016; 15:158. [PMID: 27881170 PMCID: PMC5121966 DOI: 10.1186/s12933-016-0475-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/10/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smoking is associated with increased macrovascular and microvascular complications in people with diabetes. In addition to other concomitant vascular perturbations, it also seems to influence the cardiometabolic parameters, which may partly explain the accelerated rate of vascular complications in smokers with diabetes. While smoking cessation is advocated as a universal component of the management of diabetes, there is some anecdotal evidence that HbA1c could increase following smoking cessation. The aim of this review is to explore the relationship between smoking and its cessation on cardiometabolic parameters in diabetes. METHODS Searches were conducted on Medline, EMBASE and CINAHL up to March 2016. After screening 6866 studies (Additional file 1), 14 observational studies with a total of 98,978 participants' with either type 1 or type 2 diabetes were selected for review. Narrative synthesis and meta-analyses were carried out to explore the relationship between smoking and its cessation. RESULTS Meta-analysis showed that the pooled mean difference of HbA1c between non-smokers and smokers was -0.61% (95% CI -0.88 to -0.33, p < 0.0001). The difference in LDL cholesterol between non-smokers and smokers was -0.11 mmol/l (95% CI -0.21 to -0.01, p = 0.04). The difference in HDL cholesterol between non-smokers and smokers was 0.12 mmol/l (95% CI 0.08-0.15, p < 0.001). However, there was no statistically significant difference in blood pressure between the two groups. The difference in HbA1c between quitters and continued smokers was not statistically significant -0.10% (95% CI -0.42 to 0.21, p = 0.53). However, a narrative synthesis revealed that over a period of 10 years, the HbA1c was comparable between non-smokers and quitters. CONCLUSION Non-smokers have a statistically significant lower HbA1c and more favourable lipid profile compared to smokers. Smoking cessation does not lead to an increase in HbA1c in long-term and may reduce vascular complications in diabetes by its favourable impact on lipid profile.
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Affiliation(s)
- Debasish Kar
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK. .,Derbyshire Community Health Services NHS Foundation Trust, Castle Street Medical Centre, Castle Street, Bolsover, Chesterfield, Derbyshire, UK.
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - David Webb
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Solomon Tesfaye
- Academic Unit of Diabetes and Endocrinology, University of Sheffield, Sheffield, UK
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
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19
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Buffarini R, Restrepo-Méndez MC, Silveira VM, Miranda JJ, Gonçalves HD, Oliveira IO, Horta BL, Gigante DP, Menezes AM, Assunção MCF. Distribution of Glycated Haemoglobin According to Early-Life and Contemporary Characteristics in Adolescents and Adults without Diabetes: The 1982 and 1993 Pelotas Birth Cohorts. PLoS One 2016; 11:e0162614. [PMID: 27626274 PMCID: PMC5023185 DOI: 10.1371/journal.pone.0162614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/25/2016] [Indexed: 12/23/2022] Open
Abstract
Aim Glycated haemoglobin (HbA1c), a marker of glucose control in individuals with diabetes mellitus, is also related with the incidence of cardiometabolic risk in populations free of disease. The aim of this study was to describe the distribution of HbA1c levels according to early-life and contemporary factors in adolescents and adults without diabetes mellitus. Methods HbA1c was measured in adults aged 30 years and adolescents aged 18 years who are participants in the 1982 and 1993 Pelotas Birth Cohorts, respectively. Bivariate and multivariate analyses were performed to describe the HbA1c mean values according to early-life and contemporary characteristics collected prospectively since birth. Results The distribution of the HbA1c was approximately normal in both cohorts, with a mean (SD) 5.10% (0.43) in the 1982 cohort, and 4.89% (0.50) in the 1993 cohort. HbA1c mean levels were significantly higher in individuals self-reported as black/brown skin color compared to those self-reported as white in both cohorts. Parental history of diabetes was associated with higher HbA1c mean in adults, while stunting at one year old presented an inverse relation with the outcome in adolescents. No other early and contemporary factors were associated with HbA1c levels in adults or adolescents. Conclusions We found a consistent relationship between HbA1c and skin color in both cohorts. Further research is needed to understand the role of genomic ancestry on levels of HbA1c concentrations which may inform policies and preventive actions for diabetes mellitus and cardiometabolic risk.
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Affiliation(s)
- Romina Buffarini
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
- * E-mail:
| | - María Clara Restrepo-Méndez
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160 3rd floor, 96020–220, Pelotas, Brazil
| | - Vera M. Silveira
- Clinical Medical Department, Faculty of Medicine, Federal University of Pelotas, Rua Félix da Cunha 614, Centro, 96010–000, Pelotas, Brazil
| | - Jaime J. Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Department of Medicine, School of Medicine, Lima, Peru
| | - Helen D. Gonçalves
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Isabel O. Oliveira
- Department of Physiology and Pharmacology, Federal University of Pelotas, Campus Universitário s/n, Capão do Leão, 96010–900, Pelotas, Brazil
| | - Bernardo L. Horta
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Denise P. Gigante
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Ana Maria Menezes
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Maria Cecília F. Assunção
- Department of Nutrition, School of Nutrition, Federal University of Pelotas, Campus Anglo, Gomes Carneiro 1, 96010–900, Pelotas, Brazil
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Charokopou M, Sabater FJ, Townsend R, Roudaut M, McEwan P, Verheggen BG. Methods applied in cost-effectiveness models for treatment strategies in type 2 diabetes mellitus and their use in Health Technology Assessments: a systematic review of the literature from 2008 to 2013. Curr Med Res Opin 2016; 32:207-18. [PMID: 26473650 DOI: 10.1185/03007995.2015.1102722] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify and compare health-economic models that were developed to evaluate the cost-effectiveness of treatments for type 2 diabetes mellitus (T2DM), and their use within Health Technology Assessments (HTAs). METHODS In total, six commonly used databases were searched for articles published between October 2008 and January 2013, using a protocolized search strategy and inclusion criteria. The websites of HTA organizations in nine countries, and proceedings from five relevant conferences, were also reviewed. The identified new health-economic models were qualitatively assessed using six criteria that were developed based on technical components, and characteristics related to the disease or the treatments being assessed. Finally, the number of times the models were applied within HTA reports, published literature, and/or major conferences was determined. RESULTS Thirteen new models were identified and reviewed in depth. Most of these were based on identical key data sources, and applied a similar model structure, either using Markov modeling or microsimulation techniques. The UKPDS equations and panel regressions were frequently used to estimate the occurrence of diabetes-related complications and the probability of developing risk factors in the long term. The qualitative assessment demonstrated that the CARDIFF, Sheffield T2DM and ECHO T2DM models seem technically equipped to appropriately assess the long-term health-economic consequences of chronic treatments for patients with T2DM. It was observed that the CORE model is the most widely described in literature and conferences, and the most often applied model within HTA submissions, followed by the CARDIFF and UKPDS models. CONCLUSION This research provides an overview of T2DM models that were developed between 2008 and January 2013. The outcomes of the qualitative assessments, combined with frequent use in local reimbursement decisions, prove the applicability of the CORE, CARDIFF and UKPDS models to address decision problems related to the long-term clinical and economic consequences of new and existing T2DM treatments.
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Affiliation(s)
- M Charokopou
- a a Pharmerit International , Rotterdam , the Netherlands (at the time of the research)
| | - F J Sabater
- b b Bristol-Myers Squibb , Rueil-Malmaison , France
| | - R Townsend
- c c AstraZeneca , Brussels , Belgium (at the time of the research)
| | - M Roudaut
- d d Bristol-Myers Squibb , Rueil-Malmaison , France (at the time of the research)
| | - P McEwan
- e e Centre for Health Economics, Swansea University , Wales , UK
- f f Health Economics & Outcomes Research Ltd , Wales , UK
| | - B G Verheggen
- g g Pharmerit International , Rotterdam , the Netherlands
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Grossman A, Beloosesky Y, Schlesinger A, Gafter-Gvili A, Koren-Morag N, Meyerovitch J, Weiss A. The association between glycated hemoglobin levels and mortality in non-diabetic elderly subjects. Eur J Intern Med 2016; 27:57-61. [PMID: 26520045 DOI: 10.1016/j.ejim.2015.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/08/2015] [Accepted: 10/14/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Glycated hemoglobin (HgbA1c) is extensively used as a screening tool for the diagnosis of diabetes mellitus (DM). Although its prognostic value among diabetics has been extensively studied, similar data among non-diabetics is scarce. The aim of this study was to evaluate the association between HgbA1c and mortality in non-diabetic elderly individuals. METHODS A review of a computerized database of a large health care organization was performed. Non-diabetic individuals≥65years old with HgbA1c levels<6.5% evaluated during the years 2002-2012 were included in the analysis. Subjects were stratified into quintiles based on HgbA1c levels. Hazard ratios (HR) for mortality were compared between the quintiles. RESULTS The cohort included 12,937 non-diabetic individuals≥65years who did not develop DM during the follow-up period. The lowest mortality rate was observed in the fourth HgbA1c quintile [HgbA1c 5.9-6.1% (41-43mmol/mol)]. Compared with the mortality rate in the fourth quintile, mortality rate was increased in the lowest (HgbA1c<5.39%, 35mmol/mol, HR 1.21 CI 1.09-1.35) and highest (HgbA1c>6.11%, 43mmol/mol, HR 1.17 CI 1.04-1.32) HgbA1c quintiles. This association persisted after adjustment for age, gender and co-morbidities. CONCLUSIONS The association between HgbA1c and all-cause mortality in non-diabetic elderly individuals has a U-shape form with the highest mortality in those with the lowest and highest HgbA1c levels.
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Affiliation(s)
- Alon Grossman
- Unit of Endocrinology and Metabolism, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Yichayahou Beloosesky
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Agatha Schlesinger
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Anat Gafter-Gvili
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Internal Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Nira Koren-Morag
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Chief Pediatrician, Community Division, Clalit Health Services, Tel Aviv, Israel; Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Avraham Weiss
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, Deedwania P, Eckel RH, Ershow AG, Fradkin J, Inzucchi SE, Kosiborod M, Nelson RG, Patel MJ, Pignone M, Quinn L, Schauer PR, Selvin E, Vafiadis DK. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. Diabetes Care 2015; 38:1777-803. [PMID: 26246459 PMCID: PMC4876675 DOI: 10.2337/dci15-0012] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.
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23
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Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, Deedwania P, Eckel RH, Ershow AG, Fradkin J, Inzucchi SE, Kosiborod M, Nelson RG, Patel MJ, Pignone M, Quinn L, Schauer PR, Selvin E, Vafiadis DK. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. Circulation 2015; 132:691-718. [PMID: 26246173 DOI: 10.1161/cir.0000000000000230] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.
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Huang X, Zhou Y, Xu B, Sun W, Lin L, Sun J, Xu M, Lu J, Bi Y, Wang W, Xu Y, Ning G. Glycated haemoglobin A1c is associated with low-grade albuminuria in Chinese adults. BMJ Open 2015; 5:e007429. [PMID: 26243552 PMCID: PMC4538277 DOI: 10.1136/bmjopen-2014-007429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Diabetes is a strong risk factor for cardiovascular diseases, whereas few studies have investigated simultaneously the associations of glycated haemoglobin A1c (HbA1c), fasting blood glucose (fasting plasma glucose (FPG)) and 2 h postload blood glucose (2 h PG) with low-grade albuminuria, which is an earlier marker of cardiovascular diseases in the general population. Our study aimed to investigate and compare associations of HbA1c, FPG, and 2 h PG levels with risks of low-grade albuminuria in the middle-aged and elderly Chinese. DESIGN AND METHODS This was a cross-sectional study involving 9188 participants aged 40 years or older. All participants underwent a standard 75 g oral glucose tolerance test. Low-grade albuminuria was defined as the highest quartile of urinary albumin-to-creatinine ratio (ACR) (>6.10 mg/g in males and >8.76 mg/g in females) in respondents without microalbuminuria or macroalbuminuria. RESULTS HbA1c, FPG and 2 h PG were all significantly correlated with urinary ACR after adjustment for confounders (all p values <0.0001). After adjustment for HbA1c, the relationships of FPG and 2 h PG with ACR reduced to null. HbA1c levels were still significantly associated with ACR after further adjustment for FPG and 2 h PG. Multiple logistic regression showed that risks of low-grade albuminuria were positively associated with HbA1c levels in a dose-response manner. Compared with participants with HbA1c ≤ 37 mmol/mol (5.5%), ORs (95% CIs) for low-grade albuminuria were 1.05 (0.94 to 1.18), 1.25 (1.04 to 1.50), 1.40 (1.04 to 1.90) and 2.21 (1.61 to 3.03) for HbA1c categories of 38-42 mmol/mol (5.6-6.0%), 43-48 mmol/mol (6.1-6.5%), 49-53 mmol/mol (6.6-7.0%), and >53 mmol/mol (7.0%), respectively (p for trend <0.0001). CONCLUSIONS HbA1c, but not FPG or 2 h PG, was independently associated with an increased risk of low-grade albuminuria in the middle-aged and elderly Chinese.
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Affiliation(s)
- Xiaolin Huang
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yulin Zhou
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Baihui Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Wanwan Sun
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Lin Lin
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Jichao Sun
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai, China
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
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Change in HbA1c levels between the age of 8 years and the age of 12 years in Dutch children without diabetes: the PIAMA birth cohort study. PLoS One 2015; 10:e0119615. [PMID: 25875773 PMCID: PMC4395421 DOI: 10.1371/journal.pone.0119615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 02/02/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE HbA1c is associated with cardiovascular risk in persons without diabetes and cardiovascular risk accumulates over the life course. Therefore, insight in factors determining HbA1c from childhood onwards is important. We investigated (lifestyle) determinants of HbA1c at age 12 years and the effects of growth on change in HbA1c and the tracking of HbA1c between the age of 8 and 12 years. STUDY DESIGN AND METHODS Anthropometric measurements were taken and HbA1c levels were assessed in 955 children without diabetes aged around 12 years participating in the PIAMA birth cohort study. In 363 of these children HbA1c was also measured at age 8 years. Data on parents and children were collected prospectively by questionnaires. RESULTS We found no significant association between known risk factors for diabetes and HbA1c at age 12 years. Mean(SD) change in HbA1c between ages 8 and 12 years was 0.6(0.7) mmol/mol per year (or 0.1(0.1) %/yr). Anthropometric measures at age 8 and their change between age 8 and 12 years were not associated with the change in HbA1c. 68.9% of the children remained in the same quintile or had an HbA1c one quintile higher or lower at age 8 years compared to age 12 years. CONCLUSION The lack of association between known risk factors for diabetes and HbA1c suggest that HbA1c in children without diabetes is relatively unaffected by factors associated with glycaemia. HbA1c at age 8 years is by far the most important predictor of HbA1c at age 12. Therefore, the ranking of HbA1c levels appear to be fairly stable over time.
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Hofer SE, Raile K, Fröhlich-Reiterer E, Kapellen T, Dost A, Rosenbauer J, Grulich-Henn J, Holl RW. Tracking of metabolic control from childhood to young adulthood in type 1 diabetes. J Pediatr 2014; 165:956-61.e1-2. [PMID: 25151197 DOI: 10.1016/j.jpeds.2014.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/11/2014] [Accepted: 07/01/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This prospective longitudinal survey was designed to follow patients with diabetes from disease onset in childhood over an extended period of time including puberty until young adulthood with respect to metabolic control. STUDY DESIGN An electronic diabetes patient documentation system used in diabetes centers in Austria and Germany was utilized for standardized data collection. Complete documentation of metabolic control for prepuberty (≤ 13 years), puberty (14-19 years), and adulthood (≥ 20 years) was available in 1146 patients. RESULTS Median age at diabetes manifestation was 7.2 (IQR 4.7-9.4) years; 49% were male. In the prepubertal stage, median glycated hemoglobin A1c (HbA1c) was 7.5 (IQR 6.8-8.3), during puberty 8.0 (IQR 7.3-8.9), and after puberty 7.8 (IQR 7.1-9.0). A significant intra-individual correlation was found for prepuberty to puberty HbA1c levels (R = 0.55, P < .001), puberty to adulthood (R = 0.59, P < .001), as well as prepuberty to adulthood (R = 0.30, P < .001). When patients were divided into tertiles of prepubertal HbA1c, HbA1c increased in all 3 groups over time, however, significant group differences tracked into adulthood (P < .001 at all stages). A regression model identified pre-pubertal HbA1c as a significant and relevant predictor of metabolic control in young adulthood adjusted for confounders (P < .001). CONCLUSIONS This survey provides evidence for long-term tracking of metabolic control from childhood until adulthood, suggesting an early focus on metabolic control.
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Affiliation(s)
- Sabine E Hofer
- Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria.
| | - Klemens Raile
- Department of Pediatrics, Experimental and Clinical Research Center, Charite, Berlin, Germany
| | | | - Thomas Kapellen
- Department of Pediatrics, University of Leipzig, Leipzig, Germany
| | - Axel Dost
- Department of Pediatrics, University of Jena, Jena, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Marino M, Li Y, Pencina MJ, D'Agostino RB, Berkman LF, Buxton OM. Quantifying cardiometabolic risk using modifiable non-self-reported risk factors. Am J Prev Med 2014; 47:131-40. [PMID: 24951039 PMCID: PMC4107093 DOI: 10.1016/j.amepre.2014.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 02/18/2014] [Accepted: 03/03/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sensitive general cardiometabolic risk assessment tools of modifiable risk factors would be helpful and practical in a range of primary prevention interventions or for preventive health maintenance. PURPOSE To develop and validate a cumulative general cardiometabolic risk score that focuses on non-self-reported modifiable risk factors such as glycosylated hemoglobin (HbA1c) and BMI so as to be sensitive to small changes across a span of major modifiable risk factors, which may not individually cross clinical cut-off points for risk categories. METHODS We prospectively followed 2,359 cardiovascular disease (CVD)-free subjects from the Framingham offspring cohort over a 14-year follow-up. Baseline (fifth offspring examination cycle) included HbA1c and cholesterol measurements. Gender-specific Cox proportional hazards models were considered to evaluate the effects of non-self-reported modifiable risk factors (blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking, BMI, and HbA1c) on general CVD risk. We constructed 10-year general cardiometabolic risk score functions and evaluated its predictive performance in 2012-2013. RESULTS HbA1c was significantly related to general CVD risk. The proposed cardiometabolic general CVD risk model showed good predictive performance as determined by cross-validated discrimination (male C-index=0.703, 95% CI=0.668, 0.734; female C-index=0.762, 95% CI=0.726, 0.801) and calibration (lack-of-fit chi-square=9.05 [p=0.338] and 12.54 [p=0.128] for men and women, respectively). CONCLUSIONS This study presents a risk factor algorithm that provides a convenient and informative way to quantify cardiometabolic risk on the basis of modifiable risk factors that can motivate an individual's commitment to prevention and intervention.
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Affiliation(s)
- Miguel Marino
- Department of Family Medicine, Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health Science University, Portland, Oregon.
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Michael J Pencina
- Duke Clinical Research Institute and Department of Biostatistics and Bioinformatics and Framingham Heart Study, Duke University, Durham, North Carolina
| | - Ralph B D'Agostino
- Department of Mathematics/Statistics, Biostatistics and Epidemiology, Boston University
| | - Lisa F Berkman
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Orfeu M Buxton
- Department of Medicine, Brigham and Women's Hospital, Department of Social and Behavioral Sciences, Harvard School of Public Health, Division of Sleep Medicine, Harvard Medical School Boston; Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
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Garg N, Moorthy N, Kapoor A, Tewari S, Kumar S, Sinha A, Shrivastava A, Goel PK. Hemoglobin A(1c) in nondiabetic patients: an independent predictor of coronary artery disease and its severity. Mayo Clin Proc 2014; 89:908-16. [PMID: 24996234 DOI: 10.1016/j.mayocp.2014.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/16/2014] [Accepted: 03/25/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the association between hemoglobin A(1c) (HbA(1c)) and the presence, severity, and complexity of angiographically proven coronary artery disease (CAD) in nondiabetic patients. PATIENTS AND METHODS We performed a single-center, observational, cross-sectional study of 1141 consecutive nondiabetic patients who underwent coronary angiography from January 1, 2011, through December 31, 2011. The study population was divided into 4 interquartiles according to HbA(1c) levels (<5.5%, 5.5%-5.7%, 5.8%-6.1%, and >6.1%). RESULTS Patients with higher HbA(1c) levels tended to be older, overweight, and hypertensive, had higher blood glucose levels, and had lower glomerular filtration rates. Higher HbA(1c) levels were associated in a graded fashion with the presence of CAD, disease severity (higher number of diseased vessels and presence of left main and/or triple vessel disease), and disease complexity (higher SYNTAX score, higher number of patients in intermediate or high SYNTAX tertiles, coronary calcium, and chronic total occlusions). After adjustment for major conventional cardiovascular risk factors, compared with patients with HbA(1c) levels less than 5.5%, the odds ratios of occurrence of CAD in the HbA(1c) quartiles of 5.5% to 5.7%, 5.8% to 6.1%, and greater than 6.1% were 1.8 (95% CI, 1.2-2.7), 3.5 (95% CI, 2.3-5.3), and 4.9 (95% CI, 3.0-8.1), respectively. CONCLUSION The HbA(1c) level has a linear incremental association with CAD in nondiabetic individuals. The HbA(1c) level is also independently correlated with disease severity and higher SYNTAX scores. Thus, HbA(1c) measurement could be used to improve cardiovascular risk assessment in nondiabetic individuals.
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Affiliation(s)
- Naveen Garg
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nagaraja Moorthy
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Archana Sinha
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshika Shrivastava
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Pravin K Goel
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Bell EJ, Selvin E, Lutsey PL, Nambi V, Cushman M, Folsom AR. Glycemia (hemoglobin A1c) and incident venous thromboembolism in the Atherosclerosis Risk in Communities cohort study. Vasc Med 2014; 18:245-50. [PMID: 24165467 DOI: 10.1177/1358863x13506764] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diabetes has been inconsistently associated with increased risk of venous thromboembolism (VTE) and there is little direct evidence on the associations of glycemia levels with VTE. We used data from the Atherosclerosis Risk in Communities study to test the hypothesis that glycemia, as measured by hemoglobin A1c (A1c), is positively associated with VTE. Participants aged 45-64 years (n = 12,298) had A1c measured in 1990 and were followed for incident VTE (n = 345) through 2005. Because A1c is affected by diabetes treatment, analyses were stratified by history of diagnosed diabetes. Owing to evidence of non-linearity, we categorized A1c according to clinical cut-points: <5.7, 5.7-6.4, and ≥ 6.5% in those with no diagnosed diabetes; <7.0 and ≥ 7.0% in those with diagnosed diabetes. After adjustment for potential confounders, the hazard ratios (95% CIs) for VTE across increasing A1c categories were 1 (referent), 1.02 (0.77, 1.35) and 0.72 (0.41, 1.29) for those without diagnosed diabetes, and 1.30 (0.77, 2.17) and 1.41 (0.95, 2.09) for those with diagnosed diabetes. To explore the relation, we employed various models to adjust for potential confounding variables and modeled A1c as tertiles. We consistently found elevated hazard ratios in those with diagnosed diabetes, though the association was not statistically significant in every model. Hazard ratios in those without diagnosed diabetes were close to 1. In conclusion, our results are mildly suggestive that diagnosed diabetes and high levels of glucose, per se, may increase the risk of VTE. Elevated glucose was not related to VTE in those without diagnosed diabetes.
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Affiliation(s)
- Elizabeth J Bell
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
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Bower JK, Pankow JS, Lazo M, Christenson E, Hoogeveen RC, Ballantyne CM, Halushka MK, Astor BC, Selvin E. Three-year variability in plasma concentrations of the soluble receptor for advanced glycation end products (sRAGE). Clin Biochem 2014; 47:132-4. [PMID: 24246851 PMCID: PMC4263345 DOI: 10.1016/j.clinbiochem.2013.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 11/01/2013] [Accepted: 11/06/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The soluble receptor for advanced glycation end products (sRAGE) has been implicated in the development of diabetes-related vascular complications, but the variability of concentrations of sRAGE in the blood is unknown. The objective of this study was to characterize within-person three-year variability of plasma levels of sRAGE. DESIGN AND METHODS We measured sRAGE in plasma samples from 179 men and women in the community-based Atherosclerosis Risk in Communities (ARIC) Study at two time points, three years apart. We calculated correlation coefficients and the within-person coefficient of variation (CVw) to characterize variability in sRAGE. We compared these estimates to total cholesterol and white blood cell count (WBC) in the same participants. RESULTS Mean sRAGE concentrations at the two time points (mean time between measurements = 2.9 years) were 1096.2 pg/mL and 990.2 pg/mL, respectively (mean difference = -106.0 pg/mL, p-value < 0.001). The Pearson's correlation was 0.78 (Spearman's, 0.73). The intra-class correlation coefficient was 0.76 and the CVw was 26.6%. Compared to sRAGE, Pearson's and Spearman's correlations for total cholesterol (0.76 and 0.77) and white blood cell count (0.61 and 0.72) were similar, although CVw for both was lower (8.7% for cholesterol, 15.6% for WBC). Less than 4% of participants' values changed substantially (50% or greater) over the three-year interval. CONCLUSIONS We observed that sRAGE concentrations remained relatively stable over three years. Our findings suggest that a single measure of circulating sRAGE tracks well in a community-based population and could be a useful measure in clinical and epidemiologic studies of long-term risk.
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Affiliation(s)
- Julie K Bower
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Mariana Lazo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Ron C Hoogeveen
- Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Marc K Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brad C Astor
- Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Parrinello CM, Selvin E. Beyond HbA1c and glucose: the role of nontraditional glycemic markers in diabetes diagnosis, prognosis, and management. Curr Diab Rep 2014; 14:548. [PMID: 25249070 PMCID: PMC4214073 DOI: 10.1007/s11892-014-0548-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fasting glucose and hemoglobin A1c (HbA1c) are the standard measures for diagnosis and monitoring of diabetes. There has been recent interest in nontraditional markers of hyperglycemia, including fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG), as alternatives or adjuncts to standard measures. There is a growing literature linking these nontraditional markers with microvascular and macrovascular complications. Fructosamine and glycated albumin have also been shown to improve identification of persons with diabetes. However, long-term prospective studies with clinical outcomes are lacking. Some modern laboratory assays for fructosamine, glycated albumin, and 1,5-AG have excellent performance. Expanded use of these tests has the potential to improve diabetes care as these measures may overcome limitations of HbA1c in certain patients, complement traditional measures by providing additional information on shorter-term glycemic control, and improve risk stratification for diabetes and its complications. Nonetheless, studies are needed to demonstrate if their routine use will benefit patients and improve outcomes.
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Affiliation(s)
- Christina M Parrinello
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD, 21287, USA,
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Menke A, Rust KF, Savage PJ, Cowie CC. Hemoglobin A1c, fasting plasma glucose, and 2-hour plasma glucose distributions in U.S. population subgroups: NHANES 2005-2010. Ann Epidemiol 2013; 24:83-9. [PMID: 24246264 DOI: 10.1016/j.annepidem.2013.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 10/01/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Although mean concentrations of hemoglobin A1c (A1C), fasting plasma glucose, and 2-hour plasma glucose differ by demographics, it is unclear what other characteristics of the distributions may differ, such as the amount of asymmetry of the distribution (skewness) and shift left or right compared with another distribution (shift). METHODS Using kernel density estimation, we created smoothed plots of the distributions of fasting plasma glucose (N = 7250), 2-hour plasma glucose (N = 5851), and A1C (N = 16,209) by age, race-ethnicity, and sex in the 2005-2010 National Health and Nutrition Examination Survey, a nationally representative sample of U.S. adults including people with and without diabetes. We tested differences in distributions using cumulative logistic regression. RESULTS The distributions were generally unimodal and right-skewed. All distributions were shifted higher and more right-skewed for older age groups (P < .001 for each marker). Compared with non-Hispanic whites, the distribution of fasting plasma glucose was shifted higher for Mexican-Americans (P = .01), whereas the distribution of A1C was shifted higher for non-Hispanic blacks (P < .001). The distribution of fasting plasma glucose was shifted higher for men (P < .001) and the distribution of 2-hour plasma glucose was shifted higher for women (P = .01). CONCLUSIONS We provide a graphic reference for comparing these distributions and diabetes cut-points by demographic factors.
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Affiliation(s)
- Andy Menke
- Social & Scientific Systems, Inc., Silver Spring, MD.
| | | | - Peter J Savage
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Catherine C Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Eskesen K, Jensen MT, Galatius S, Vestergaard H, Hildebrandt P, Marott JL, Jensen JS. Glycated haemoglobin and the risk of cardiovascular disease, diabetes and all-cause mortality in the Copenhagen City Heart Study. J Intern Med 2013; 273:94-101. [PMID: 23009556 DOI: 10.1111/j.1365-2796.2012.02594.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Individuals with diabetes mellitus (DM) have a considerably elevated risk of developing serious health problems including cardiovascular disease (CVD). Long-term elevated levels of blood glucose in nondiabetic individuals may also be associated with increased risk of CVD. The aim of this study was to investigate the relationships between glycated haemoglobin A(1c) (HbA(1c) ) and CVD, DM and all-cause mortality. SUBJECTS AND DESIGN The Copenhagen City Heart Study is a prospective study of individuals from the Danish general population. The cohort was followed for 10 years via national registers with respect to incident CVD, DM and all-cause mortality. Follow-up was 100% complete. RESULTS A total of 5127 subjects were included, of whom 597 had DM. In the nondiabetic population, HbA(1c) was significantly associated with incident CVD events in both univariate [hazard ratio (HR) 1.38, 95% CI 1.11-1.71] and multivariate analyses (HR 1.31, 95% CI 1.05-1.64). In the nondiabetic population, increased levels of HbA(1c) were correlated with developing DM. There was a threefold increase in risk of incident DM per unit increase in HbA(1c) with a univariate HR of 3.83 (95% CI 1.96-7.51). This relationship was essentially unchanged after multivariate adjustments (HR 4.19, 95% CI 2.01-8.71). Furthermore, we found that net reclassification improvement for diagnosed DM and CVD was significantly improved with the addition of HbA(1c) in the analyses. Although not statistically significant, we found a strong trend towards an association between HbA(1c) and all-cause mortality (HR 1.21, 95% CI 0.99-1.47). We did not find the same associations amongst the population with DM. CONCLUSION In the Danish general population, HbA(1c) was strongly associated with CVD in individuals without DM.
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Affiliation(s)
- K Eskesen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
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Sahin OZ, Asci G, Kircelli F, Yilmaz M, Duman S, Ozkahya M, Dogan C, Odabas AR, Cirit M, Ok E. The impact of low serum sodium level on mortality depends on glycemic control. Eur J Clin Invest 2012; 42:534-40. [PMID: 22049913 DOI: 10.1111/j.1365-2362.2011.02613.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low serum sodium levels have been associated with mortality both in patients with and without chronic kidney disease. In this study, we investigated this association in relation to glycemic control in hemodialysis (HD) patients. MATERIALS AND METHODS Between March and September 2005, 697 prevalent HD patients were enrolled in this prospective observational study and followed up for all-cause and cardiovascular mortality. The associations of serum sodium concentration with both overall and cardiovascular survival rates were studied. RESULTS At baseline, mean predialysis serum sodium concentration was 138.4 ± 2.3 mEq/L (range: 130-145 mEq/L). Mild hyponatremia (< 135 mEq/L) was present in only 41 subjects (5.9%), and no patient had serum sodium level < 130 mEq/L. During 20.2 ± 6.2 months of follow-up, 119 patients (15.9%) died, 68 from CV causes. In adjusted Cox regression analysis, lowest sodium quartile was associated with 2.13-fold increased risk of overall mortality (95% confidence interval (CI) 1.14-3.98, P = 0.01, model chi-square 114.6, P < 0.001). As a continuous variable, each 1 mEq/L increase in predialysis sodium concentration was associated with a hazard ratio (HR) of 0.87 for overall mortality (95% CI 0.81-0.95, P = 0.002) and 0.86 for cardiovascular mortality (95% CI 0.78-0.96, P = 0.007). The predictivity of low serum sodium was prominent in diabetic subjects but not in nondiabetics. However, relationship between serum sodium and patient survival in diabetics was lost after adjustment for the HbA1c level: HR 0.91 (95% CI 0.78-1.05, P = 0.20). CONCLUSIONS Low serum sodium concentration is associated with mortality only in those with diabetes. Furthermore, the impact of serum sodium on survival in these patients seems to be derived from poor glucose control.
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Affiliation(s)
- Osman Z Sahin
- Division of Nephrology, Ataturk Traning and Research Hospital, Izmir, Turkey.
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Joshu CE, Prizment AE, Dluzniewski PJ, Menke A, Folsom AR, Coresh J, Yeh HC, Brancati FL, Platz EA, Selvin E. Glycated hemoglobin and cancer incidence and mortality in the Atherosclerosis in Communities (ARIC) Study, 1990-2006. Int J Cancer 2012; 131:1667-77. [PMID: 22161730 DOI: 10.1002/ijc.27394] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/15/2011] [Indexed: 12/13/2022]
Abstract
Diabetes is a risk factor for many cancers; chronic hyperglycemia is hypothesized to be, in part, explanatory. We evaluated the association between glycated hemoglobin, a time-integrated glycemia measure, and cancer incidence and mortality in nondiabetic and diabetic men and women. We conducted a prospective study of 12,792 cancer-free participants attending the second visit (1990-1992) of the Atherosclerosis Risk in Communities (ARIC) Study. We measured glycated hemoglobin in whole-blood samples using HPLC. Incident cancers were ascertained from registries and hospital records through 2006. We estimated multivariable-adjusted hazard ratios (HR) of cancer incidence and mortality for nondiabetic participants with values ≥ 5.7% (elevated), nondiabetic participants with <5.0% (low) and diabetic participants all compared with nondiabetic participants with 5.0-5.6% (normal). We ascertained 2,349 incident cancer cases and 887 cancer deaths. Compared with nondiabetic women with normal glycated hemoglobin, nondiabetic women with elevated values had an increased risk of cancer incidence (HR:1.24; 95% CI:1.07,1.44) and mortality (HR:1.58; 95% CI:1.23,2.05) as did diabetic women (incidence, HR:1.30; 95% CI:1.06,1.60, mortality, HR:1.96; 95% CI:1.40,2.76). Nondiabetic women with low values also had increased risk. Diabetic women with good glycemic control (<7.0%) had a lower cancer risk than those with higher values. Glycated hemoglobin in nondiabetic and diabetic men, and diabetes were not statistically significantly associated with total cancer risk. Our findings support the hypothesis that chronic hyperglycemia, even in the nondiabetic range, increases cancer risk in women. Maintaining normal glycated hemoglobin overall, and good glycemic control among diabetic adults, may reduce the burden of cancer, especially in women.
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Affiliation(s)
- Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Selvin E, Steffes MW, Gregg E, Brancati FL, Coresh J. Performance of A1C for the classification and prediction of diabetes. Diabetes Care 2011; 34:84-9. [PMID: 20855549 PMCID: PMC3005486 DOI: 10.2337/dc10-1235] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although A1C is now recommended to diagnose diabetes, its test performance for diagnosis and prognosis is uncertain. Our objective was to assess the test performance of A1C against single and repeat glucose measurements for diagnosis of prevalent diabetes and for prediction of incident diabetes. RESEARCH DESIGN AND METHODS We conducted population-based analyses of 12,485 participants in the Atherosclerosis Risk in Communities (ARIC) study and a subpopulation of 691 participants in the Third National Health and Nutrition Examination Survey (NHANES III) with repeat test results. RESULTS Against a single fasting glucose ≥126 mg/dl, the sensitivity and specificity of A1C ≥6.5% for detection of prevalent diabetes were 47 and 98%, respectively (area under the curve 0.892). Against repeated fasting glucose (3 years apart) ≥126 mg/dl, sensitivity improved to 67% and specificity remained high (97%) (AUC 0.936). Similar results were obtained in NHANES III against repeated fasting glucose 2 weeks apart. The accuracy of A1C was consistent across age, BMI, and race groups. For individuals with fasting glucose ≥126 mg/dl and A1C ≥6.5% at baseline, the 10-year risk of diagnosed diabetes was 88% compared with 55% among those individuals with fasting glucose ≥126 mg/dl and A1C 5.7-<6.5%. CONCLUSIONS A1C performs well as a diagnostic tool when diabetes definitions that most closely resemble those used in clinical practice are used as the "gold standard." The high risk of diabetes among individuals with both elevated fasting glucose and A1C suggests a dual role for fasting glucose and A1C for prediction of diabetes.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Matsushita K, Blecker S, Pazin-Filho A, Bertoni A, Chang PP, Coresh J, Selvin E. The association of hemoglobin a1c with incident heart failure among people without diabetes: the atherosclerosis risk in communities study. Diabetes 2010; 59:2020-6. [PMID: 20484138 PMCID: PMC2911067 DOI: 10.2337/db10-0165] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE This study sought to investigate an association of HbA1c (A1C) with incident heart failure among individuals without diabetes and compare it to fasting glucose. RESEARCH DESIGN AND METHODS We studied 11,057 participants of the Atherosclerosis Risk in Communities (ARIC) Study without heart failure or diabetes at baseline and estimated hazard ratios of incident heart failure by categories of A1C (<5.0, 5.0-5.4 [reference], 5.5-5.9, and 6.0-6.4%) and fasting glucose (<90, 90-99 [reference], 100-109, and 110-125 mg/dl) using Cox proportional hazards models. RESULTS A total of 841 cases of incident heart failure hospitalization or deaths (International Classification of Disease, 9th/10th Revision, 428/I50) occurred during a median follow-up of 14.1 years (incidence rate 5.7 per 1,000 person-years). After the adjustment for covariates including fasting glucose, the hazard ratio of incident heart failure was higher in individuals with A1C 6.0-6.4% (1.40 [95% CI, 1.09-1.79]) and 5.5-6.0% (1.16 [0.98-1.37]) as compared with the reference group. Similar results were observed when adjusting for insulin level or limiting to heart failure cases without preceding coronary events or developed diabetes during follow-up. In contrast, elevated fasting glucose was not associated with heart failure after adjustment for covariates and A1C. Similar findings were observed when the top quartile (A1C, 5.7-6.4%, and fasting glucose, 108-125 mg/dl) was compared with the lowest quartile (<5.2% and <95 mg/dl, respectively). CONCLUSIONS Elevated A1C (> or =5.5-6.0%) was associated with incident heart failure in a middle-aged population without diabetes, suggesting that chronic hyperglycemia prior to the development of diabetes contributes to development of heart failure.
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Affiliation(s)
- Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, Coresh J, Brancati FL. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 2010; 362:800-11. [PMID: 20200384 PMCID: PMC2872990 DOI: 10.1056/nejmoa0908359] [Citation(s) in RCA: 1048] [Impact Index Per Article: 74.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fasting glucose is the standard measure used to diagnose diabetes in the United States. Recently, glycated hemoglobin was also recommended for this purpose. METHODS We compared the prognostic value of glycated hemoglobin and fasting glucose for identifying adults at risk for diabetes or cardiovascular disease. We measured glycated hemoglobin in whole-blood samples from 11,092 black or white adults who did not have a history of diabetes or cardiovascular disease and who attended the second visit (occurring in the 1990-1992 period) of the Atherosclerosis Risk in Communities (ARIC) study. RESULTS The glycated hemoglobin value at baseline was associated with newly diagnosed diabetes and cardiovascular outcomes. For glycated hemoglobin values of less than 5.0%, 5.0 to less than 5.5%, 5.5 to less than 6.0%, 6.0 to less than 6.5%, and 6.5% or greater, the multivariable-adjusted hazard ratios (with 95% confidence intervals) for diagnosed diabetes were 0.52 (0.40 to 0.69), 1.00 (reference), 1.86 (1.67 to 2.08), 4.48 (3.92 to 5.13), and 16.47 (14.22 to 19.08), respectively. For coronary heart disease, the hazard ratios were 0.96 (0.74 to 1.24), 1.00 (reference), 1.23 (1.07 to 1.41), 1.78 (1.48 to 2.15), and 1.95 (1.53 to 2.48), respectively. The hazard ratios for stroke were similar. In contrast, glycated hemoglobin and death from any cause were found to have a J-shaped association curve. All these associations remained significant after adjustment for the baseline fasting glucose level. The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant in models with adjustment for all covariates as well as glycated hemoglobin. For coronary heart disease, measures of risk discrimination showed significant improvement when glycated hemoglobin was added to models including fasting glucose. CONCLUSIONS In this community-based population of nondiabetic adults, glycated hemoglobin was similarly associated with a risk of diabetes and more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose. These data add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes.
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Affiliation(s)
- Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA.
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Mazighi M, Labreuche J, Amarenco P. Glucose level and brain infarction: a prospective case-control study and prospective study. Int J Stroke 2009; 4:346-51. [PMID: 19765122 DOI: 10.1111/j.1747-4949.2009.00329.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hyperglycaemia in the acute phase of stroke has been established as a predictor of higher mortality. But recent data regarding active treatment of hyperglycaemia showed no clinical benefit suggesting that hyperglycaemia may not have a detrimental effect in brain infarction. Additional data are needed to resolve this uncertainty and identify patients at higher risk if any. METHODS A total of 477 adult Caucasian patients with brain infarction and 395 age- and sex-matched controls admitted at the same centres for nonneurological causes were recruited consecutively from 12 neurological centres in France. Electrocardiographic, carotid ultrasonography, and transcranial Doppler studies were performed. Blood was drawn in the morning from fasting subjects for glucose measurement. Functional outcome was measured on admission, at 10 days and at 6 months after the onset of stroke using the modified Rankin scale. RESULTS Among 477 brain infarction patients and 395 hospitalised controls the adjusted mean (+/-SEM) glucose level was higher in cases (6.4+/-1.0 mmol/l) than in controls (6.0+/-1.01 mmol/l, P=0.006), with a significant heterogeneity across sexes. The fully adjusted odds ratio of brain infarction per 1-standard deviation increase in log-glucose level was 1.02 (95% confidence interval, 0.77-1.37) in men and 2.21 (95% confidence interval, 1.44-3.40) in women. Among the 477 brain infarction cases elevated admission glucose levels were associated with poor outcomes and higher poststroke mortality after adjustment for conventional vascular risk factors and infarct volume. These relationships were not modified by sex. CONCLUSIONS Elevated admission glucose levels were associated with brain infarction in women only and with a higher 5-year mortality. Further investigation focusing on the impact of glucose level in different target population is needed to optimise glycaemic management in acute brain infarction patients.
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Affiliation(s)
- M Mazighi
- INSERM U-698 and Denis Diderot University, Paris VII, France
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40
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Heo SH, Lee SH, Kim BJ, Kang BS, Yoon BW. Does glycated hemoglobin have clinical significance in ischemic stroke patients? Clin Neurol Neurosurg 2009; 112:98-102. [PMID: 19766387 DOI: 10.1016/j.clineuro.2009.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 08/10/2009] [Accepted: 08/24/2009] [Indexed: 01/01/2023]
Abstract
OBJECTIVES It has been suggested that patients with an elevated hemoglobin A1c (HbA1c) level have an increased risk of cardiovascular disease regardless of the presence of diabetes. However, an association between HbA1c and stroke has not yet been determined. In this study, our purpose was to examine whether HbA1c was independently associated with various types of cerebral vascular lesions in stroke patients. METHODS A consecutive series of acute ischemic stroke patients were included for this analysis from October, 2002, to March, 2006. HbA1c was examined on admission, and MR imaging was performed for analysis of large artery diseases (LADs) and small artery diseases (SADs). Symptomatic or asymptomatic LAD was diagnosed by MR angiography, and SAD was classified as leukoaraiosis, microbleeds, or old lacunar infarctions. RESULTS A total of 639 stroke patients were analyzed (diabetics, n=247; non-diabetics, n=392). There was no relationship between the level of HbA1c and any type of cerebrovascular lesion in the non-diabetic patients. In contrast, HbA1c showed a significant negative association with symptomatic LAD and leukoaraiosis in the diabetic patients using univariate analysis (p=0.01 and p<0.05, respectively). These associations did not remain significant, however, after adjustment for age and hypertension. This was, in part, because the HbA1c level in our diabetic population decreased gradually with age (p=0.03). CONCLUSIONS Our results indicate that HbA1c is not associated with risk for various types of cerebrovascular lesions in ischemic stroke patients. The negative association between age and HbA1c in diabetic patients should be further investigated.
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Affiliation(s)
- Sung Hyuk Heo
- Clinical Research Center for Stroke, Clinical Research Institute, Seoul National University Hospital, Republic of Korea
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Abstract
Hemoglobin A1c (HbA1c) is widely used as an index of mean glycemia, a measure of risk for the development of diabetes complications, and a measure of the quality of diabetes care. Emerging literature suggests that, although HbA1c levels change little over time within persons without diabetes, they vary considerably among individuals, suggesting that factors other than glycemia may impact HbA1c. Racial and ethnic differences in HbA1c have been described that do not appear to be explained by differences in glycemia. It is imperative that the nonglycemic factors that affect HbA1c be more clearly defined. Even more important, it must be determined whether differences among individuals or groups correlate with susceptibility to complications or merely reflect variation in hemoglobin glycation.
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Wendland EM, Pinto ME, Duncan BB, Belizán JM, Schmidt MI. Cigarette smoking and risk of gestational diabetes: a systematic review of observational studies. BMC Pregnancy Childbirth 2008; 8:53. [PMID: 19077324 PMCID: PMC2632653 DOI: 10.1186/1471-2393-8-53] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 12/16/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational diabetes is a prevalent disease associated with adverse outcomes of pregnancy. Smoking as been associated with glucose intolerance during pregnancy in some but not all studies. Therefore, we aimed to systematically review all epidemiological evidence to examine the association between cigarette smoking during pregnancy and risk of developing gestational diabetes mellitus. METHODS We conducted a systematic review of articles published up to 2007, using PubMed, Embase, LILACS e CINAHL to identify the articles. Because this review focuses on studies of smoking during pregnancy, we excluded studies evaluating smoking outside pregnancy. Two investigators independently abstracted information on participant's characteristics, assessment of exposure and outcome, and estimates for the association under study. We evaluated the studies for publication bias and performed heterogeneity analyses. We also assessed the effect of each study individually through sensitivity analysis. RESULTS We found and critically reviewed 32 studies, of which 12 met the criteria for inclusion in the review. Most of the studies provided only unadjusted measurements. Combining the results of the individual studies, we obtained a crude odds ratio of 1.03 (99% CI 0.85-1.25). Only 4 studies presented adjusted measurements of association, and no association was found when these alone were analyzed (OR 0.95; 99% CI 0.85-1.07). Subgroup analysis could not be done due to small sample size. CONCLUSION The number of studies is small, with major heterogeneity in research design and findings. Taken together, current data do not support an association between cigarette smoking during pregnancy and the risk of gestational diabetes.
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Affiliation(s)
- Eliana M Wendland
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria Eugênia Pinto
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce B Duncan
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - José M Belizán
- Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Maria Inês Schmidt
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Nguyen QM, Srinivasan SR, Xu JH, Chen W, Berenson GS. Distribution and cardiovascular risk correlates of hemoglobin A(1c) in nondiabetic younger adults: the Bogalusa Heart Study. Metabolism 2008; 57:1487-92. [PMID: 18940383 DOI: 10.1016/j.metabol.2008.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 04/09/2008] [Indexed: 12/15/2022]
Abstract
Excess glycated hemoglobin (HbA(1c)), an indicator of long-term glucose homeostasis, is recognized as a risk factor for cardiovascular (CV) disease and mortality even among persons without diabetes. However, information is scant regarding its distribution and correlates of CV risk in nondiabetic younger adults. This aspect was examined in a biracial (black-white) community-based sample of 1111 younger adults (mean age: 36.2 years; 71% white, 43% male) enrolled in the Bogalusa Heart Study. Blacks vs whites and women vs men had higher HbA(1c) values (P < .0001). In bivariate analysis adjusted for age, race, sex, and smoking status, significant adverse trends were noted for body mass index, waist circumference, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), total cholesterol to HDL-C ratio, insulin, glucose, and homeostasis model assessment of insulin resistance across HbA(1c) quartiles; trends were not significant for mean arterial blood pressure, triglycerides, C-reactive protein, adiponectin, and estimated glomerular filtration rate. In multivariate analysis, besides race and sex, total cholesterol to HDL-C ratio and waist circumference were independent correlates of HbA(1c). Furthermore, the prevalence of excess (top decile) HbA(1c) was 1.6-fold (P < .05) higher among those with metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III and 2.1-fold (P < .01) and 1.5-fold (P < .05) higher, respectively, among those with positive parental history of CV disease and type 2 diabetes mellitus. These findings underscore the potential value of HbA(1c) in risk assessments of CV disease and type 2 diabetes mellitus in nondiabetic, apparently "healthy" younger adults.
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Affiliation(s)
- Quoc Manh Nguyen
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, LA 70112, USA
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Pani LN, Korenda L, Meigs JB, Driver C, Chamany S, Fox CS, Sullivan L, D'Agostino RB, Nathan DM. Effect of aging on A1C levels in individuals without diabetes: evidence from the Framingham Offspring Study and the National Health and Nutrition Examination Survey 2001-2004. Diabetes Care 2008; 31:1991-6. [PMID: 18628569 PMCID: PMC2551641 DOI: 10.2337/dc08-0577] [Citation(s) in RCA: 264] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although glycemic levels are known to rise with normal aging, the nondiabetic A1C range is not age specific. We examined whether A1C was associated with age in nondiabetic subjects and in subjects with normal glucose tolerance (NGT) in two population-based cohorts. RESEARCH DESIGN AND METHODS We performed cross-sectional analyses of A1C across age categories in 2,473 nondiabetic participants of the Framingham Offspring Study (FOS) and in 3,270 nondiabetic participants from the National Health and Nutrition Examination Survey (NHANES) 2001-2004. In FOS, we examined A1C by age in a subset with NGT, i.e., after excluding those with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Multivariate analyses were performed, adjusting for sex, BMI, fasting glucose, and 2-h postload glucose values. RESULTS In the FOS and NHANES cohorts, A1C levels were positively associated with age in nondiabetic subjects. Linear regression revealed 0.014- and 0.010-unit increases in A1C per year in the nondiabetic FOS and NHANES populations, respectively. The 97.5th percentiles for A1C were 6.0% and 5.6% for nondiabetic individuals aged <40 years in FOS and NHANES, respectively, compared with 6.6% and 6.2% for individuals aged >or=70 years (P(trend) < 0.001). The association of A1C with age was similar when restricted to the subset of FOS subjects with NGT and after adjustments for sex, BMI, fasting glucose, and 2-h postload glucose values. CONCLUSIONS A1C levels are positively associated with age in nondiabetic populations even after exclusion of subjects with IFG and/or IGT. Further studies are needed to determine whether age-specific diagnostic and treatment criteria would be appropriate.
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Affiliation(s)
- Lydie N Pani
- Department of Medicine, Diabetes Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab 2008; 93:2447-53. [PMID: 18460560 DOI: 10.1210/jc.2007-2174] [Citation(s) in RCA: 265] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Diabetes is underdiagnosed. About one third of people with diabetes do not know they have it, and the average lag between onset and diagnosis is 7 yr. This report reconsiders the criteria for diagnosing diabetes and recommends screening criteria to make case finding easier for clinicians and patients. PARTICIPANTS R.M.B. invited experts in the area of diagnosis, monitoring, and management of diabetes to form a panel to review the literature and develop consensus regarding the screening and diagnosis of diabetes with particular reference to the use of hemoglobin A1c (HbA1c). Participants met in open session and by E-mail thereafter. Metrika, Inc. sponsored the meeting. EVIDENCE A literature search was performed using standard search engines. CONSENSUS PROCESS The panel heard each member's discussion of the issues, reviewing evidence prior to drafting conclusions. Principal conclusions were agreed on, and then specific cut points were discussed in an iterative consensus process. CONCLUSIONS The main factors in support of using HbA1c as a screening and diagnostic test include: 1) HbA1c does not require patients to be fasting; 2) HbA1c reflects longer-term glycemia than does plasma glucose; 3) HbA1c laboratory methods are now well standardized and reliable; and 4) errors caused by nonglycemic factors affecting HbA1c such as hemoglobinopathies are infrequent and can be minimized by confirming the diagnosis of diabetes with a plasma glucose (PG)-specific test. Specific recommendations include: 1) screening standards should be established that prompt further testing and closer follow-up, including fasting PG of 100 mg/dl or greater, random PG of 130 mg/dl or greater, or HbA1c greater than 6.0%; 2) HbA1c of 6.5-6.9% or greater, confirmed by a PG-specific test (fasting plasma glucose or oral glucose tolerance test), should establish the diagnosis of diabetes; and 3) HbA1c of 7% or greater, confirmed by another HbA1c- or a PG-specific test (fasting plasma glucose or oral glucose tolerance test) should establish the diagnosis of diabetes. The recommendations are offered for consideration of the clinical community and interested associations and societies.
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Golden SH, Selvin E, Cunningham KE. Glycaemic status and cardiovascular disease in type 2 diabetes mellitus: re-visiting glycated haemoglobin targets for cardiovascular disease prevention. Diabetes Obes Metab 2007; 9:792-8. [PMID: 17924863 DOI: 10.1111/j.1463-1326.2006.00673.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among people with type 2 diabetes. Recent attention has focused on chronic hyperglycaemia as an additional risk factor in people with diabetes since their excess CVD risk is not entirely explained by traditional cardiovascular risk factors. Clinical trials of intensive glucose control to reduce CVD events have been equivocal, but recent epidemiological studies have shown that HbAlc, a measure of chronic hyperglycaemia, predicts incident cardiovascular events. This review, which focuses on type 2 diabetes, summarizes (i) the epidemiological literature examining the relation between glycaemic status, as assessed by glycated haemoglobin (HbAlc) and CVD, (ii) the controversy regarding treatment goals for HbAlc in terms of preventing microvascular disease vs. macrovascular disease and (iii) on-going clinical trials of intensive glycaemic control for CVD prevention.
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Affiliation(s)
- Sherita H Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Herman WH, Ma Y, Uwaifo G, Haffner S, Kahn SE, Horton ES, Lachin JM, Montez MG, Brenneman T, Barrett-Connor E. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Diabetes Care 2007; 30:2453-7. [PMID: 17536077 PMCID: PMC2373980 DOI: 10.2337/dc06-2003] [Citation(s) in RCA: 420] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to examine racial and ethnic differences in A1C in individuals with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS We studied 3,819 individuals aged > or = 25 years with IGT who were found to be eligible to participant in the Diabetes Prevention Program. A1C was compared among five racial and ethnic groups before and after adjustment for factors that differed among groups or might affect glycemia including age, sex, education, marital status, blood pressure, adiposity (BMI and waist circumference), hematocrit, fasting and post-glucose load glucose levels, glucose area under the curve (AUC), beta-cell function, and insulin resistance. RESULTS Mean +/- SD A1C was 5.91 +/- 0.50%. Among whites, A1C was 5.80 +/- 0.44%, among Hispanics 5.89 +/- 0.46%, among Asian 5.96 +/- 0.45%, among American Indians 5.96 +/- 0.46%, and among blacks 6.19 +/- 0.59%. Age, sex, systolic blood pressure, diastolic blood pressure, BMI, fasting glucose, glucose AUC, corrected insulin response, and insulin resistance were each independent predictors of A1C. Adjusting for these and other factors, mean A1C levels were 5.78% for whites, 5.93% for Hispanics, 6.00% for Asians, 6.12% for American Indians, and 6.18% for blacks (P < 0.001). CONCLUSIONS A1C levels are higher among U.S. racial and ethnic minority groups with IGT after adjustment for factors likely to affect glycemia. Among patients with IGT, A1C may not be valid for assessing and comparing glycemic control across racial and ethnic groups or as an indicator of health care disparities.
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Affiliation(s)
- William H Herman
- Department of Internal Medicine and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Pradhan AD, Rifai N, Buring JE, Ridker PM. Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women. Am J Med 2007; 120:720-7. [PMID: 17679132 PMCID: PMC2585540 DOI: 10.1016/j.amjmed.2007.03.022] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/22/2007] [Accepted: 03/06/2007] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hemoglobin A1c (HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period. Whether mild elevations of this biomarker provide prognostic information for development of clinically evident type 2 diabetes and cardiovascular disease among individuals at usual risk for these disorders is uncertain. METHODS We examined baseline HbA1c levels as a predictor of incident clinical diabetes and cardiovascular disease (nonfatal myocardial infarction, coronary revascularization procedure, ischemic stroke, or death from cardiovascular causes) in a prospective cohort study beginning in 1992 of 26,563 US female health professionals aged 45 years or more without diagnosed diabetes or vascular disease (median follow-up 10.1 years). RESULTS During follow-up, 1238 cases of diabetes and 684 cardiovascular events occurred. In age-adjusted analyses using quintiles of HbA1c, a risk gradient was observed for both incident diabetes and cardiovascular disease. After multivariable adjustment, HbA1c remained a strong predictor of diabetes but was no longer significantly associated with incident cardiovascular disease. In analyses of threshold effects, adjusted relative risks for incident diabetes in HbA1c categories of less than 5.0%, 5.0% to 5.4%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 6.9%, and 7.0% or more were 1.0, 2.9, 12.1, 29.3, 28.2, and 81.2, respectively. Risk associations persisted after additional adjustment for C-reactive protein and after excluding individuals developing diabetes within 2 and 5 years of follow-up. CONCLUSIONS These prospective findings suggest that HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders. In contrast, the association of HbA1c with incident cardiovascular events is modest and largely attributable to coexistent traditional risk factors.
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Affiliation(s)
- Aruna D Pradhan
- Center for Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, VA Boston Medical Center, Boston, Mass, USA.
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Herman WH. Diabetes epidemiology: guiding clinical and public health practice: the Kelly West Award Lecture, 2006. Diabetes Care 2007; 30:1912-9. [PMID: 17496237 DOI: 10.2337/dc07-9924] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William H Herman
- Michigan Diabetes Research and Training Center, University of Michigan Health System, 3920 Taubman Center, Ann Arbor, MI 48109-0354, USA.
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Viberti G, Lachin J, Holman R, Zinman B, Haffner S, Kravitz B, Heise MA, Jones NP, O'Neill MC, Freed MI, Kahn SE, Herman WH. A Diabetes Outcome Progression Trial (ADOPT): baseline characteristics of Type 2 diabetic patients in North America and Europe. Diabet Med 2006; 23:1289-94. [PMID: 17116177 DOI: 10.1111/j.1464-5491.2006.02022.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To examine baseline characteristics of patients recruited into ADOPT, a multinational trial comparing three oral glucose-lowering monotherapies. METHODS Between April 2000 and June 2002, 4360 patients aged 30-75 years with Type 2 diabetes diagnosed for < 3 years and remaining on diet therapy alone with fasting plasma glucose levels (FPG) between 7.0 and 10.0 mmol/l were enrolled by 488 North American and European centres. Medical histories, anthropometric data and laboratory measurements were determined using common methodologies. RESULTS The mean (SD) age of the patients was 57 (10) years, body mass index 32.2 (6.4) kg/m(2), HbA(1c) 7.4 (0.9)%; 58% were male, 88% Caucasian and 15% smoked. North American Caucasians (NAC) were younger, more obese, and more insulin resistant than European Caucasians (EUC), but had better pancreatic B-cell function. NAC had lower total, low-density lipoprotein- and high-density liporpotein-cholesterol concentrations with higher triglyceride concentrations and were more often on lipid-lowering treatment. They had lower blood pressure levels but were equally likely to be on antihypertensive treatment. Metabolic syndrome was more frequent and microalbuminuria less frequent in NAC. Within North America, NAC had lower HbA(1c) concentrations than Blacks, Hispanics and Asians despite similar or higher FPG and 30-min postchallenge glucose concentrations. CONCLUSIONS Caucasian North American and European ADOPT patients differ with respect to adiposity, insulin resistance and metabolic syndrome prevalence. North American Blacks, Hispanics and Asians had lower HbA(1c) concentrations than NAC despite similar or higher glucose concentrations. These phenotypic differences may influence the progression of Type 2 diabetes and the response to initial oral glucose-lowering monotherapy.
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Affiliation(s)
- G Viberti
- Unit for Metabolic Medicine, KCL Guy's Hospital, London, UK.
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