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Huang CJ, Lin CH, Liu TL, Lin PC, Chu CC, Wang JJ, Wei CW, Weng SF. Healthcare Utilization and Its Correlates in Comorbid Type 2 Diabetes Mellitus and Generalized Anxiety Disorder. Psychiatr Q 2024; 95:233-252. [PMID: 38639873 DOI: 10.1007/s11126-024-10072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
This study investigated the healthcare utilization and medical expenditure of type 2 diabetes mellitus (T2DM) patients with generalized anxiety disorder (GAD) and identified the associated factors. The healthcare utilization and expenditure of T2DM patients with (case group) and without (control group) GAD between 2002 and 2013 were examined using the population-based Taiwan National Health Insurance Research Database. Healthcare utilization included outpatient visits and hospitalization; health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, nonpsychiatric healthcare utilization and medical expenditure were distinguished from total healthcare utilization and medical expenditure. The average healthcare utilization, including outpatient visits and hospitalization, was significantly higher for the case group than for the control group (total and nonpsychiatric). The results regarding differences in average outpatient expenditure (total and nonpsychiatric), inpatient expenditure (total and nonpsychiatric), and total expenditure (total and nonpsychiatric) between the case and control groups are inconsistent. Sex, age, income, comorbidities/complications, and the diabetes mellitus complication severity index were significantly associated with outpatient visits, medical expenditure, and hospitalization in the case group (total and nonpsychiatric). Greater knowledge of factors affecting healthcare utilization and expenditure in comorbid individuals may help healthcare providers intervene to improve patient management and possibly reduce the healthcare burden in the future.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chun-Wang Wei
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Pan D, Wang H, Wu S, Wang J, Ning Y, Guo J, Wang C, Gu Y. Unveiling the Hidden Burden: Estimating All-Cause Mortality Risk in Older Individuals with Type 2 Diabetes. J Diabetes Res 2024; 2024:1741878. [PMID: 38282658 PMCID: PMC10821805 DOI: 10.1155/2024/1741878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/30/2024] Open
Abstract
Background The mortality rate among older persons with diabetes has been steadily increasing, resulting in significant health and economic burdens on both society and individuals. The objective of this study is to develop and validate a predictive nomogram for estimating the 5-year all-cause mortality risk in older persons with T2D (T2D). Methods We obtained data from the National Health and Nutrition Survey (NHANES). A random 7 : 3 split was made between the training and validation sets. By linking the national mortality index up until December 31, 2019, we ensured a minimum of 5 years of follow-up to assess all-cause mortality. A nomogram was developed in the training cohort using a logistic regression model as well as a least absolute shrinkage and selection operator (LASSO) regression model for predicting the 5-year risk of all-cause mortality. Finally, the prediction performance of the nomogram is evaluated using several validation methods. Results We constructed a comprehensive prediction model based on the results of multivariate analysis and LASSO binomial regression. These models were then validated using data from the validation cohort. The final model includes four independent predictors: age, gender, estimated glomerular filtration rate, and white blood cell count. The C-index values for the training and validation cohorts were 0.748 and 0.762, respectively. The calibration curve demonstrates satisfactory consistency between the two cohorts. Conclusions The newly developed nomogram proves to be a valuable tool in accurately predicting the 5-year all-cause mortality risk among older persons with diabetes, providing crucial information for tailored interventions.
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Affiliation(s)
- Dikang Pan
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sensen Wu
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingyu Wang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Yachan Ning
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cong Wang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Xuanwu Hospital, Capital Medical University, Beijing, China
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Hsieh HM, Lin CH, Weng SF, Lin PC, Liu TL, Huang CJ. Health-related quality of life, medical resource use and physical function in patients with diabetes mellitus and depression: A cross-sectional analysis from the National Health and Nutrition Examination Survey. J Affect Disord 2023; 327:93-100. [PMID: 36754091 DOI: 10.1016/j.jad.2023.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with either diabetes (DM) or depression (DP) are prone to developing other diseases and require more medical resources than do the general population. This study aimed to examine health-related quality of life, medical resource use, and physical function of patients with both diabetes mellitus and depression, and the magnitude of effects among patients with different combinations of comorbid diseases. METHODS A retrospective cross-sectional study was conducted using the National Health and Nutrition Examination Survey data from 2009 to 2014. Total 16,159 patients were studied and classified into one of 4 groups: both DM and DP(DM+/DP+), DM+/without DP(DP-), without DM (DM-)/DP+, and DM-/DP-, according to the perceived score in Patient Health Questionnaire and diabetes questionnaire in NHANES. Health-related quality of life (HRQoL), medical resource use, and physical function were measured as outcomes of interests. Multivariate logistic regression models were used. RESULTS Compared with DM-/DP- patients, the DM+/DP+ (adjusted odds ratio [AOR]: 2.59; 95 % CI: 1.77-3.80) and DM-/DP+ (AOR: 2.44; 95 % CI: 1.94-3.06) had greater likely to have worse health. In addition, the DM+/DP+ (AOR: 5.40; 95 % CI: 1.30-22.41) and DM+/DP- (AOR: 2.49; 95 % CI: 1.91-3.25) were more likely to have medical visits, and worse physical function. CONCLUSIONS This study found that both depression and diabetes mellitus worsen HRQoL, increase medical resource use, and decrease physical function. Depression status should be considered by clinicians treating diabetes mellitus patients in order to improve their HRQoL, reduce medical resource use, and improve physical function.
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Affiliation(s)
- Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pai-Cheng Lin
- Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Huang CJ, Liu TL, Huang YT, Hsieh HM, Chang CC, Chu CC, Wei CW, Weng SF. Healthcare burden and factors of type 2 diabetes mellitus with Schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:519-529. [PMID: 33860331 DOI: 10.1007/s00406-021-01258-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/30/2021] [Indexed: 02/08/2023]
Abstract
This study investigated healthcare utilization and expenditure for patients with type 2 diabetes mellitus and schizophrenia and associated factors. Healthcare utilization (outpatient visits and hospitalization) and expenditure (outpatient, inpatient, and total medical expenditure) between 2002 and 2013 of patients with T2DM with schizophrenia (case group) and without (control group) were examined using the Taiwan National Health Insurance Research Database. (1) The average total numbers of outpatient visits and hospital admissions of the case group were 35.14 outpatient visits and 1.09 hospital admissions significantly higher than those of the control group in the whole study period (based on every 3-year period). Nonpsychiatric outpatient visits and nonpsychiatric hospital admissions were significantly more numerous for the case group. (2) The total outpatient expenditure, total inpatient expenditure, and total medical expenditure of the case group were NT$65,000, NT$170,000, and NT$235,000 significantly higher than those of the control group, respectively. Nonpsychiatric outpatient expenditure was significantly lower for the case group, but the inpatient and total nonpsychiatric medical expenditure were similar between groups. (3) Patients who were elder of low income, with complications, and high diabetes mellitus complication severity index had higher total numbers of outpatient visits and hospitalizations and medical expenditure. (4) Women had a higher number of outpatient visits but a lower number of hospitalization and medical expenditure. Lower non-psychiatric outpatient expenditure despite more visits indicated non-psychiatrist may not understand schizophrenia patients and cannot communicate well with them, leading to neglect of medical evaluation and treatment that should be carried out.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, 807, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Huang
- Division of Medical Statistics and Bioinformatics, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, 807, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 442, Section. 2, Shulin Street, South District, Tainan, 702, Taiwan.,Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, 901, Chung Hwa Rd, Yung Kang District, Tainan, 710, Taiwan
| | - Chun-Wang Wei
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Huang CJ, Hsieh HM, Tu HP, Jiang HJ, Wang PW, Lin CH. Generalized anxiety disorder in type 2 diabetes mellitus: prevalence and clinical characteristics. ACTA ACUST UNITED AC 2020; 42:621-629. [PMID: 32321059 PMCID: PMC7678902 DOI: 10.1590/1516-4446-2019-0605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
Objective: This study investigated the prevalence of generalized anxiety disorder (GAD) in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective observational study was conducted with a random sample of patients from the entire population of National Health Insurance enrollees during 2000-2010 and used ICD-9-CM diagnostic codes to identify T2DM patients and GAD. The prevalence of GAD was compared between T2DM patients and the general population. Results: Between 2000 and 2010, the prevalence of GAD was significantly greater in the T2DM patients than the general population, while the increase of GAD was higher in the general population (from 0.25 to 0.63%) than among T2DM patients (from 0.81 to 1.03%). In T2DM patients, GAD was associated with female gender, a Charlson Comorbidity Index ≥ 1, diabetes mellitus duration > 9 years, and the following comorbidities: congestive heart failure, peripheral vascular disease, and depressive disorder. The prevalence of GAD among T2DM patients was negatively associated with rapid-acting insulin injection therapy and with the use of metformin and sulfonylureas. Conclusion: Since the prevalence of GAD was greater among T2DM patients than the general population, public health initiatives are needed to prevent and treat GAD in T2DM patients, specifically those with the above mentioned risk factors.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Adult Psychiatry, Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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Alzaid A, Ladrón de Guevara P, Beillat M, Lehner Martin V, Atanasov P. Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses. Expert Rev Pharmacoecon Outcomes Res 2020; 21:785-798. [PMID: 32686530 DOI: 10.1080/14737167.2020.1782748] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: To estimate the clinical and economic burden of type 2 diabetes (T2D) in established (EST) and emerging markets (EMG).Methods: Three systematic literature reviews were conducted in MEDLINE and Embase to capture all relevant publications reporting 1) the epidemiology of T2D and complications in T2D and 2) the economic burden of T2D and associated complications.Results: In total, 294 studies were included in this analysis. Evidence indicates a high and increasing overall prevalence of T2D globally, ranging up to 23% in EMG markets and 14% in EST markets. Undiagnosed cases were higher in EMG versus EST markets (up to 67% vs 38%), potentially due to a lack of education and disease awareness in certain regions, that could lead to important clinical and economic consequences. Poor glycemic control was associated with the development of several complications (e.g. retinopathy, cardiovascular diseases and nephropathy) that increase the risk of morbidity and mortality. Direct costs were up to 9-fold higher in patients with vs without T2D-related complications.Conclusions: The burden of T2D, related complications and inherent costs are higher in emerging versus established market countries. This review explores potential strategies to reduce costs and enhance outcomes of T2D treatment in developing countries.
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Affiliation(s)
- Aus Alzaid
- Consultant Diabetologist, Riyadh, Saudi Arabia
| | - Patricia Ladrón de Guevara
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maud Beillat
- Global Market Access, Health Economics & Outcomes Research, Servier Global Market Access & HEOR, France
| | | | - Petar Atanasov
- Health Economics & Market Access, Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
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Lee CH, Wu YL, Kuo JF, Chen JF, Chin MC, Hung YJ. Prevalence of diabetic macrovascular complications and related factors from 2005 to 2014 in Taiwan: A nationwide survey. J Formos Med Assoc 2019; 118 Suppl 2:S96-S102. [DOI: 10.1016/j.jfma.2019.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/25/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022] Open
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Huang CJ, Lin CH, Hsieh HM, Chang CC, Chu CC, Sun DP, Weng SF. A longitudinal study of healthcare utilisation and expenditure in people with type 2 diabetes mellitus with and without major depressive disorder. Gen Hosp Psychiatry 2019; 57:50-58. [PMID: 30908962 DOI: 10.1016/j.genhosppsych.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 09/12/2018] [Accepted: 09/16/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated the healthcare service utilisation and expenditure of patients with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) and identified associated factors. METHODS Healthcare service utilisation and expenditure of patients with T2DM with and without MDD during 2002-2013 were examined using Taiwan's population-based National Health Insurance claims database. Healthcare service utilisation included outpatient visits and inpatient admissions, and health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, non-psychiatric health service utilisation and expenditure were distinguished from total health service utilisation and medical expenditure. RESULTS Average healthcare service utilisation was significantly higher in those with comorbid MDD (both total and non-psychiatric utilisation). The higher overall costs of the patients with comorbid MDD largely driven by psychiatric costs and non-psychiatric costs between the groups were not significantly different. Gender, age, income, comorbidities and complications, and diabetes complications severity index were significant factors in outpatient visits, medical expenditure, and hospitalisation in those with comorbid MDD. CONCLUSIONS Type 2 diabetes patients with comorbid MDD were found to have higher costs, and that they appeared to be driven by more visits in the first 6 years and by psychiatric-related costs rather than general medical costs.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung 807, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung 807, Taiwan; Department of Adult Psychiatry, Kai-Suan Psychiatric Hospital, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung 807, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 442, Section 2, Shulin Street, South District, Tainan City 702, Taiwan; Department of Health Psychology, Chang Jung Christian University, 1, Changda Rd., Gueiren District, Tainan City 711, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, 901, Chung Hwa Rd, Yung Kang District, Tainan 710, Taiwan
| | - Ding-Ping Sun
- Department of Surgery, Chi-Mei Medical Center, 901, Chung Hwa Rd, Yung Kang District, Tainan 710, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Chiang JI, Jani BD, Mair FS, Nicholl BI, Furler J, O’Neal D, Jenkins A, Condron P, Manski-Nankervis JA. Associations between multimorbidity, all-cause mortality and glycaemia in people with type 2 diabetes: A systematic review. PLoS One 2018; 13:e0209585. [PMID: 30586451 PMCID: PMC6306267 DOI: 10.1371/journal.pone.0209585] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/08/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Type 2 diabetes (T2D) is a major health priority worldwide and the majority of people with diabetes live with multimorbidity (MM) (the co-occurrence of ≥2 chronic conditions). The aim of this systematic review was to explore the association between MM and all-cause mortality and glycaemic outcomes in people with T2D. Methods The search strategy centred on: T2D, MM, comorbidity, mortality and glycaemia. Databases searched: MEDLINE, EMBASE, CINAHL Complete, The Cochrane Library, and SCOPUS. Restrictions included: English language, quantitative empirical studies. Two reviewers independently carried out: abstract and full text screening, data extraction, and quality appraisal. Disagreements adjudicated by a third reviewer. Results Of the 4882 papers identified; 41 met inclusion criteria. The outcome was all-cause mortality in 16 studies, glycaemia in 24 studies and both outcomes in one study. There were 28 longitudinal cohort studies and 13 cross-sectional studies, with the number of participants ranging from 96–892,223. Included studies were conducted in high or upper-middle-income countries. Fifteen of 17 studies showed a statistically significant association between increasing MM and higher mortality. Ten of 14 studies showed no significant associations between MM and HbA1c. Four of 14 studies found higher levels of MM associated with higher HbA1c. Increasing MM was significantly associated with hypoglycaemia in 9/10 studies. There was no significant association between MM and fasting glucose (one study). No studies explored effects on glycaemic variability. Conclusions This review demonstrates that MM in T2D is associated with higher mortality and hypoglycaemia, whilst evidence regarding the association with other measures of glycaemic control is mixed. The current single disease focused approach to management of T2D seems inappropriate. Our findings highlight the need for clinical guidelines to support a holistic approach to the complex care needs of those with T2D and MM, accounting for the various conditions that people with T2D may be living with. Systematic review registration International Prospective Register of Systematic Reviews CRD42017079500
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Affiliation(s)
- Jason I. Chiang
- Department of General Practice, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Barbara I. Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Furler
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - David O’Neal
- Department of Medicine, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Patrick Condron
- Brownless Biomedical Library, University of Melbourne, Melbourne, Australia
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Huang CJ, Hsieh HM, Tu HP, Jiang HJ, Wang PW, Lin CH. Schizophrenia in type 2 diabetes mellitus: Prevalence and clinical characteristics. Eur Psychiatry 2018; 54:102-108. [PMID: 30193140 DOI: 10.1016/j.eurpsy.2018.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/14/2018] [Accepted: 08/18/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study investigated the prevalence and characteristics of schizophrenia in patients with type 2 diabetes mellitus (T2DM) in Taiwan. METHODS National Health Insurance claims data for patients with principal diagnoses of schizophrenia and T2DM were analysed. RESULTS Compared with patients with schizophrenia in the general population (GP), those with schizophrenia and T2DM were more likely to have higher Charlson comorbidity index (CCI) scores and multiple comorbidities, and were older. The prevalence of schizophrenia was significantly higher in patients with T2DM than in the GP from 2000 to 2010. In addition, during this period, the prevalence of schizophrenia in patients with T2DM increased from 0.64% to 0.85%; such an increase in the GP was also observed. A high prevalence of schizophrenia was observed in patients with T2DM aged less than 60 years old; those residing in eastern Taiwan; those with incomes of ≤NT$17,280, NT$17,281-NT$22,880, NT$22,881-NT$28,800, and NT$36,301-NT$45,800; and those with CCI > 2. CONCLUSIONS Our study found the prevalence of schizophrenia is higher in patients with T2DM than in the GP, particularly those with earlier ages less than 60 years old. Public health initiatives are necessary to prevent and treat schizophrenia in patients with T2DM, specifically for those with the aforementioned and premature death risk.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Adult Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung, Taiwan.
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Huang CJ, Hsieh HM, Tu HP, Jiang HJ, Wang PW, Lin CH. Major depressive disorder in patients with type 2 diabetes mellitus: Prevalence and clinical characteristics. J Affect Disord 2018; 227:141-148. [PMID: 29073576 DOI: 10.1016/j.jad.2017.09.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/12/2017] [Accepted: 09/24/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study investigated the prevalence of major depressive disorder (MDD) among Taiwanese patients with type 2 diabetes mellitus (T2DM). METHODS We enrolled patients with at least one service claim for ambulatory or inpatient care with a principal diagnosis of MDD and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2DM, as listed in Taiwan's National Health Insurance database. RESULTS We enrolled 715,756 people from the general population (GP), 61,589 patients with T2DM but without MDD, and 778 patients with both T2DM and MDD. The prevalence of MDD increased from 0.70% to 1.25% in the patients with T2DM, whereas it increased from 0.25% to 0.67% in the GP from 2000 to 2010. The higher prevalence of MDD was associated with the female sex, residing in the southern regions of Taiwan, and having comorbidities of cerebrovascular disease and anxiety disorder as well as higher comorbidity severity (Charlson comorbidity index, 1-2 and > 2). LIMITATIONS One limitation is the use of secondary data on diagnoses of MDD and T2DM. Another limitation is that we could not access some crucial related variables. CONCLUSIONS The prevalence of MDD was higher in the patients with T2DM than in the GP. In this study, the prevalence of MDD in the patients with T2DM was lower than that reported in Western countries.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, Faculty of medicine, College of medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, Faculty of medicine, College of medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan; Department of Psychiatry, Faculty of medicine, College of medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Huang CJ, Hsieh HM, Chiu HC, Wang PW, Lee MH, Li CY, Lin CH. Health Care Utilization and Expenditures of Patients with Diabetes Comorbid with Depression Disorder: A National Population-Based Cohort Study. Psychiatry Investig 2017; 14:770-778. [PMID: 29209380 PMCID: PMC5714718 DOI: 10.4306/pi.2017.14.6.770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/14/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study investigated to compare health care utilization and expenditures between diabetic patients with and without depression in Taiwan. METHODS Health care utilization and expenditure among diabetic patients with and without depression disorder during 2000 and 2004 were examined using Taiwan's population-based National Health Insurance claims database. Health care utilization included outpatient visits and the use of inpatient services, and health expenditures were outpatient, inpatient, and total medical expenditures. Moreover, general estimation equation models were used for analyzing the factors associated with outpatient visits and expenditures. Multiple logistic regression analysis was applied for identifying the factors associated with hospitalization. RESULTS The average annual outpatient visits and annual total medical expenditures in the study period were 44.23-52.20; NT$87,496-133,077 and 30.75-32.92; NT$64,411-80,955 for diabetic patients with and without depression. After adjustment for covariates, our results revealed that gender and complication were associated with out-patient visits. Moreover, the time factor was associated with the total medical expenditure, and residential urbanization and complication factors were associated with hospitalization. CONCLUSION Health care utilization and expenditures for diabetic patients with depression were significantly higher than those without depression. Sex, complications, time, and urbanization are the factors associated with health care utilization and expenditures.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yi Li
- Division of Secretary, Kaohsiung Medical University Hospital, Kaohsiung Medical, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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13
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Prevalence of anxiety disorder in patients with type 2 diabetes: a nationwide population-based study in Taiwan 2000-2010. Psychiatr Q 2017; 88:75-91. [PMID: 27155828 DOI: 10.1007/s11126-016-9436-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study investigates the prevalence of anxiety disorder (AD) in Taiwanese patients with type 2 diabetes (T2D). Study participants were identified based on at least one service claim for ambulatory or inpatient care with a principal diagnosis of AD and at least 2 service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2D, as listed in the National Health Insurance database of Taiwan. The prevalence of AD decreased from 13.75 to 11.00 % in patients with T2D, whereas it increased from 4.17 to 6.09 % in the general population during the 2000-2010 period. A high prevalence of AD in patients with T2D was associated with age >30 years, the female sex, living in the northern region, comorbidities of congestive heart failure, peripheral vascular disease, cerebrovascular disease, and depression disorder, and a Charlson participant comorbidity index of ≥1. A low prevalence of AD in patients with T2D was associated with residency in urban areas, the comorbidity of hemiplegia or paraplegia, the usage of metformin and sulfonylureas, and rapid-acting insulin injection therapy. The prevalence of AD was higher in patients with T2D than in the general population. Therefore, more public health emphasis is required for preventing and treating AD in patients with T2D, specifically those with the mentioned risk factors.
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Huang CJ, Hsieh HM, Chiu HC, Wang PW, Lee MH, Li CY, Lin CH. Impact of Anxiety Disorders on Mortality for Persons With Diabetes: A National Population-Based Cohort Study. PSYCHOSOMATICS 2016; 58:266-273. [PMID: 28189286 DOI: 10.1016/j.psym.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Most studies of the relationship between psychiatric disorders and mortality in patients with diabetes mellitus (DM) have focused on the role of depression. OBJECTIVE The aim of this study was to investigate the impact of anxiety disorders (ADs) on mortality in persons with DM in Taiwan. METHODS We used Taiwan׳s National Health Insurance claims database interlinked externally with Taiwan׳s Death Registry to study mortality in diabetic patients with and without ADs during the study period 2000-2004. Five-year survival cures were calculated using the Kaplan-Meier method for DM with ADs and DM without ADs. Cox regression analysis was used to analyze the predictive factors for DM mortality. RESULTS We identified 5685 persons with DM, including 732 (12.88%) who also had ADs. The 5-year survival was longer for diabetic patients with ADs than those without it. A higher risk of mortality was found in diabetic patients who were male. It was also higher for those who were 45-64 years old and ≥65 years old, those who resided in rural areas, those who had incomes <US$ 666 (NT$ 20,000) or were living on dependent incomes. ADs were found to confer a lower risk of mortality regardless of diabetes type. CONCLUSIONS ADs confer some protection from mortality in patients with DM. Our findings add valuable epidemiological information from a different ethnic population.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yi Li
- Division of Secretary, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
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Tu HP, Hsieh HM, Liu TL, Jiang HJ, Wang PW, Huang CJ. Prevalence of Depressive Disorder in Persons With Type 2 Diabetes: A National Population-Based Cohort Study 2000-2010. PSYCHOSOMATICS 2016; 58:151-163. [PMID: 28190545 DOI: 10.1016/j.psym.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diabetes mellitus, a chronic and disabling disease, is epidemic worldwide. Depressive disorder affects the productivity of workers and leads to disability. OBJECTIVE This study investigated the prevalence of depressive disorder among persons with type 2 diabetes in Taiwan. METHODS We extracted service claims data for subjects who had at least 2 ambulatory care service claims or 1 inpatient service claim with a principal diagnosis of type 2 diabetes and at least 1 ambulatory or inpatient service claim with a principal diagnosis of depressive disorder from Taiwan's National Health Insurance Database. RESULTS From 2000-2010, the prevalence of depressive disorder increased from 3.50-4.07% in people with type 2 diabetes, and from 1.05-2.27% in the general population. The higher prevalence of depressive disorder in persons with type 2 diabetes was associated with being female; residence in central, southern, and eastern Taiwan; residence in urban areas; the comorbidities of hemiplegia or paraplegia, cerebrovascular disease, and anxiety disorder; Charlson Comorbidity Index scores ≥1; diabetes duration >9 years; and the use of rapid-acting insulin injection therapy. CONCLUSIONS The prevalence of depressive disorder is higher among persons with type 2 diabetes than the general population. Consequently, more public health attention should be devoted to the prevention and treatment of this debilitating disease in persons with type 2 diabetes, especially those with the earlier mentioned risk factors.
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Affiliation(s)
- Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Shi Z, Zhen S, Zimmet PZ, Zhou Y, Zhou Y, Magliano DJ, Taylor AW. Association of impaired fasting glucose, diabetes and dietary patterns with mortality: a 10-year follow-up cohort in Eastern China. Acta Diabetol 2016; 53:799-806. [PMID: 27311686 DOI: 10.1007/s00592-016-0875-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/02/2016] [Indexed: 01/09/2023]
Abstract
AIMS To examine the association between impaired fasting glucose (IFG)/type 2 diabetes and mortality as well as to explore any interactions with dietary intake patterns in a Chinese population. METHODS We followed 2849 Chinese adults aged 20 years and older for 10 years. Fasting plasma glucose was measured at baseline in 2002. Dietary patterns were constructed using factor analysis. Hazard ratios (HRs) and 95 % confidence interval (CI) were calculated by Cox proportional hazards analysis (all-cause mortality) and competing risks regression [cardiovascular disease (CVD)]. RESULTS Of the 2849 participants, 102 had diabetes and 178 had impaired fasting glucose (IFG) at baseline. We documented 184 deaths (70 CVD deaths) during 27,914 person-years of follow-up. Diabetes was associated with death from all causes (HR 2.69, 95 % CI 1.62-4.49) after adjusting for sociodemographic and lifestyle factors. Diabetes had a HR of 1.97 (95 % CI 0.84-4.60) for CVD death. IFG had 83 % increased risk of all-cause mortality. Among those with low and high intake of a vegetable-rich dietary pattern, the HR of IFG/diabetes for all-cause mortality was 3.25 (95 %CI 1.95-5.44) and 1.38 (95 % CI 0.75-2.55) (p for interaction 0.019), respectively. CONCLUSIONS Diabetes and IFG are associated with a substantial increased risk of death in Chinese adults. Dietary patterns associated with a high intake of vegetable were associated with a decrease in the risk of mortality for those with IFG/diabetes.
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Affiliation(s)
- Zumin Shi
- Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.
- Discipline of Medicine, University of Adelaide, Level 7, SAHMRI, North TCE, Adelaide, 5000, Australia.
| | - Shiqi Zhen
- Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Paul Z Zimmet
- BakerIDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Yonglin Zhou
- Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Yijing Zhou
- Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | | | - Anne W Taylor
- Discipline of Medicine, University of Adelaide, Level 7, SAHMRI, North TCE, Adelaide, 5000, Australia
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Abstract
The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.
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Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol 2016; 4:537-47. [PMID: 27156051 DOI: 10.1016/s2213-8587(16)30010-9] [Citation(s) in RCA: 347] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/16/2022]
Abstract
The global increase in type 2 diabetes prevalence is well documented, but international trends in complications of type 2 diabetes are less clear. The available data suggest large reductions in classic complications of type 2 diabetes in high-income countries over the past 20 years, predominantly reductions in myocardial infarction, stroke, amputations, and mortality. These trends might be accompanied by less obvious, but still important, changes in the character of morbidity in people with diabetes. In the USA, for example, substantial reductions in macrovascular complications in adults aged 65 years or older mean that a large proportion of total complications now occur among adults aged 45-64 years instead, rates of renal disease could persist more than other complications, and obesity-related type 2 diabetes could have increasing effect in youth and adults under 45 years of age. Additionally, the combination of decreasing mortality and increasing diabetes prevalence has increased the overall mean years lived with diabetes and could lead to a diversification of diabetes morbidity, including continued high rates of renal disease, ageing-related disability, and cancers. Unfortunately, data on trends in diabetes-related complications are limited to only about a dozen countries, most of which are high income, leaving the changing character for countries of low and middle income ambiguous.
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Affiliation(s)
- Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mohammed K Ali
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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