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Kubota T, Todoroki-Mori K, Iwamoto M, Kobori T, Kikuchi T, Tahara T, Onishi Y, Araki M, Kasuga M, Yoshida Y. Thirty-Year Trends in the Prevalence and Severity of Diabetic Retinopathy at the First Visit in Patients with Untreated Type 2 Diabetes Mellitus. Ophthalmic Epidemiol 2024:1-8. [PMID: 39116416 DOI: 10.1080/09286586.2024.2383285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 06/16/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE Although the rate of diabetic retinopathy (DR)-related blindness has decreased in developed countries in recent years, the reasons for this decrease have remained unclear. The prevalence/severity trends of DR at the first visit in patients with untreated type 2 diabetes mellitus (T2DM) patients seen between the1986s and 2018s were assessed. METHODS A total of 1979 Japanese T2DM patients diagnosed between 1986 and 2018 were divided into four groups by the decade of their first visit: the 1986 years (1986-1987), the 1996 years (1996-1997), the 2006 years (2006-2008), the 2016 years (2016-2018). The DR prevalence/severity trends were assessed. RESULTS A significant decrease in the rate of prevalence of DR from the 1986s to 2016s was observed among previously untreated T2DM patients visiting our hospital for the first time (1986s: 25.5%; 1996s: 26.2%; 2006s: 22.2%; and 2016s: 15.6%). The prevalence was significantly higher in females (30.2%) than in males (21.3%). Although the severity trend of DR did not differ significantly among the four measurement years, the rate of simple DR was the highest in the 2016s. CONCLUSION We found, for the first time, a significant decrease in the rate of prevalence of DR from the 1986s to 2016s in patients with untreated T2DM visiting our hospital for the first time. A decrease in the rate of DR prevalence could explain, at least in part, the observed reduction in the rate of blindness in patients with T2DM.
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Affiliation(s)
- Tetsuya Kubota
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
- AI Nutrition Project, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Bunkyō, Japan
- Laboratory for Intestinal Ecosystem, RIKEN Center for Integrative Medical Sciences (IMS), Kanagawa, Japan
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kikue Todoroki-Mori
- AI Nutrition Project, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Japan
- Department of Nutritional Science, Faculty of Applied Bioscience, Tokyo University of Agriculture, Tokyo, Japan
| | - Masahiko Iwamoto
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
| | - Toshiko Kobori
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
| | - Takako Kikuchi
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
| | - Tazu Tahara
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
| | - Yukiko Onishi
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
| | - Michihiro Araki
- AI Nutrition Project, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Ibaraki, Japan
| | - Masato Kasuga
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
| | - Yoko Yoshida
- Division of diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Chuo-ku, Japan
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Chang LH, Chang TT, Chu CH, Huang CC, Lin LY. Soluble tumor necrosis factor receptor type 1 is an alternative marker of urinary albumin-creatinine ratio and estimated glomerular filtration rate for predicting the decline of renal function in subjects with type 2 diabetes mellitus. Clin Chim Acta 2024; 558:117880. [PMID: 38555050 DOI: 10.1016/j.cca.2024.117880] [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: 01/03/2024] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rates (eGFR) help predict worsening diabetic kidney disease (DKD) but have their limitations. Soluble tumor necrosis factor receptor type 1 (sTNFR1) is a biomarker of DKD. The predictive abilities of sTNFR1 and UACR plus eGFR have not been compared. METHODS This prospective cohort study included patients with type 2 diabetes (T2D) to identify the risk factors of worsening DKD. Renal events were defined as > 30 % loss in eGFR based on consecutive tests after 6 months. The associations of sTNFR1, UACR, and eGFR levels and the risks of renal events were tested using a Cox regression model and the area under the curve (AUC) was compared between sTNFR1 levels and UACR plus eGFR using receiver-operating characteristic (ROC) analysis. The accuracy of stratification was evaluated using Kaplan-Meier analysis. RESULTS Levels of sTNFR1 and UACR were associated with risks of > 30 % decline in eGFR after adjusting for relevant factors. The association between sTNFR1 levels and renal outcomes was independent of UACR and eGFR at baseline. The AUC of sTNFR1 level was comparable with that of combined UACR and eGFR (0.73 vs. 0.71, respectively, p = 0.72) and the results persisted for quartile groups of sTNFR1 and risk categories of Kidney Disease: Improving Global Outcomes (KDIGO) (0.70 vs. 0.71, respectively, p = 0.84). Both stratifications by sTNFR1 levels and KDIGO were accurate. CONCLUSION sTNFR1 could be an alternative marker for identifying patients with diabetes at risk of declining renal function.
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Affiliation(s)
- Li-Hsin Chang
- Division of Endocrinology and Metabolism, Department of Medicine, Yeezen General Hospital, Taoyuan, Taiwan
| | - Ting-Ting Chang
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Huei Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Chin-Chou Huang
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Yu Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Chaurasia S, Thool AR, Ansari KK, Saifi AI. Advancement in Understanding Diabetic Retinopathy: A Comprehensive Review. Cureus 2023; 15:e49211. [PMID: 38143687 PMCID: PMC10739189 DOI: 10.7759/cureus.49211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Diabetic retinopathy (DR) is a significant global health concern, with its prevalence and severity increasing alongside the rising incidence of diabetes. DR is a leading cause of vision impairment among working-age adults, resulting in substantial economic and healthcare burdens. This article explores the epidemiology and pathophysiology of DR, highlighting the global variation in its prevalence and the associated systemic risk factors. It delves into the complex relationship between glycemic control, duration of diabetes, and medication use in the context of DR development and progression. The review also discusses current screening methods and their implications, emphasizing the need for efficient and scalable approaches. Furthermore, it investigates the various treatment strategies available for DR, including laser photocoagulation, vitreous body excision, and anti-vascular endothelial growth factor (VEGF) therapy, while underlining their limitations and potential side effects. In conclusion, this article underscores the urgency of developing novel preventive and therapeutic approaches for DR. It highlights the potential role of cytokines and growth factors as treatment targets and emphasizes the importance of glycemic control and management of systemic risk factors in mitigating the impact of this vision-threatening complication of diabetes. The article serves as a comprehensive resource for understanding the challenges posed by DR and the need for innovative strategies to address this growing public health concern.
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Affiliation(s)
- Sharad Chaurasia
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Archana R Thool
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Khizer K Ansari
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Azeem I Saifi
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lin CC, Lee CY, Huang JY, Hsu SM, Hung JH, Yang SF. Trends in diabetic eye disorders and associated comorbidities in Taiwan: a 10-year nationwide population-based cohort study. Br J Ophthalmol 2023; 107:1303-1310. [PMID: 35396213 DOI: 10.1136/bjophthalmol-2021-320917] [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: 12/09/2021] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS In-depth analysis is needed to investigate trends in diabetic retinopathy (DR), diabetic macular oedema (DME) and associated comorbidities in patients with type 2 diabetes mellitus (T2DM) so that we can better understand their prevalence and incidence. METHODS A retrospective population-based study was conducted using data from Taiwan's National Health Insurance Research Database from 2005 to 2015, and T2DM, DR and associated comorbidities were identified based on diagnostic codes. We used a standardised incidence rate with age and sex adjustment to estimate the prevalence and incidence of DR, proliferative DR (PDR), advanced PDR (aPDR) and DME, while the difference in each study period was calculated as the annual percentage change. We used the absolute standardised difference to analyse changes in related comorbidities in different periods. RESULTS The population of patients with DM increased over 50% between 2005 and 2015, while the prevalence and incidence of DR decreased, as did the incidence of PDR and aPDR. However, the prevalence and incidence of DME increased over the course of 10 years, with an upward trend in all forms of DR. The percentage of patients with hyperlipidaemia in DME and all DR increased, and the percentage of patients with end-stage renal disease (ESRD) was also elevated in DME. CONCLUSION The prevalence and incidence of DR, PDR and aPDR decreased with time in patientsT2DM, while the ratio of DME increased gradually. The incidence of hyperlipidaemia also increased in all forms of diabetic eye disorders, while ESRD increased solely in DME.
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Affiliation(s)
- Chia-Chen Lin
- Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
| | | | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sheng-Min Hsu
- Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Yen FS, Wei JCC, Shih YH, Hsu CC, Hwu CM. Impact of individual microvascular disease on the risks of macrovascular complications in type 2 diabetes: a nationwide population-based cohort study. Cardiovasc Diabetol 2023; 22:109. [PMID: 37161539 PMCID: PMC10170797 DOI: 10.1186/s12933-023-01821-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND This study compared the risks of cardiovascular morbidity and mortality between patients with type 2 diabetes (T2D) with and without microvascular diseases, and between matched patients with microvascular diseases. METHODS We identified newly diagnosed type 2 diabetes patients from National Health Insurance Research Database in Taiwan from January 1, 2008, to December 31, 2019. Propensity score matching was applied to construct matched pairs of patients with diabetic kidney disease, retinopathy, or neuropathy. Multivariable Cox proportional-hazard models were adopted to compare the risks of cardiovascular morbidity and mortality. RESULTS Patients with microvascular disease had a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. Among the matched cohorts, patients with diabetic retinopathy had a significantly higher risk of stroke development than those with diabetic kidney disease (aHR 1.11, 95%CI 1.03-1.2). Diabetic neuropathy showed a significantly higher risk of stroke development than diabetic kidney disease (aHR 1.17, 95%CI 1.1-1.25) and diabetic retinopathy (aHR 1.12, 95%CI 1.03-1.21). Diabetic retinopathy had a significantly higher risk of incident heart failure than diabetic kidney disease (aHR 1.43, 95%CI 1.3-1.57), and diabetic neuropathy had a significantly lower risk of incident heart failure than diabetic retinopathy (aHR 0.79, 95%CI 0.71-0.87). CONCLUSIONS T2D patients with microvascular disease have a significantly higher risk of cardiovascular morbidities and mortality than those without microvascular disease. In the matched cohorts, diabetic neuropathy was significantly associated with stroke development, and diabetic retinopathy had a significant association with heart failure compared to other microvascular diseases.
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Affiliation(s)
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ying-Hsiu Shih
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan.
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang-Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Xiao B, Gu X, Jin L, Chan VF, Li Y, Price-Sanchez C, Liu Y, Wang Y, Fu H, Li D, Congdon N. Willingness to pay for diabetic retinopathy screening in Qujiang District, rural Guangdong, southern China: a cross-sectional study. BMJ Open 2023; 13:e065792. [PMID: 37185202 PMCID: PMC10151899 DOI: 10.1136/bmjopen-2022-065792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To determine willingness to pay for a diabetic retinopathy screening, and its determinants, among people with diabetes mellitus in Qujiang District of Shaoguan City, rural Guangdong, southern China. DESIGN This cross-sectional study was conducted through a large-scale screening programme in 2019. We randomly selected 575 (21.5%) among 2677 people over 18 years old with known diabetes who attended the screening. Participants elected to pay nothing or RMB10-RMB120 (US$1.6-US$18.8), in RMB10 intervals, displayed on printed cards. One trained interviewer collected all the data. SETTING Ten primary health centres in Qujiang District of Shaoguan City, Guangdong. PARTICIPANTS 545 from the 575 randomly selected people (94.8%) agreed to participate in the study. OUTCOME MEASURES Proportion of participants willing to pay anything for screening, mean amount they were willing to pay and determinants of these figures. RESULTS Among 545 participants (mean age 64.6 years (SD±10.4), 40.7% men), 327 (60.0%) were willing to pay something for screening, of whom 273 (83.5%) would pay RMB10-RMB30 (US$1.6-US$4.7). People living in rural areas and those from lower-income families were more likely to be willing to pay anything, while men, urban residents and those covered by employer-linked insurance were willing to pay larger sums (p<0.05 for all). CONCLUSION Nearly two-thirds of participants were willing to pay for screening in this screening programme organised at the primary care level in rural China. This finding offers the potential that such activities can be sustained and scaled up through user fees.
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Affiliation(s)
- Baixiang Xiao
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
| | - Xuejun Gu
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Ling Jin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ving Fai Chan
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Yanping Li
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | | | - Yuanping Liu
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yanfang Wang
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haoxiang Fu
- Zhenjiang District Hospital, Shaoguan, Guangdong Province, China
| | - Dongfeng Li
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
| | - Nathan Congdon
- Centre for Publich Health, Queen's University Belfast, Belfast, UK
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Orbis International, NY, New York, USA
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Chen SM, (Jo) Wu CJ. Investigating the effects of digital foot self-management program on enhancing self-efficacy and self-care behavior among community-dwelling older adults with type 2 diabetes: A randomized controlled trial. Digit Health 2023; 9:20552076231220791. [PMID: 38107978 PMCID: PMC10722916 DOI: 10.1177/20552076231220791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Diabetic foot self-management intervention programs have been proven to positively influence individuals' behaviors in preventing diabetic foot ulcers. Using digital technologies to deliver programs can facilitate compliance with diabetes self-management programs. However, few studies have focused on the effects of such digital programs on improving the self-efficacy and behaviors of older adults with type 2 diabetes in the community. Aim To evaluate the effects of a digital foot self-management program on self-efficacy, self-care behavior, and Hemoglobin A1c levels. Design A single-blinded, randomized controlled trial was conducted. Methods The intervention program comprised a 4-week digital foot care program with one face-to-face education session, phone calls once weekly, and LINE messages (social media) three times per research nurse and a follow-up of three months. Patients in the control group received routine care. Results A total of 100 participants (n = 50 in the control and n = 50 in the intervention groups) completed the study with a mean age of 67.55 (SD = 11.17). The results showed significant improvements in self-efficacy (F = 2187.24, p < 0.01) and self-care behavior (F = 614.71, p < 0.01) in foot care between the groups. The Hemoglobin A1c levels showed a 0.41% reduction over time in the experimental group (t = -3.759; p < 0.01), whereas the control group showed a 0.06% reduction (t = -0.797, p > 0.05). Conclusion The newly developed digital foot self-management program was effective in community-dwelling older adult patients with type 2 diabetes.
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Affiliation(s)
- Shu-Ming Chen
- Deputy Dean, School of Nursing, Fooyin University, Taiwan
| | - Chiung-Jung (Jo) Wu
- School of Health, University of the Sunshine Coast, Australia
- Royal Brisbane and Women's Hospital, Australia
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Lin CW, Armstrong DG, Huang CH, Lin CH, Hung SY, Liu PH, Huang YY. Diabetic foot disease in subjects with End-stage renal Disease: A nationwide study over 14 years highlighting an emerging threat. Diabetes Res Clin Pract 2022; 193:110134. [PMID: 36349589 DOI: 10.1016/j.diabres.2022.110134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
AIMS To disclose prevalence, demographic, foot characteristics as well as management and lower-extremity amputations (LEAs) of subjects with end-stage renal disease (ESRD) on diabetic foot diseases (DFDs). METHODS Data were derived from the Taiwan National Health Insurance Research Database between 2004 and 2017. DFDs were defined as ulcers, infections, or severe peripheral arterial diseases (PADs) in patients with type 2 diabetes. Clinical characteristics were analyzed between subjects with and without ESRD. RESULTS Subjects with ESRD have increased impacts on the DFD population either from annual prevalence (2.7 % to 10.42 %, P for trend < 0.001), or proportional representation in LEAs (7.91 % to 26.37 %, P < 0.001) over 14 years. The annual trends for major-LEAs rates have decreased in both subjects with and without ESRD (13.67 % to 5.82 % and 3.48 % to 1.47 %, both P < 0.001). Notably, the concomitant increase of endovascular treatments (EVTs) (7.09 % to 29.41 %, P < 0.001) was associated with the decrease of major-LEAs (P for interaction < 0.001) in subjects with ESRD. CONCLUSIONS As the annual prevalence of subjects with ESRD has increased 3.9-fold over years, they now account for more than 30% of annual major-LEA of the total DFD population. Interdisciplinary team approach and aggressive EVTs might reduce major-LEAs in these patients.
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Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, USA (D.G.A.)
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Tsai KY, Chen S, Chou CW, Tzeng TF, Lee YJ, Chen ML. Quality of care and prescription patterns among patients with diabetic kidney disease-a large-scale cohort study from Taiwanese clinics. PeerJ 2022; 10:e13636. [PMID: 35915752 PMCID: PMC9338750 DOI: 10.7717/peerj.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/06/2022] [Indexed: 01/17/2023] Open
Abstract
Aims To investigate the quality of care and prescription patterns of patients with diabetic kidney disease (DKD) receiving primary care at local clinics in Taiwan. Methods A retrospective chart review was conducted in 43 primary care clinics in Taiwan. The patients' baseline characteristics, laboratory tests, presence of complications and antidiabetic agents prescribed were analyzed. Results 7,200 patients with type 2 diabetes mellitus were enrolled. Percentage of HbA1c, blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) goals reached were 52.5% in HbA1c < 7%, 40.9% in BP < 130/80 mmHg and 79.7% in LDL-C < 2.59 mmol/L. 18.3% achieved all three ABC goals. However, patients with DKD had a lower rate of ABC goal attainment and higher rate of complications. Among DKD patients with eGFR ≥ 30 ml/min/1.73 m2 and on monotherapy, metformin was most frequently prescribed. As for dual therapy, the most common combinations were metformin with sulfonylurea and metformin with DPP-4 inhibitors. Conclusions Diabetes patients in Taiwan receiving primary diabetes care at local clinics had generally satisfactory management performance. However, more aggressive HbA1c, BP, and LDL-C management among DKD patients should be emphasized. Contrary to current recommendations, SGLT-2 inhibitors and GLP-1 receptor agonists as frontline therapy were under-prescribed.
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Affiliation(s)
| | | | | | | | | | - Min-ling Chen
- Chen Min-Ling Medical Clinic, New Taipei City, Taiwan
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Ou CY, Wu MS, Lin MC, Chang CM. Short-term and long-term outcomes of free flap reconstruction versus amputation for diabetic foot reconstruction in patients with end-stage renal disease. J Plast Reconstr Aesthet Surg 2022; 75:2511-2519. [PMID: 35643595 DOI: 10.1016/j.bjps.2022.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Taiwan, the prevalence of diabetes mellitus complicated by end-stage renal disease (ESRD) has been increasing and diabetes-related foot amputation is commonplace. In recent years, limb salvage has become top priority. The long-term outcomes of patients on hemodialysis undergoing diabetic foot reconstruction using free flaps remain unknown. METHODS Data from the National Health Insurance Research Database on hemodialysis patients with type 2 diabetes who received amputation or free flap reconstruction surgery for diabetic foot ulcer were analyzed from 2000 to 2013 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. After 1:4 propensity score matching, 86 and 344 patients were assigned to the free flap reconstruction and amputation groups, respectively. RESULTS The 5-year survival rate was significantly higher in patients who received free flap compared to the amputated group (1-year survival rate = 80.0% vs. 67.6%, p = 0.030; 3-year survival rate = 49.7% vs. 35.5%, p = 0.024; 5-year rate=30.1% vs. 19.9%, p = 0.018; however, after 5 years, the overall long-term survival rate was similar in both groups (p = 0.064). Patients who had lower limb amputation after flap reconstruction were susceptible to mortality (adjusted HR = 1.39; p = 0.069). Peripheral arterial disease was a dependent risk factor (HR = 1.45; p = 0.037) for long-term survival, whereas old age (> 75 years; HR = 1.65; p = 0.004), cerebrovascular disease (adjusted HR = 1.36; p = 0.011), and sepsis (adjusted HR = 1.85; p = 0.035) served as independent risk factors. Hemodialysis patients with diabetic foot ulcer who had limb salvaged showed a higher 5-year survival rate as compared to the amputated group.
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Affiliation(s)
- Chia-Yu Ou
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Meng-Si Wu
- Division of Plastic surgery, Department of surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chang
- Division of General Surgery, Department of surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan.
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Chang LH, Chu CH, Huang CC, Lin LY. Fibroblast Growth Factor 21 Levels Exhibit the Association With Renal Outcomes in Subjects With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:846018. [PMID: 35528011 PMCID: PMC9069677 DOI: 10.3389/fendo.2022.846018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Whether microalbuminuria predicts renal outcomes in patients with type 2 diabetes mellitus (T2DM) is argued. Fibroblast growth factor 21 (FGF-21) levels were elevated by the pathogenic process of diabetic kidney disease. The purpose of the study was to evaluate the associations of FGF-21 and renal outcomes in subjects with T2DM. Methods Chinese patients with T2DM were enrolled and then observed prospectively, and FGF-21 levels at baseline were measured. The associations of FGF-21 levels and renal composite events, defined by a drop > 30% of eGFR or worsening category of albuminuria, were evaluated using Cox analysis. The appropriate cut-off value of FGF-21 was mapped by the receiver operating characteristic (ROC) curve. Results Among 312 subjects, higher FGF-21 levels were associated with higher risks of renal events in Cox analysis. The area under the curve of FGF-21 levels in the ROC curve was optimal (0.67, p < 0.001), and the cut-off value of 1.40 pg/dl exhibited the best sensitivity (76.2%) and specificity (53.5%). The frequency of renal composite events was higher in subjects with FGF-21 ≥ 1.40 pg/dl than in others (30% vs. 10%, p<0.001 by the log-rank test). The worse renal outcomes predicted by FGF-21 ≥ 1.40 pg/dl were confirmed using the adjustments of Cox sequential models (hazard ratio 2.28, 95% confidence interval 1.23-4.24, p=0.009) and consistent across subjects with different status of baseline characteristics and renal risks. Conclusion FGF-21 levels were proportional to the risks of renal events in broad- spectrum Chinese T2DM subjects, making it a potential biomarker to predict the renal outcomes of T2DM.
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Affiliation(s)
- Li-Hsin Chang
- Division of Endocrinology and Metabolism, Department of Medicine, Yeezen General Hospital, Taoyuan, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Chia-Huei Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan
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12
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Wang J, Yen F, Lin K, Shin S, Hsu Y, Hsu C. Epidemiological characteristics of diabetic kidney disease in Taiwan. J Diabetes Investig 2021; 12:2112-2123. [PMID: 34529360 PMCID: PMC8668071 DOI: 10.1111/jdi.13668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/02/2021] [Accepted: 09/12/2021] [Indexed: 12/17/2022] Open
Abstract
Diabetic kidney disease (DKD) is a critical microvascular complication of diabetes. With the continuous increase in the prevalence of diabetes since 2000, the prevalence of DKD has also been increasing in past years. The prevalence of DKD among individuals with type 2 diabetes in Taiwan increased from 13.32% in 2000 to 17.92% in 2014. The cumulative incidence of DKD among individuals with type 1 diabetes in Taiwan was higher than 30% during 1999-2012. DKD is the leading cause of end-stage renal disease (ESRD), with a prevalence of approximately 45% in a population on chronic dialysis in Taiwan. Among individuals with type 2 diabetes, the prevalence of ESRD in the receipt of dialysis also increased from 1.32% in 2005 to 1.47% in 2014. Risk factors for DKD development are age, race, family history, hyperglycemia, hypertension, dyslipidemia, dietary patterns, and lifestyles. Prognostic factors that aggravate DKD progression include age, family history, sex, glycemic control, blood pressure (BP), microvascular complications, and atherosclerosis. This review summarizes updated information on the onset and progression of DKD, particularly in the Taiwanese population. Translating these epidemiological features is essential to optimizing the kidney care and improving the prognosis of DKD in Asian populations.
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Affiliation(s)
- Jun‐Sing Wang
- Division of Endocrinology and MetabolismDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
- Faculty of MedicineSchool of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- Rong Hsing Research Center for Translational MedicineInstitute of Biomedical ScienceNational Chung Hsing UniversityTaichungTaiwan
- PhD Program in Translational MedicineNational Chung Hsing UniversityTaichungTaiwan
| | | | - Kun‐Der Lin
- Department of Internal MedicineKaohsiung Municipal Ta‐Tung HospitalKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
- Division of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University Hospital and College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Shyi‐Jang Shin
- Division of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University Hospital and College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Grander ClinicKaohsiungTaiwan
| | - Yueh‐Han Hsu
- Department of Internal MedicineDitmanson Medical Foundation Chia‐Yi Christian HospitalChia‐Yi CityTaiwan
- Department of NursingMin‐Hwei College of Health Care ManagementTainan CityTaiwan
| | - Chih‐Cheng Hsu
- Institute of Population Health SciencesNational Health Research InstituteZhunan, MiaoliTaiwan
- Department of Health Services AdministrationChina Medical UniversityTaichung CityTaiwan
- Department of Family MedicineMin‐Sheng General HospitalTaoyuanTaiwan
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13
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Lu CW, Wu YF, Chen TH, Chung CM, Lin CL, Lin YS, Chen MY, Yang YH, Lin MS. A nationwide cohort investigation on pay-for-performance and major adverse limb events in patients with diabetes. Prev Med 2021; 153:106787. [PMID: 34506818 DOI: 10.1016/j.ypmed.2021.106787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/18/2021] [Accepted: 09/04/2021] [Indexed: 11/19/2022]
Abstract
A retrospective cohort study was conducted using claims data from Taiwan's National Health Insurance program to assess the effect of diabetic pay-for-performance (P4P) program on major adverse limb events (MALE) and major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). This study included patients with T2DM who had completed or not completed a 1-year P4P program from 2002 to 2013. Propensity-score matching was used to balance the baseline characteristics between groups. The Cox proportional-hazard model and Fine and Gray subdistribution hazard model were used to examine the association between P4P and the risks of MALE, MACE, systemic thromboembolism (ST), heart failure (HF) hospitalization, and all-cause mortality. Patients who underwent the P4P program had a significantly decreased incidence of MALE (2.0% vs. 2.6%, subdistribution hazard ratio [SHR] 0.73, 95% CI 0.71-0.76). Regarding the individual components, the P4P group demonstrated lower risks for foot ulcer (1.1% vs 1.3%, SHR 0.80, 95% CI 0.77-0.84), gangrene (0.57% vs 0.93%, SHR 0.59, 95% CI 0.56-0.63), percutaneous transluminal angioplasty (0.61% vs 0.79%, SHR 0.72, 95% CI 0.68-0.77), and amputation (0.46% vs 0.75%, SHR 0.58, 95% CI 0.55-0.62). In addition, the risks of MACE, ST, HF hospitalization, and all-cause mortality were remarkably lower in the P4P group. The P4P program might significantly reduce critical events of MALE, MACE, ST, HF, and mortality in the diabetic population.
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Affiliation(s)
- Cheng-Wei Lu
- Department of Family Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Fang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tien-Hsing Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chang-Min Chung
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shyan Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
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Yen FS, Wei JCC, Shih YH, Hsu CC, Hwu CM. The Risk of Nephropathy, Retinopathy, and Leg Amputation in Patients With Diabetes and Hypertension: A Nationwide, Population-Based Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:756189. [PMID: 34867799 PMCID: PMC8637105 DOI: 10.3389/fendo.2021.756189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare the risks of chronic kidney disease (CKD), end-stage renal disease (ESRD), sight-threatening retinopathy, and leg amputation between patients with diabetes or hypertension. Methods From January 1, 2000, to December 31, 2015, we identified 28943 matched pairs of patients with diabetes with and without subsequent hypertension, 89102 pairs of patients with hypertension with and without subsequent diabetes, and 145294 pairs of patients with coexisting diabetes and hypertension with a previous history of diabetes or hypertension from Taiwan's National Health Insurance Research Database. Cox proportional-hazard models were used for calculating the risks of CKD, sight-threatening retinopathy, and leg amputation. Results The mean follow-up time of this study in different cohorts was between 3.59 and 4.28 years. In diabetes patients with vs. without subsequent hypertension, hypertension patients with vs. without subsequent diabetes, and comorbid diabetes and hypertension patients with previous diabetes vs. with previous hypertension, the adjusted HRs (95% CIs) for CKD were 2.77 (2.61-2.94), 1.73 (1.68-1.77), and 1.04 (1.02-1.07); for ESRD were 42.38 (22.62-79.4), 2.76 (2.43-3.13), and 0.72 (0.66-0.79); for sight-threatening retinopathy were 2.07 (1.85-2.3), 3.41 (3.14-3.71), and for leg amputation were 1.51 (1.43-1.58); and 4.74 (3.02-7.43), 6.27(4.72-8.31), and 1.19(1.03-1.38). Conclusions This study demonstrated that both diabetes and hypertension are risk factors for the development of CKD, retinopathy, and amputation. Tracing subsequent diabetes for patients with hypertension, and hypertension for patients with diabetes are important in clinical settings.
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Affiliation(s)
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung City, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung City, Taiwan
| | - Ying-Hsiu Shih
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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15
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Wang JS, Lo SH, Yeh YP, Hwu CM, Huang CN, Hsieh CH, Sheu WHH. Distinct associations of self-monitoring of blood glucose with glycemic control and hypoglycemia between groups of recently diagnosed and long-term follow-up type 2 diabetes: The Taiwan Diabetes Registry. Int J Clin Pract 2021; 75:e14410. [PMID: 34048138 DOI: 10.1111/ijcp.14410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated the uses and frequency of self-monitoring of blood glucose (SMBG) with glycemic control and hypoglycemia in two groups of type 2 diabetes (T2D) (recently diagnosed and long-term follow-up) using real-world data in Taiwan (the Taiwan Diabetes Registry). METHODS Patients with T2D recently diagnosed within 6 months (n = 3297, mean age 54.4 ± 13.9 years) and T2D patients with long-term follow-up (n = 1201, mean age 65.5 ± 12.1 years, mean diabetes duration 14.3 ± 7.8 years) from the Taiwan Diabetes Registry were analysed. All patients were interviewed by certified diabetes educators. Information about SMBG and hypoglycemia was recorded. Demography, personal history, and laboratory data were obtained from electronic medical records. Logistic regression analyses were used to examine the associations of SMBG with glycated haemoglobin (HbA1c) <7% and hypoglycemia. RESULTS Mean HbA1c values were 8.4 ± 2.5 and 7.6 ± 1.4%, respectively, in the recently diagnosed and long-term follow-up T2D groups. The self-reported rates of hypoglycemic events within 3 months were 10.5% and 19.0%, respectively. SMBG was associated with higher odds of HbA1c <7% (OR 1.21, 95% CI 1.01-1.44) in patients with recently diagnosed T2D, but with lower odds of HbA1c <7% in T2D patients with long-term follow-up (OR 0.60, 95% CI 0.44-0.82). In both study populations, SMBG was independently associated with hypoglycemia (OR 3.90 [95% CI 2.99-5.08] and OR 3.93 [95% CI 2.73-5.66], respectively). The aforementioned findings were consistent across the strata of SMBG frequency. CONCLUSION We reported different associations between SMBG and glycemic control in patients recently diagnosed with T2D and in T2D patients with long-term follow-up. SMBG was associated with higher detection of hypoglycemic episodes in both study populations.
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Affiliation(s)
- Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan
| | - Su-Huey Lo
- Tao-Yuan General Hospital, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, Changhua, Taiwan
| | - Chii-Min Hwu
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Ning Huang
- Institute of Medicine, Chung Shang Medical University Hospital, Taichung, Taiwan
| | - Chang-Hsun Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan
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16
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Lin K, Hsih W, Lin Y, Wen C, Chang T. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. J Diabetes Investig 2021; 12:1322-1325. [PMID: 33316144 PMCID: PMC8354492 DOI: 10.1111/jdi.13480] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022] Open
Abstract
Despite progress in the treatment of diabetic macular edema and diabetic retinopathy, the rate of lower fundus examination due to limitations of medical resources delays the diagnosis and treatment of diabetic retinopathy. Therefore, implementation of automated diabetic retinopathy screening program and the identification of more specific and sensitive biomarkers are important for facilitating the earlier detection of diabetic macular edema and diabetic retinopathy to decrease the prevalence of poor vision and blindness.
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Affiliation(s)
- Kuan‐Yu Lin
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Wen‐Hui Hsih
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Yen‐Bo Lin
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chen‐Yu Wen
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Tien‐Jyun Chang
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
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17
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Li YH, Sheu WHH, Chou CC, Lin CH, Cheng YS, Wang CY, Wu CL, Lee IT. The Clinical Influence after Implementation of Convolutional Neural Network-Based Software for Diabetic Retinopathy Detection in the Primary Care Setting. Life (Basel) 2021; 11:life11030200. [PMID: 33807545 PMCID: PMC8035657 DOI: 10.3390/life11030200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/04/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
Deep learning-based software is developed to assist physicians in terms of diagnosis; however, its clinical application is still under investigation. We integrated deep-learning-based software for diabetic retinopathy (DR) grading into the clinical workflow of an endocrinology department where endocrinologists grade for retinal images and evaluated the influence of its implementation. A total of 1432 images from 716 patients and 1400 images from 700 patients were collected before and after implementation, respectively. Using the grading by ophthalmologists as the reference standard, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to detect referable DR (RDR) were 0.91 (0.87-0.96), 0.90 (0.87-0.92), and 0.90 (0.87-0.93) at the image level; and 0.91 (0.81-0.97), 0.84 (0.80-0.87), and 0.87 (0.83-0.91) at the patient level. The monthly RDR rate dropped from 55.1% to 43.0% after implementation. The monthly percentage of finishing grading within the allotted time increased from 66.8% to 77.6%. There was a wide range of agreement values between the software and endocrinologists after implementation (kappa values of 0.17-0.65). In conclusion, we observed the clinical influence of deep-learning-based software on graders without the retinal subspecialty. However, the validation using images from local datasets is recommended before clinical implementation.
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Affiliation(s)
- Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.L.); (W.H.-H.S.)
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.L.); (W.H.-H.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chien-Chih Chou
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Chun-Hsien Lin
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Yuan-Shao Cheng
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Chun-Yuan Wang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Chieh Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Automatic Control Engineering, Feng Chia University, Taichung 40703, Taiwan
| | - I.-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.L.); (W.H.-H.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- College of Science, Tunghai University, Taichung 40704, Taiwan
- Correspondence:
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Yu ZL, Wong CS, Lai YT, Chou WH, Faridah IN, Kao CC, Lin YF, Chang WC. Gender Differences in Genetic Associations of RAB38 with Urinary Protein-to-Creatinine Ratio (UPCR) Levels in Diabetic Nephropathy Patients. J Pers Med 2020; 10:jpm10040184. [PMID: 33096837 PMCID: PMC7711808 DOI: 10.3390/jpm10040184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Renal dysfunction is common in patients with diabetes mellitus (DM). Previous findings from a meta-analysis of GWAS indicated that the variation of RAB38/CTSC is highly associated with the urinary albumin-to-creatinine ratio (UACR) in European populations. In addition, RAB38 knockout rats showed an increase in urinary albumins. Although the prevalence of chronic kidney disease is high in Taiwan, the role of genetic variants in diabetic renal function is still unclear. In the current study, 275 diabetic nephropathy (DN) patients were recruited to perform a genetic association study. Our results indicated that rs1027027, rs302647, and rs302646 in RAB38 were significantly associated with urinary protein-to-creatinine ratio (UPCR) levels in DN patients. Importantly, after analysis stratified by gender, a significant genetic influence on UPCR levels was observed in the male population. The findings confirmed the roles of gender and variants of RAB38 in the risk of UPCR in Diabetic Nephropathy patients.
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Affiliation(s)
- Zhi-Lei Yu
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan; (Z.-L.Y.); (Y.T.L.); (W.-H.C.); (I.N.F.)
| | - Chung-Shun Wong
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235041, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi Ting Lai
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan; (Z.-L.Y.); (Y.T.L.); (W.-H.C.); (I.N.F.)
| | - Wan-Hsuan Chou
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan; (Z.-L.Y.); (Y.T.L.); (W.-H.C.); (I.N.F.)
| | - Imaniar Noor Faridah
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan; (Z.-L.Y.); (Y.T.L.); (W.-H.C.); (I.N.F.)
- Faculty of Pharmacy, Ahmad Dahlan University, Yogyakarta 55164, Indonesia
| | - Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110301, Taiwan;
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Yuh-Feng Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Correspondence: (Y.-F.L.); (W.-C.C.)
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan; (Z.-L.Y.); (Y.T.L.); (W.-H.C.); (I.N.F.)
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei 110301, Taiwan
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei 110301, Taiwan
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Correspondence: (Y.-F.L.); (W.-C.C.)
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19
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Shen FC, Cheng BC, Chen JF. Peri-renal fat thickness is positively associated with the urine albumin excretion rate in patients with type 2 diabetes. Obes Res Clin Pract 2020; 14:345-349. [PMID: 32653293 DOI: 10.1016/j.orcp.2020.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUNDS Albuminuria, the earliest clinical manifestation of diabetic kidney disease (DKD), is a major prognostic indicator of renal progression. Obesity itself is associated with the development of DKD and accelerates its progression. Accumulation of peri-renal fat on the kidneys can damage kidney function. Measuring the perirenal fat thickness (PFT) by ultrasound is a non-invasive method to measure ectopic fat deposition on the kidney. In this study, we aim to obtain the association between albuminuria and PFT. METHODS Eighty-nine subjects with type 2 diabetes mellitus (T2DM) were enrolled. Albuminuria was defined as a urine albumin-to-creatinine ratio (UACR) ≧30 mg/g. Measurement of the PFT was performed by B-mode ultrasound (Toshiba SSA-680A) and determined from the surface of the abdominal musculature to the surface of kidney. Pearson correlation coefficients were determined to test the significant independent relationship between the PFT and demographic, anthropometric and laboratory parameters. RESULTS Patients were divided into those with (n = 66) and without (n = 23) albuminuria. PFT (odds ratio [OR], 19.3; 95% CI, 2.25-165.00; p = 0.01) was significantly correlated with albuminuria based on multiple logistic regression analysis. Additionally, linear regression confirmed that degree of albuminuria has a positive association with the PFT (r = 0.233; p = 0.03). CONCLUSIONS Our study showed that an increased PFT is positively associated with the albuminuria among patients with T2DM. Our findings suggest that measurement of the PFT may represent a helpful tool to assess the risk of developing albuminuria in patients with T2DM.
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Affiliation(s)
- Feng-Chih Shen
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Mitochondrial Research and Medicine, Departments of Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jung-Fu Chen
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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20
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Prídavková D, Samoš M, Bolek T, Škorňová I, Žolková J, Kubisz P, Staško J, Mokáň M. Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation. J Diabetes Res 2019; 2019:5158308. [PMID: 31886279 PMCID: PMC6925766 DOI: 10.1155/2019/5158308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.
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Affiliation(s)
- Dana Prídavková
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ingrid Škorňová
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jana Žolková
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubisz
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ján Staško
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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21
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Yang WS. A phase of diabetes care at the verge of paradigm shift. J Formos Med Assoc 2019; 118 Suppl 2:S63-S65. [PMID: 31564386 DOI: 10.1016/j.jfma.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Wei-Shiung Yang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan; Departments of Internal Medicine and Medical Research, National Taiwan University Hospital, Taiwan.
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22
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Hsu CC, Tu ST, Sheu WHH. 2019 Diabetes Atlas: Achievements and challenges in diabetes care in Taiwan. J Formos Med Assoc 2019; 118 Suppl 2:S130-S134. [PMID: 31387840 DOI: 10.1016/j.jfma.2019.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/03/2019] [Accepted: 06/25/2019] [Indexed: 01/30/2023] Open
Abstract
The 2019 Diabetes Atlas delineated both accomplishments and challenges in diabetes care in Taiwan between 2005 and 2014. The series reported that Taiwan had significantly improved aspects of care quality for patients with diabetes. For example, the mortality rate decreased, the difference between the life expectancies of patients with diabetes and those of the general population decreased, and the rates of hospitalization because of heart diseases, cerebrovascular diseases, chronic kidney diseases, and unsatisfactory glycemic control decreased. However, despite these achievements, the 2019 Diabetes Atlas also reported some substantial challenges that have not been overcome. For example, the incidence of diabetes among women aged <19 years and 20-39 years increased by 27% and 33%, respectively. Furthermore, a high prevalence of macrovascular complications, a continuous increase in the dialysis prevalence rates among men with diabetes of all ages, and a low participation rate (<20%) of patients with diabetes in the pay-for-performance program were observed. The publication of the 2019 Diabetes Atlas is a milestone that demonstrates a strong will in medical societies to improve the quality of diabetes care. We expect this initiative can be reorganized every 5 years to report the results of continuous monitoring and surveillance and update the epidemiological features of diabetes in Taiwan.
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Affiliation(s)
- Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institute, Miaoli, Taiwan; Department of Health Services Administration, China Medical University, Taichung City, Taiwan; Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Shih-Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Taiwanese Association of Diabetes Educators, Taipei, Taiwan.
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Rong-Hsing Research Center for Translation Medicine, National Chung-Hsing University, Taichung, Taiwan; Diabetes Association of the Republic of China, Taipei, Taiwan.
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