1
|
Paquet S, Sassenou J, Ringa V, Czernichow S, Zins M, Ozguler A, Rigal L. Women with type 2 diabetes have LDL cholesterol levels higher than those of men, regardless of their treatment and their cardiovascular risk level. Nutr Metab Cardiovasc Dis 2023; 33:1254-1262. [PMID: 37088650 DOI: 10.1016/j.numecd.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/14/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND AIMS Several works have shown that control of the principal cardiovascular risk factors, especially LDL-C, is poorer among women with type 2 diabetes than men with this disease. Our objectives were to compare the statin treatments and LDL-C levels between men and women with type 2 diabetes, according to the potency of the statin they take, while taking their cardiovascular risk level into account. METHOD AND RESULTS This is a descriptive cross-sectional study within the French CONSTANCES cohort. At inclusion, each individual completed several self-administered questionnaires. Data were then matched to their health insurance fund reimbursement data. The study population comprises cohort members with pharmacologically treated type 2 diabetes. We identified 2541 individuals with type 2 diabetes; 2214 had an available LDL-C value. In the total sample, treatment by statins did not differ between men and women, while the women had a higher mean LCL-C level than men. The analyses stratified by cardiovascular risk showed that women at very high cardiovascular risk received significantly less frequent statin delivery than men (OR = 0.72 [0.56-0.92]; p = 0.01). At the same time, women received the same rate of high-potency statins as men. Women taking equivalently potent statins had significantly higher LDL-C levels than men did. CONCLUSION For the same cardiovascular risk level and the same statin treatment, women had an LDL-C level higher than that of men. They thus present a residual cardiovascular risk that justifies intensification of their statin treatment if tolerance allows.
Collapse
Affiliation(s)
- Sylvain Paquet
- Department of General Practice, University of Paris-Saclay, Paris, France; CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention, Villejuif, France.
| | - Jeanne Sassenou
- Department of General Practice, University of Paris-Saclay, Paris, France; CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention, Villejuif, France.
| | - Virginie Ringa
- CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention, Villejuif, France.
| | - Sébastien Czernichow
- Université de Paris, Paris, France; AP-HP, Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France.
| | - Marie Zins
- Inserm, Population-based Epidemiologic Cohorts Units, UMS 011, Villejuif, France.
| | - Anna Ozguler
- Inserm, Population-based Epidemiologic Cohorts Units, UMS 011, Villejuif, France.
| | - Laurent Rigal
- Department of General Practice, University of Paris-Saclay, Paris, France; CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, équipe soins primaires et prévention, Villejuif, France.
| |
Collapse
|
2
|
Increased Risk of Hospitalization for Pancreatic Cancer in the First 8 Years after a Gestational Diabetes Mellitus regardless of Subsequent Type 2 Diabetes: A Nationwide Population-Based Study. Cancers (Basel) 2021; 13:cancers13020308. [PMID: 33467667 PMCID: PMC7829937 DOI: 10.3390/cancers13020308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Pancreatic cancer is one of the cancers with the highest mortality rate which is most often attributed to late diagnosis. The identification of risk factors is therefore important. While gestational diabetes also shares mechanisms of action with diabetes mellitus, several studies have provided hypotheses that could explain the pathophysiology of the link between diabetes mellitus and risk of pancreatic cancer. Accordingly, the aim of our study was to determine the risk of developing pancreatic cancer in women with a history of gestational diabetes from a quasi-exhaustive national medico-administrative database for deliveries in France. We included 1,368,755 women in our study. We showed that gestational diabetes was significantly associated with a greater risk of pancreatic cancer, regardless of subsequent type 2 diabetes. Our results suggest a better follow-up of patients after a gestational diabetes in order to identify high-risk profiles of developing more serious conditions, such as pancreatic cancer. Abstract The aim of this large retrospective cohort study was to use a quasi-exhaustive national medico-administrative database of deliveries in France to determine the risk of developing pancreatic cancer (PC) in women with a history of gestational diabetes mellitus (GDM). This nationwide population-based study included women aged 14–55 who gave birth between 1st January 2008 and 31 December 2009. The women were followed-up epidemiologically for eight years. Survival analyses using Cox regression models, adjusted for age, subsequent type 2 diabetes, and tobacco consumption, were performed on the time to occurrence of hospitalization for PC. The onset of GDM, tobacco consumption and subsequent type 2 diabetes were considered as time-dependent variables. Among 1,352,560 women included, 95,314 had a history of GDM (7.05%) and 126 women were hospitalized for PC (0.01%). Over the eight years of follow-up, GDM was significantly associated with a higher risk of hospitalization with PC in the first Cox regression model adjusted for age and subsequent type 2 diabetes (HR = 1.81 95% CI [1.06–3.10]). The second Cox regression model adjusted for the same covariates, plus tobacco consumption, showed that GDM was still significantly associated with a higher risk of hospitalization for PC with nearly the same estimated risk (HR = 1.77 95% CI [1.03–3.03]). Gestational diabetes was significantly associated with a greater risk of hospital admission for pancreatic cancer within eight years, regardless of subsequent type 2 diabetes.
Collapse
|
3
|
Berete F, Demarest S, Charafeddine R, Bruyère O, Van der Heyden J. Comparing health insurance data and health interview survey data for ascertaining chronic disease prevalence in Belgium. ACTA ACUST UNITED AC 2020; 78:120. [PMID: 33292534 PMCID: PMC7672883 DOI: 10.1186/s13690-020-00500-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/04/2020] [Indexed: 11/11/2022]
Abstract
Background Health administrative data were increasingly used for chronic diseases (CDs) surveillance purposes. This cross sectional study explored the agreement between Belgian compulsory health insurance (BCHI) data and Belgian health interview survey (BHIS) data for asserting CDs. Methods Individual BHIS 2013 data were linked with BCHI data using the unique national register number. The study population included all participants of the BHIS 2013 aged 15 years and older. Linkage was possible for 93% of BHIS-participants, resulting in a study sample of 8474 individuals. For seven CDs disease status was available both through self-reported information from the BHIS and algorithms based on ATC-codes of disease-specific medication, developed on demand of the National Institute for Health and Disability Insurance (NIHDI). CD prevalence rates from both data sources were compared. Agreement was measured using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) assuming BHIS data as gold standard. Kappa statistic was also calculated. Participants’ sociodemographic and health status characteristics associated with agreement were tested using logistic regression for each CD. Results Prevalence from BCHI data was significantly higher for CVDs but significantly lower for COPD and asthma. No significant difference was found between the two data sources for the remaining CDs. Sensitivity was 83% for CVDs, 78% for diabetes and ranged from 27 to 67% for the other CDs. Specificity was excellent for all CDs (above 98%) except for CVDs. The highest PPV was found for Parkinson’s disease (83%) and ranged from 41 to 75% for the remaining CDs. Irrespective of the CDs, the NPV was excellent. Kappa statistic was good for diabetes, CVDs, Parkinson’s disease and thyroid disorders, moderate for epilepsy and fair for COPD and asthma. Agreement between BHIS and BCHI data is affected by individual sociodemographic characteristics and health status, although these effects varied across CDs. Conclusions NHIDI’s CDs case definitions are an acceptable alternative to identify cases of diabetes, CVDs, Parkinson’s disease and thyroid disorders but yield in a significant underestimated number of patients suffering from asthma and COPD. Further research is needed to refine the definitions of CDs from administrative data. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-020-00500-4.
Collapse
Affiliation(s)
- Finaba Berete
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium. .,Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Stefaan Demarest
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium
| | - Rana Charafeddine
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health aspects of musculoskeletal health and ageing, Department of Public Health, Epidemiology and Health Economics, University of Liege, Liège, Belgium
| | - Johan Van der Heyden
- SD Epidemiology and public health, Sciensano, Juliette Wytsmanstraat, 14 1050, Brussels, Belgium
| |
Collapse
|
4
|
Conte C, Lapeyre-Mestre M, Hanaire H, Ritz P. Diabetes Remission and Relapse After Bariatric Surgery: a Nationwide Population-Based Study. Obes Surg 2020; 30:4810-4820. [PMID: 32869127 DOI: 10.1007/s11695-020-04924-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The long-term impact of bariatric surgery on the remission of type 2 diabetes (T2DM) remains to be clarified through large nationally representative cohorts. The objectives were to determine the incidence of T2DM remission and relapse after bariatric surgery, to determine the factors associated with remission and to establish a profile for patients at risk for relapse. MATERIALS AND METHODS We conducted a population-based cohort study using data from the French national health insurance database (Systeme national des données de santé [SNDS]). We had access to exhaustive regional data between 2013 and 2017 and to a national representative sample of the French population (EGB) from 2008 to 2018. Patients were included if they were adults and diabetics with incidental bariatric surgery. RESULTS This study shows that 50% of patients are in remission from diabetes after bariatric surgery within a median of 2 to 4 months. Diabetes relapse was observed in 13-20% within 10 years. The factors favouring remission already described were noted (non-insulin-dependent diabetes) and original factors were also identified, in particular the advantage of bypass surgery over sleeve gastrectomy, with more remissions and fewer relapses. CONCLUSION This study highlights a 50% prevalence of remission and a low prevalence of relapse. There are non-modifiable risk factors for remission and relapse (characteristics of diabetes, age, lipid-lowering therapy) and modifiable factors (type of surgery). Identifying these factors is essential for optimal management of patients. Additional data are essential to confirm the results of our analysis of the factors associated with relapse.
Collapse
Affiliation(s)
- C Conte
- Clinical Pharmacology Department, Toulouse University Hospital, Toulouse, France.,Clinical Investigation Center (CIC 1436), INSERM and Toulouse University Hospital, Toulouse, France.,Inserm unit 1027, University of Toulouse 3, Toulouse, France
| | - M Lapeyre-Mestre
- Clinical Pharmacology Department, Toulouse University Hospital, Toulouse, France.,Clinical Investigation Center (CIC 1436), INSERM and Toulouse University Hospital, Toulouse, France.,Inserm unit 1027, University of Toulouse 3, Toulouse, France
| | - H Hanaire
- Diabetes Department, Toulouse CIO (Obesity Medicine Reference Center) and CHU (University Hospital), Toulouse, France
| | - P Ritz
- Inserm unit 1027, University of Toulouse 3, Toulouse, France. .,Nutrition Department, Toulouse CIO and CHU, Toulouse, France.
| |
Collapse
|
5
|
Petit JM, Goueslard K, Chauvet-Gelinier JC, Bouillet B, Vergès B, Jollant F, Quantin C. Association between hospital admission for ketoacidosis and subsequent suicide attempt in young adults with type 1 diabetes. Diabetologia 2020; 63:1745-1752. [PMID: 32642808 DOI: 10.1007/s00125-020-05206-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/14/2020] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine the associations between hospitalisation for diabetic ketoacidosis and subsequent hospitalisation for suicide attempt in young adults with type 1 diabetes. METHODS This nationwide historical cohort study included hospital data on all young people hospitalised in France for type 1 diabetes in 2008. Epidemiological follow-up focused on hospitalisations (medical and psychiatric hospital data) from the index hospitalisation to 2017. Survival analyses were done using a Cox proportional hazards regression model to explore the association between hospitalisation for ketoacidosis and subsequent hospitalisation for a suicide attempt. RESULTS In 2008, 16,431 people aged 18-35 years had a hospitalisation mentioning type 1 diabetes. Among them, 1539 (9.4%) had at least one hospitalisation for ketoacidosis between 2008 and 2010. At 9 years, 7.2% of the group hospitalised for ketoacidosis had been hospitalised for a suicide attempt vs only 2.5% in the group not hospitalised for ketoacidosis. The association between hospitalisation for ketoacidosis and suicide attempt decreased over time and was no longer significant after 5 years. CONCLUSIONS/INTERPRETATION We found that young adults admitted to hospital for diabetic ketoacidosis have an increased risk of being admitted to hospital for a subsequent suicide attempt. The risk of a suicide attempt was the highest in the 12 months following the ketoacidosis episode. Our findings support the recommendation that screening for depression and suicide risk should be part of the routine clinical assessment of individuals with type 1 diabetes and ketoacidosis.
Collapse
Affiliation(s)
- Jean-Michel Petit
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France.
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France.
| | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | | | - Benjamin Bouillet
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Bruno Vergès
- Inserm Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, 14 rue Gaffarel, BP 77908, 21079, Dijon Cedex, France
| | - Fabrice Jollant
- Paris-Descartes University and Sainte-Anne Hospital, Paris, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, Dijon, France
- University of Burgundy and Franche-Comte, Dijon, France, Inserm, CIC 1432, Dijon, France
- Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| |
Collapse
|
6
|
Borne E, Meyer N, Rybarczyck-Vigouret MC, Blanchard O, Lombard M, Lang PO, Vogel T, Michel B. Potential Statin Overuse in Older Patients: A Retrospective Cross-Sectional Study Using French Health Insurance Databases. Drugs Aging 2020; 36:947-955. [PMID: 31317420 DOI: 10.1007/s40266-019-00695-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although compelling evidence exists supporting statins (HMG-CoA reductase inhibitors) for secondary prevention in older patients with clinical atherosclerotic diseases, the same cannot be said for primary prevention. OBJECTIVES The objectives of this study were to estimate the frequency of potential statin overuse in older patients, the potential drug cost savings if corrected, and the associated factors. METHODS A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) from 1 January to 30 April 2017. All statin users aged 80 years or over living in the community (including nursing homes) and identified from the French health insurance database were analyzed. Potential statin overuse was defined according to the STOPP/START (Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment) criteria. RESULTS Among the 38,268 aged insured, 23,228 (60.7%) had potential statin overuse. Of those living in the community, 22,132 (60.0%) patients had potential statin overuse: 12,352 (55.8%) for primary and 9780 (44.2%) for secondary prevention. Among nursing home residents, 1096 (79.0%) had potential statin overuse: 394 (35.9%) for primary and 702 (64.1%) for secondary prevention. The potential drug cost savings associated with the adjustment of potential statin overuse were €924,100 for the study period. Living in nursing home [adjusted odds ratio (ORadjusted) 3.91, 95% confidence interval (CI) 2.82-5.41] and being a female (ORadjusted 2.84, 95% CI 2.54-3.17) were the main risk factors associated with potential statin overuse. CONCLUSION The frequency of potential statin overuse is very high among older people aged 80 years or over, highlighting the need to re-evaluate statin therapy and consider deprescribing, particularly for primary prevention and in nursing homes.
Collapse
Affiliation(s)
- Emilie Borne
- OMEDIT Grand Est, Regional Health Agency, Strasbourg, France
| | - Nicolas Meyer
- Department of Public Health, University Hospitals of Strasbourg, Strasbourg, France
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | | | | | | | | | - Thomas Vogel
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Department of Geriatrics, University Hospitals of Strasbourg, Strasbourg, France
| | - Bruno Michel
- OMEDIT Grand Est, Regional Health Agency, Strasbourg, France.
- Service de Pharmacie, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
- Faculty of Pharmacy, EA7296 Laboratory of Neuro-cardiovascular Pharmacology and Toxicology, University of Strasbourg, Strasbourg, France.
| |
Collapse
|
7
|
Francis F, Terroba C, Persoz C, Gagliolo JM, Alla F. [What place for French morbidity registries in the era of big data?]. Rev Epidemiol Sante Publique 2020; 68:117-123. [PMID: 31974001 DOI: 10.1016/j.respe.2019.11.018] [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: 06/26/2019] [Revised: 10/21/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022] Open
Abstract
The recent opening of massive health databases, as well as the development of methods and tools adapted to their data processing, questions the French model of "morbidity registry". In France in 2019, nearly 61 health registries were operating. As defined by law, these registries identify exhaustively all patients with a given disease in a given territory. Established several decades ago, these registries are part of the French surveillance system that is used for research and evaluation purposes. Since the advent of recent technological progress, large-scale databases are made available to researchers and it is possible with these databases to answer questions initially assigned to the registries. What is the place of such registries in this new context: are they obsolete or still useful? Should they be opposed to the new tools or are they complementary to them, and if so, what is their place in the new French public health ecosystem? The objective of this work was to assess the roles and missions of existing registries and to reflect on their positioning in this new environment. The French model of registry is sometimes questioned because of the complexity of its circuits, requiring a significant amount of human resources. However, the data that constitute them, validated by cross-checking information from several sources, are of very high quality, and make it possible to validate the data in the new databases (National Health Data System (NSDS) or Hospital Data Warehouses). Registries and new databases are in fact complementary, and far from jeopardizing this model, the recent opening of these databases represents an opportunity for registries to modernize their operations and respond to new missions.
Collapse
Affiliation(s)
- F Francis
- Université de Bordeaux, Isped, Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France; CHU de Bordeaux, pôle de santé publique, service d'information médicale, 33000 Bordeaux, France.
| | - C Terroba
- Inserm, institut thématique santé publique, Paris, France
| | - C Persoz
- Inserm, institut thématique santé publique, Paris, France
| | - J-M Gagliolo
- Inserm, institut thématique santé publique, Paris, France
| | - F Alla
- Université de Bordeaux, Isped, Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France; Inserm, CIC 1401-EC, 33000 Bordeaux, France
| |
Collapse
|
8
|
Identifying diabetes cases in health administrative databases: a validation study based on a large French cohort. Int J Public Health 2018; 64:441-450. [PMID: 30515552 DOI: 10.1007/s00038-018-1186-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/03/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES In the French national health insurance information system (SNDS) three diabetes case definition algorithms are applied to identify diabetic patients. The objective of this study was to validate those using data from a large cohort. METHODS The CONSTANCES cohort (Cohorte des consultants des Centres d'examens de santé) comprises a randomly selected sample of adults living in France. Between 2012 and 2014, data from 45,739 participants recorded in a self-administrated questionnaire and in a medical examination were linked to the SNDS. Two gold standards were defined: known diabetes and pharmacologically treated diabetes. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and kappa coefficients (k) were estimated. RESULTS All three algorithms had specificities and NPV over 99%. Their sensitivities ranged from 73 to 77% in algorithm A, to 86 and 97% in algorithm B and to 93 and 99% in algorithm C, when identifying known and pharmacologically treated diabetes, respectively. Algorithm C had the highest k when using known diabetes as the gold standard (0.95). Algorithm B had the highest k (0.98) when testing for pharmacologically treated diabetes. CONCLUSIONS The SNDS is an excellent source for diabetes surveillance and studies on diabetes since the case definition algorithms applied have very good test performances.
Collapse
|
9
|
Kaguelidou F, Sommet A, Lapeyre-Mestre M. Use of French healthcare insurance databases in pediatric pharmacoepidemiology. Therapie 2018; 73:127-133. [DOI: 10.1016/j.therap.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 01/24/2023]
|