Body mass index and health status in diabetic and non-diabetic individuals

Denosumab in postmenopausal women with osteoporosis and diabetes: Subgroup analysis of FREEDOM and FREEDOM extension

PURPOSE

Diabetes and osteoporosis occur frequently in older adults and are both associated with increased fracture risk. Denosumab treatment reduced new vertebral, nonvertebral, and hip fractures over 3 years, with continued low fracture incidence for up to 10 years in postmenopausal women with osteoporosis. However, its effects in diabetic subjects with osteoporosis have not yet been investigated.

METHODS

Post hoc analysis of the 3-year, placebo-controlled FREEDOM study and 7-year Extension included postmenopausal women with osteoporosis and diabetes. Effects on BMD, vertebral, and nonvertebral fracture incidence were evaluated.

RESULTS

Of 7808 subjects in FREEDOM, 508 with diabetes received denosumab (n = 266) or placebo (n = 242). Among those, BMD increased significantly with denosumab versus placebo in FREEDOM, and continued to increase during the Extension in long-term (continuing denosumab) and crossover (placebo to denosumab) denosumab subjects. In FREEDOM, denosumab-treated subjects with diabetes had significantly lower new vertebral fracture rates (1.6%) versus placebo (8.0%) (RR: 0.20 [95% CI 0.07-0.61]; p = .001). Nonvertebral fracture incidence was higher with denosumab (11.7%) versus placebo (5.9%) (HR: 1.94 [95% CI 1.00-3.77]; p = .046), although there were fewer hip fractures with denosumab (World Health Organization, 2017 [1]) than placebo (4; nonsignificant). During the first 3 years in FREEDOM Extension, new vertebral and nonvertebral fracture incidences were low in long-term and crossover denosumab diabetic groups (≤6%), consistent with the overall Extension population; yearly nonvertebral fracture incidence was comparable to the FREEDOM placebo group.

CONCLUSION

Denosumab significantly increased BMD and decreased vertebral fracture risk in subjects with osteoporosis and diabetes. No reduction in nonvertebral fractures was observed.

Human Tongue Thermography Could Be a Prognostic Tool for Prescreening the Type II Diabetes Mellitus

Diabetes mellitus is one of the life threatening diseases over the globe, and an early prediction of diabetes is of utmost importance in this current scenario. International Diabetes Federation (IDF) reported nearly half of the world's population was undiagnosed and unaware of being developed into diabetes. In 2017, around 84 million individuals were living with diabetes, and it might increase to 156 million by the end of 2045 stated by IDF. Generally, the diagnosis of diabetes relies on the biochemical method that may cause uneasiness and probability of infections to the subjects. To overcome such difficulties, a noninvasive method is much needed around the globe for primary screening. A change in body temperature is an indication of various diseases. Infrared thermal imaging is relatively a novel technique for skin temperature measurement and turned out to be well known in the medical field due to being noninvasive, risk-free, and repeatable. According to traditional Chinese medicine, the human tongue is a sensitive mirror that reflects the body's pathophysiological condition. So, we have (i) analysed and classified diabetes based on thermal variations at human tongue, (ii) segmented the hot spot regions from tongue thermogram by RGB (red, green, blue) based color histogram image segmentation method and extracted the features using gray level co-occurrence matrix algorithm, (iii) classified normal and diabetes using various machine learning algorithms, and (iv) developed computer aided diagnostic system to classify diabetes mellitus. The baseline measurements and tongue thermograms were obtained from 140 subjects. The measured tongue surface temperature of the diabetic group was found to be greater than normal. The statistical correlation between the HbA_1c and the thermal distribution in the tongue region was found to be r² = 0.5688. The Convolutional Neural Network has outperformed the other classifiers with 94.28% accuracy rate. Thus, tongue thermograms could be used as a preliminary screening approach for diabetes prognosis.

Validating the Short Form-12 and the development of disease-specific norms in a cohort of Australian private health insurance members

Despite the large number of Australians with private health insurance (PHI), normative quality-of-life data are not available for this population. The Short Form (SF)-12 has been used to characterise the health-related quality of life of Australians in the general population, but there is debate concerning the appropriate algorithm that should be used to calculate its physical and mental component summary scores. The standard (orthogonal method) approach assumes that the mental and physical components are unrelated, whereas an alternate approach (the correlated method) assumes that the two components are related. A consecutive sample of 24957 PHI members with four major initial disease conditions were administered the SF-12 via phone and 4330 participants were followed up at a mean of 16 months after the first survey. The SF-12 was scored using both the orthogonal and correlated methods, and both scoring models were assessed for model fit and ability to discriminate between the four major disease conditions. Confirmatory factor analysis demonstrated superior model fit and improved discriminative validity when the SF-12 was scored using the correlated method instead of the default orthogonal method. Further, the correlated method demonstrated utility by producing scores that were responsive to change over time.

Validation of Brunei's Malay EQ-5D Questionnaire in Patients with Type 2 Diabetes

Background

The Malay spoken in Brunei a South East Asian country where Malay is the national language is distinctive and different from Malay spoken in Malaysia, Singapore and Indonesia. This study aimed to develop a Brunei Malay version of the 5-level EQ-5D questionnaire (EQ-5D-5L) and to assess its psychometric properties among patients with type 2 diabetes mellitus (T2DM).

Methods

The Brunei Malay EQ-5D-5L was developed by culturally adapting two existing Malay versions. A total of 154 Bruneians with T2DM completed the questionnaire in two different points of time with one week apart. Known-groups validity of the utility-based EQ-5D-5L index and visual analogue scale (EQ-VAS) was evaluated by comparing subgroups of patients known to differ in health status. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) or Cohen’s kappa.

Results

As hypothesized, patients known to have ‘better’ health had higher EQ-5D-5L index scores than those having ‘worse’ health in all 7 known-groups comparisons. The hypothesized difference in the EQ-VAS scores was observed in only 4 of the 7 known-groups comparisons. Kappa values ranged from 0.206 to 0.446 for the EQ-5D-5L items; the ICC value for the EQ-5D-5L index and EQ-VAS was 0.626 and 0.521, respectively.

Conclusions

The utility-based EQ-5D-5L index appears to be valid and reliable for measuring the health of Brunei patients with T2DM. The validity of the EQ-VAS in Brunei requires further investigation.