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Kong D, Chen R, Chen Y, Zhao L, Huang R, Luo L, Lai F, Yang Z, Wang S, Zhang J, Chen H, Mai Z, Yu H, Wu K, Ding Y. Bayesian network analysis of factors influencing type 2 diabetes, coronary heart disease, and their comorbidities. BMC Public Health 2024; 24:1267. [PMID: 38720267 PMCID: PMC11080276 DOI: 10.1186/s12889-024-18737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Bayesian network (BN) models were developed to explore the specific relationships between influencing factors and type 2 diabetes mellitus (T2DM), coronary heart disease (CAD), and their comorbidities. The aim was to predict disease occurrence and diagnose etiology using these models, thereby informing the development of effective prevention and control strategies for T2DM, CAD, and their comorbidities. METHOD Employing a case-control design, the study compared individuals with T2DM, CAD, and their comorbidities (case group) with healthy counterparts (control group). Univariate and multivariate Logistic regression analyses were conducted to identify disease-influencing factors. The BN structure was learned using the Tabu search algorithm, with parameter estimation achieved through maximum likelihood estimation. The predictive performance of the BN model was assessed using the confusion matrix, and Netica software was utilized for visual prediction and diagnosis. RESULT The study involved 3,824 participants, including 1,175 controls, 1,163 T2DM cases, 982 CAD cases, and 504 comorbidity cases. The BN model unveiled factors directly and indirectly impacting T2DM, such as age, region, education level, and family history (FH). Variables like exercise, LDL-C, TC, fruit, and sweet food intake exhibited direct effects, while smoking, alcohol consumption, occupation, heart rate, HDL-C, meat, and staple food intake had indirect effects. Similarly, for CAD, factors with direct and indirect effects included age, smoking, SBP, exercise, meat, and fruit intake, while sleeping time and heart rate showed direct effects. Regarding T2DM and CAD comorbidities, age, FBG, SBP, fruit, and sweet intake demonstrated both direct and indirect effects, whereas exercise and HDL-C exhibited direct effects, and region, education level, DBP, and TC showed indirect effects. CONCLUSION The BN model constructed using the Tabu search algorithm showcased robust predictive performance, reliability, and applicability in forecasting disease probabilities for T2DM, CAD, and their comorbidities. These findings offer valuable insights for enhancing prevention and control strategies and exploring the application of BN in predicting and diagnosing chronic diseases.
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Affiliation(s)
- Danli Kong
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Rong Chen
- Department of Infection Control, Ankang Hospital of Traditional Chinese Medicine, Ankang, 725000, Shaanxi, China
| | - Yongze Chen
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
- Department of Gastroenterology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524002, Guangdong, China
| | - Le Zhao
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Ruixian Huang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Ling Luo
- School of Public Health and Emergency Management, South University of Science and Technology of China, Shenzhen, 518055, Guangdong, China
| | - Fengxia Lai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Zihua Yang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Shuang Wang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Jingjing Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Hao Chen
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China
| | - Zhenhua Mai
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China.
- Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University Zhanjiang, Zhanjiang, 524001, China.
| | - Haibing Yu
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China.
| | - Keng Wu
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China.
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524002, Guangdong, China.
| | - Yuanlin Ding
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, 523808, Guangdong, China.
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Panchal K, Lawson C, Chandramouli C, Lam C, Khunti K, Zaccardi F. Diabetes and risk of heart failure in people with and without cardiovascular disease: systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 207:111054. [PMID: 38104900 DOI: 10.1016/j.diabres.2023.111054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/06/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND People with diabetes have an increased risk of heart failure (HF), compared to those without diabetes. However, no comprehensive systematic review and meta-analysis has explored whether these associations could differ in relation to prevalent cardiovascular disease (CVD). AIMS To estimate the association between diabetes and incident heart failure (HF), compared to without diabetes, in individuals with and without CVD. METHODS PubMed, Scopus, and Web of Science were searched for observational cohort studies from the earliest dates to 22nd March 2023. A random-effects model calculated the pooled relative risk (RR). RESULTS Of 11,609 articles, 31 and 6 studies reported data in people with type 2 diabetes (T2D) and type 1 diabetes (T1D) respectively. Individuals with T2D had an increased risk of HF irrespective of CVD prevalence: 1.61 (95% CI: 1.35-1.92) in those with CVD; 1.78 (1.60-1.99) without CVD; and 2.02 (1.75-2.33) with unspecified CVD prevalence. Meta-regression did not identify a significant difference comparing HF risk in T2D individuals with vs. without CVD (p = 0.232). CONCLUSION Peoplewith T2D, compared to those without diabetes, have similar increased risk of HF, regardless of CVD prevalence. Strategiesproven to lower HF risk in T2D individuals should be prioritized for those with and without CVD.
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Affiliation(s)
- Kajal Panchal
- University of Leicester, Leicester Diabetes Centre, UK.
| | - Claire Lawson
- University of Leicester, Department of Cardiovascular Sciences, UK.
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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Li CY. Pregnancy is associated with more severe injuries from motor vehicle crashes. J Formos Med Assoc 2023:S0929-6646(23)00489-8. [PMID: 38129265 DOI: 10.1016/j.jfma.2023.12.009] [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: 08/31/2023] [Revised: 11/21/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Whether pregnancy is associated with severe injuries from motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate the potential relationship between pregnancy and severity of injuries from MVCs. METHODS We identified a total of 23,559 pregnant women victims who encountered MVCs during pregnancy as well as 94,236 age- and calendar year-at MVC matched non-pregnant women victims that are also involved in MVCs. Injury severity was assessed using the Maximum Abbreviated Injury Scale (MAIS) based on the diagnosis of medical claims after MVCs. Multinomial logistic regression models were used to estimate the odds ratio and corresponding 95 % CI of injury severity levels associated with pregnancy. RESULTS Pregnant women had a significantly higher risk of both severe (adjusted odds ratio, aOR = 1.79, 95 % CI = 1.54-2.08) and mild injuries (aOR = 8.63, 95 % CI = 8.21-9.07) following MVCs as compared to non-pregnant women victims. Particularly, pregnant women who were riding scooters had an increased risk of severe injury (aOR = 4.25, 95 % CI = 3.58-5.04). In addition, pregnant women who experienced MVC but without any injury were more likely to visit a clinic than non-pregnant MVC victims. CONCLUSION Pregnant women victims, particularly those who were riding scooters involved in MVCs suffered from a higher risk of severe injury as compared to their non-pregnant counterparts. Our findings suggest that women should consider avoiding riding a scooter and must use restrictive devices during pregnancy, which would help reduce the severity of injuries sustained following an MVC.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Wang Y, Hou R, Ni B, Jiang Y, Zhang Y. Development and validation of a prediction model based on machine learning algorithms for predicting the risk of heart failure in middle-aged and older US people with prediabetes or diabetes. Clin Cardiol 2023; 46:1234-1243. [PMID: 37519220 PMCID: PMC10577538 DOI: 10.1002/clc.24104] [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: 04/18/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to develop and validate a machine learning (ML) based prediction model for the risk of heart failure (HF) in patients with prediabetes or diabetes. METHODS We used 3527 subjects aged 40 years and older with a prior diagnosis of prediabetes or diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. The search for independent risk variables linked to HF was conducted using univariate and multivariable logistic regression analysis. The 3527 subjects were randomly divided into training set and validation set in a 7:3 ratio. Five ML models were built on the training set using five ML algorithms, including random forest (RF), and then validated on the validation set. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis and Bootstrap resampling method were used to measure the predictive performance of the five ML models. RESULTS Multivariate logistic regression analysis showed that age, poverty-to-income ratio, myocardial infarction condition, coronary heart disease condition, chest pain condition, and glucose-lowering medication use were independent predictors of HF. By comparing the performance of the five ML models, the RF model (AUC = 0.978) was the best prediction model. CONCLUSIONS The risk of HF in middle-aged and elderly patients with prediabetes or diabetes can be accurately predicted using ML models. The best prediction performance is presented by RF model, which can assist doctors in making clinical decisions.
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Affiliation(s)
- Yicheng Wang
- Department of Cardiovascular medicineAffiliated Fuzhou First Hospital of Fujian Medical UniversityFuzhouFujianChina
- The Third Clinical Medical CollegeFujian Medical UniversityFuzhouFujianChina
- Cardiovascular Disease Research Institute of Fuzhou CityFuzhouFujianChina
| | - Riting Hou
- Department of Cardiovascular medicineAffiliated Fuzhou First Hospital of Fujian Medical UniversityFuzhouFujianChina
- The Third Clinical Medical CollegeFujian Medical UniversityFuzhouFujianChina
- Cardiovascular Disease Research Institute of Fuzhou CityFuzhouFujianChina
| | - Binghang Ni
- Department of Cardiovascular medicineAffiliated Fuzhou First Hospital of Fujian Medical UniversityFuzhouFujianChina
- The Third Clinical Medical CollegeFujian Medical UniversityFuzhouFujianChina
- Cardiovascular Disease Research Institute of Fuzhou CityFuzhouFujianChina
| | - Yu Jiang
- Department of Cardiovascular medicineAffiliated Fuzhou First Hospital of Fujian Medical UniversityFuzhouFujianChina
- The Third Clinical Medical CollegeFujian Medical UniversityFuzhouFujianChina
- Cardiovascular Disease Research Institute of Fuzhou CityFuzhouFujianChina
| | - Yan Zhang
- Department of Cardiovascular medicineAffiliated Fuzhou First Hospital of Fujian Medical UniversityFuzhouFujianChina
- The Third Clinical Medical CollegeFujian Medical UniversityFuzhouFujianChina
- Cardiovascular Disease Research Institute of Fuzhou CityFuzhouFujianChina
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Chang YH, Hou WH, Wu KF, Li CY, Hsu IL. Risk of motorcycle collisions among patients with type 2 diabetes: a population-based cohort study with age and sex stratifications in Taiwan. Acta Diabetol 2022; 59:1625-1634. [PMID: 36103089 DOI: 10.1007/s00592-022-01967-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/29/2022] [Indexed: 11/01/2022]
Abstract
AIMS To investigate the overall and sex-age-specific absolute and relative risks of motorcycle collisions at road traffic accidents among patients with type 2 diabetes. METHODS A cohort study in Taiwan was conducted by following 989,495 patients with type 2 diabetes and the same number of matched controls recruited between 2010 and 2012 to the end of 2016. Collision events by motorcycle driver victims were identified from the Police-reported Traffic Accident Registry. Overall and sex-age-specific incidence rates of collision involving motorcycle driver victims were estimated under Poisson assumption. The Cox proportional hazard regression models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of collision in association with type 2 diabetes. RESULTS Over an up to 7 years of follow-up, patients with type 2 diabetes had a higher incidence rate of motorcycle collision than controls at 1.16 and 0.89 per 100 person-years, respectively, which represented a significantly elevated HR of 1.28 (95% CI 1.27-1.30) after adjusting for potential confounders including various diabetic complications. The elevated HR was similarly seen in both men and women patients, and was significantly decreasing with increasing age regardless of sex. Little evidence supported the dose-response relationship between duration of type 2 diabetes and motorcycle collision risk. CONCLUSIONS After adjustment for common diabetic complications and comorbidities that could impair driving performance, patients with type 2 diabetes still suffered from increased risk of motorcycle collisions, regardless of sex, but was more evident in younger than in older patients.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Hsuan Hou
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ke-Fei Wu
- Department of Accounting Information, Chihlee University of Technology, New Taipei, Taiwan
- Department of Business Management, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Hou WH, Chang YH, Hendrati LY, Isfandiari MA, Li CY, Hsu IL. Evaluation of motor vehicle crashes between scooter riders and car drivers after diagnosis of type 2 diabetes in Taiwan. Injury 2022; 53:3950-3955. [PMID: 36224056 DOI: 10.1016/j.injury.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the plausibility that diabetes may increase the risk of motor vehicle crashes (MVCs) due to various diabetes related complications and co-morbidity, findings from epidemiological studies on the relationship between diabetes and MVCs remained inclusive mainly due to heterogeneity in the study design and failure to complete consideration of potential confounders. This study re-visited this putative association with an improved study design. METHOD This study employed a controlled before-after study design and included 1,264,280 people aged 18-75 years with T2D newly diagnosed from 2009-2014 and an equal number of age-, sex-, and time-matched controls. The rate ratios (RRs) of vehicle type-specific incidence rates of MVCs in the 1 and 2 years before and after diabetes diagnosis (or the matched dates) were compared between the individuals with type 2 diabetes (T2D) and their matched controls. RESULTS The rate of MVCs increased slightly among people with T2D over 1 and 2 years following diabetes diagnosis, with RRs of 1.04 (95% confidence interval [CI]=1.02-1.07) and 1.11 (95% CI=1.09-1.13), respectively. These RRs were comparable to those obtained for controls (1.06 and 1.12, respectively). By contrast, the RRs of scooter crashes were significantly higher in the T2D group than in the control group during the 1 year (1.28 vs. 1.08, p < 0.001) and 2 years (1.32 vs. 1.08, p < 0.001) following diabetes diagnosis. CONCLUSION T2D diagnosis was associated with a moderate but significant increase in the risk of MVCs among scooter drivers, but not among car drivers.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lucia Yovita Hendrati
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Muhammad Atoillah Isfandiari
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, University of Airlangga, Surabaya, Indonesia; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Hou WH, Moo CC, Kuo TL, Kuo CL, Chu SY, Wu KF, Chen LW, Li CY. Schizophrenia, but not depression or bipolar affective disorder, adds additional risk of aspiration pneumonia among stroke survivors: A national cohort study in Taiwan. J Psychosom Res 2022; 162:111033. [PMID: 36115193 DOI: 10.1016/j.jpsychores.2022.111033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Few studies have assessed the sex-specific and age-specific risk of aspiration pneumonia (AP) in patients with stroke and evaluated whether mental disorders may increase this risk. In this population-based cohort study, we investigated the sex-specific and age-specific risk of AP in association with stroke and the joint effects of stroke and mental disorders on the risk of AP. METHODS We included 23,288 patients with incident stroke admitted between 2005 and 2017 and 68,675 matched nonstroke controls. Information on mental disorders was obtained from medical claims data within the 3 years before the stroke incidence. Cox proportional hazards models considering death as a competing risk event were constructed to estimate the hazard ratio of AP incidence by the end of 2018 associated with stroke and selected mental disorders. RESULTS After ≤14 years of follow-up, AP incidence was higher in the patients with stroke than in the controls (11.30/1000 vs. 1.51/1000 person-years), representing a covariate-adjusted subdistribution hazard ratio (sHR) of 3.64, with no significant sex difference. The sHR significantly decreased with increasing age in both sexes. Stratified analyses indicated schizophrenia but not depression or bipolar affective disorder increased the risk of AP in the patients with stroke. CONCLUSION Compared with their corresponding counterparts, the patients with schizophrenia only, stroke only, and both stroke and schizophrenia had a significantly higher sHR of 4.01, 5.16, and 8.01, respectively. The risk of AP was higher in younger stroke patients than those older than 60 years. Moreover, schizophrenia was found to increase the risk of AP in patients with stroke.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cherl Cy Moo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Teng-Lung Kuo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Lun Kuo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ke-Fei Wu
- Department of Business Management, National Taichung University of Science and Technology, Taichung, Taiwan; Department of Accounting Information, Chihlee University of Technology, New Taipei City, Taiwan
| | - Liang-Wu Chen
- Department of Chest, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Relationship Between Epicardial Adipose Tissue and Biventricular Longitudinal Strain and Strain Rate in Patients with Type 2 Diabetes Mellitus. Acad Radiol 2022; 30:833-840. [PMID: 36115736 DOI: 10.1016/j.acra.2022.08.019] [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: 07/03/2022] [Revised: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) has been reported to be increased in patients with type 2 diabetes mellitus (T2DM). EAT thickness may impact left ventricular (LV) diastolic function. However, the association between EAT and right ventricular (RV) function in T2DM is unclear. We hypothesized an association between EAT volume and biventricular longitudinal strain and strain rate in patients with T2DM. MATERIALS AND METHODS A total of 20 controls and 69 T2DM patients with preserved LV ejection fraction (EF) who underwent cardiac magnetic resonance (CMR) were included. Biventricular function was evaluated by CMR Tissue-Tracking derived strain analysis, including LV global peak systolic longitudinal strain (LVGLS), peak diastolic longitudinal strain rate (LVLSR), RVGLS and RVLSR. RESULTS Compared to controls, patients with T2DM had significantly higher EAT volumes with lower LVGLS, LVLSR, RVGLS and RVLSR (all p<0.05). EAT volume was significantly correlated with LVGLS, LVLSR, RVGLS and RVLSR in T2DM patients (r=-0.45, -0.39, -0.59, -0.50, all p<0.001). Multivariate linear regression analysis revealed that EAT volume was significantly associated with LVGLS (β=0.38, p=0.001), LVLSR (β=-0.35, p=0.003), RVGLS (β=0.64, p<0.001) and RVLSR (β=-0.43, p<0.001) independently of traditional risk factors in patients with T2DM. CONCLUSION Patients with T2DM had higher EAT levels and lower biventricular function than controls. EAT volume was independently associated with biventricular longitudinal strain and strain rate in T2DM patients.
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Hou WH, Wu JL, Lu CL, Sulistyorini L, Isfandiari MA, Chiu CT, Li CY. Associations of hyperglycemic emergency and severe hypoglycemia incidences with seasonality and ambient temperature among pregnant women with diabetes: a nested case-control study in Taiwan. Environ Health Prev Med 2022; 27:11. [PMID: 35288489 PMCID: PMC9093638 DOI: 10.1265/ehpm.22-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Associations of acute glycemic complications with season and ambient temperature have been reported in general population with diabetes. However, little is known about the risks of acute glycemic complications in relation to season and ambient temperature in pregnant women, who are likely to be even more vulnerable. This work aimed to investigate the associations of season and ambient temperature with pregnancies complicated with hyperglycemia emergency or severe hypoglycemia. Methods Two separate case-control studies were nested within 150,153 pregnancies by women with type 1, type 2, or gestational diabetes between 2009 and 2014 in Taiwan. Hyperglycemia emergency (mainly diabetic ketoacidosis and hyperosmolar hyperglycemic state) and severe hypoglycemia occurred in 77 and 153 diabetic pregnancies (cases), respectively. Ten control pregnancies were randomly selected for each case by matching each case pregnancy on type of diabetes (i.e., T1DM, T2DM, or GDM), maternal age on the date of acute glycemic complication occurrence (i.e., index date), and “length of gestation at risk” (i.e., period between conception and index date). Meteorological parameters were retrieved from 542 meteorological monitoring stations across Taiwan during 2008–2014. Conditional logistic regression analysis with generalized estimation equation was separately performed to estimate the covariate adjusted odds ratios (ORs) of each of the two acute glycemic complications in association with season and ambient temperature within 30 days prior to the index date. Results Compared to summer, winter season was associated with a significantly elevated risk of severe hypoglycemia with an OR of 1.74 (95% confidence interval (CI) 1.08–2.79). The OR of hyperglycemic emergency was also elevated in winter season at OR of 1.88, but the significance is only marginal (95% CI 0.97–3.64, p = 0.0598). Subgroup analyses further noted that such seasonal variation was also observed in pregnancies with pre-pregnancy type 1 diabetes and gestational diabetes. On the other hand, ambient temperature was not significantly associated with the two acute glycemic complications. Conclusions A moderately but significantly elevated risk of severe hypoglycemia was found in pregnant women with diabetes during winter season, and such increased risk was more evident in pregnancies with T1DM. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00003.
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Affiliation(s)
- Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital
| | - Jia-Ling Wu
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University
| | - Lilis Sulistyorini
- Department of Environmental Health, Faculty of Public Health, Universitas Airlangga
| | | | - Chang-Ta Chiu
- Department of Dentistry, An Nan Hospital, China Medical University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University
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Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan. Healthcare (Basel) 2021; 9:healthcare9111402. [PMID: 34828449 PMCID: PMC8625753 DOI: 10.3390/healthcare9111402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022] Open
Abstract
(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.
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Lu CL, Chang YH, Martini S, Chang MF, Li CY. Overall and Cause-Specific Mortality in Patients With Type 1 Diabetes Mellitus: A Population-Based Cohort Study in Taiwan From 1998 Through 2014. J Epidemiol 2021; 31:503-510. [PMID: 32741854 PMCID: PMC8328860 DOI: 10.2188/jea.je20200026] [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] [Indexed: 12/02/2022] Open
Abstract
Background To investigate all-cause and cause-specific mortality in Taiwanese patients with type 1 diabetes. Methods A cohort of 17,203 patients with type 1 diabetes were identified from Taiwan’s National Health Insurance claims in the period of 1998–2014. Person-years were accumulated for each individual from date of type 1 diabetes registration to date of death or the last day of 2014. Age, sex, and calendar year standardized mortality ratios (SMRs) were calculated with reference to the general population. Results In up to 17 years of follow-up, 4,916 patients died from 182,523 person-years. Diabetes (30.15%), cancer (20.48%), circulatory diseases (13.14%), and renal diseases (11.45%) were the leading underlying causes of death. Mortality rate (26.93 per 1,000 person-years) from type 1 diabetes in Taiwan was high, the cause of death with the highest mortality rate was diabetes (8.12 per 1,000 person-years), followed by cancer (5.52 per 1,000 person-years), and circulatory diseases (3.54 per 1,000 person-years). The all-cause SMR was significantly elevated at 4.16 (95% confidence interval, 4.04–4.28), with a greater all-cause SMR noted in females than in males (4.62 vs 3.79). The cause-specific SMR was highly elevated for diabetes (SMR, 16.45), followed by renal disease (SMR, 14.48), chronic hepatitis and liver cirrhosis (SMR, 4.91) and infection (SMR, 4.59). All-cause SMRs were also significantly increased for all ages, with the greatest figure noted for 15–24 years (SMR, 8.46). Conclusions Type 1 diabetes in both genders and all ages was associated with significantly elevated SMRs for all-cause and mostly for diabetes per se and renal disease.
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Affiliation(s)
- Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga
| | | | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University.,Department of Epidemiology, Faculty of Public Health, Universitas Airlangga.,Department of Public Health, College of Public Health, China Medical University.,Department of Healthcare Administration, College of Medical and Health Science, Asia University
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12
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Lin YT, Huang WL, Wu HP, Chang MP, Chen CC. Association of Mean and Variability of HbA1c with Heart Failure in Patients with Type 2 Diabetes. J Clin Med 2021; 10:jcm10071401. [PMID: 33915706 PMCID: PMC8037774 DOI: 10.3390/jcm10071401] [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: 02/18/2021] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
Heart failure (HF) is a common presentation in patients with type 2 diabetes mellitus (T2DM). Previous studies revealed that the HbA1c level is significantly associated with HF. However, little is known about the association between HbA1c variability and HF. We aimed to evaluate the association of mean and variability of HbA1c with HF in patients with T2DM. Using Diabetes Share Care Program data, patients with T2DM who had mean HbA1c (HbA1c-Mean), and HbA1c variability (tertiles of HbA1c-SD and HbA1c-adjSD) within 12–24 months during 2001–2008 were included. The cutoffs of HbA1c-Mean were set at <7%, 7–7.9%, and ≥8%. Hazard ratios (HRs) for HF during 2008–2018 were estimated using Cox proportional hazard models. A total of 3824 patients were included, of whom 315 patients developed HF during the observation period of 11.72 years. The associated risk of HF increased with tertiles of HbA1c variability and cutoffs of HbA1c-Mean. In mutually adjusted models, HbA1c-Mean showed a consistent dose-response association with HF, while the association of HbA1c variability with HF disappeared. Among patients with HbA1c-Mean <7%, the associated risk of HF in patients with HbA1c variability in tertile 3 was comparable to patients with HbA1c-Mean ≥8%. In conclusion, mean HbA1c was an independent predictor of HF and not explained by HbA1c variability. In addition to absolute HbA1c level, targeting on stability of HbA1c in patients with good glycemic control was also important for the development of HF in patients with T2DM.
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Affiliation(s)
- You-Ting Lin
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (Y.-T.L.); (W.-L.H.)
- Department of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Wei-Lun Huang
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (Y.-T.L.); (W.-L.H.)
- Department of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Hung-Pin Wu
- Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Man-Ping Chang
- Department of Nursing, National Taichung University of Science and Technology, Taichung 40354, Taiwan;
| | - Ching-Chu Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (Y.-T.L.); (W.-L.H.)
- School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-4-2206-2121 (ext. 4676)
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13
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Kohsaka S, Kumamaru H, Nishimura S, Shoji S, Nakatani E, Ichihara N, Yamamoto H, Miyachi Y, Miyata H. Incidence of adverse cardiovascular events in type 2 diabetes mellitus patients after initiation of glucose-lowering agents: A population-based community study from the Shizuoka Kokuho database. J Diabetes Investig 2021; 12:1452-1461. [PMID: 33345452 PMCID: PMC8354514 DOI: 10.1111/jdi.13485] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 01/14/2023] Open
Abstract
Aims/Introduction Increased incidence of hospitalization for heart failure (HHF) among patients with diabetes is increasingly being reported. We investigated the incidence of adverse cardiovascular events including HHF among patients with type 2 diabetes mellitus, and the potential clinical improvement with sodium–glucose cotransporter 2 inhibitors (SGLT2i) using a contemporary administrative claims database from a large governmental district of Japan. Materials and Methods We included initiators of any oral glucose‐lowering drugs between 2013 and 2018. We estimated the 5‐year cumulative incidence of hospitalization for HF, myocardial infarction and stroke, treating death as a competing risk. We evaluated the possible impact of introducing SGLT2i to the potential recipients of the drug, using the inclusion criteria from Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA‐REG OUTCOME) and Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE‐TIMI 58) trials, assuming the same risk reduction as theirs. Results Among 23,340 drug initiators (54.0% men, and 6.4% aged >85 years), the 5‐year cumulative incidence was 5.4% (95% confidence interval 4.9–5.9%) for HHF, 1.9% (95% confidence interval 1.7–2.2%) for myocardial infarction admission and 6.1% (95% confidence interval 5.7–6.6%) for stroke admission. Among 6,192 patients with laboratory test data, 651 (10.5%) and 2,680 (43.3%) patients met the EMPA‐REG‐like and DECLARE‐like criteria, respectively. The 5‐year cumulative incidence among the 2,849 patients meeting either of the criteria was estimated to decrease from 97.1 to 75.6 events through 75% adoption of SGLT2i. Conclusions The incidence of HHF was similar to that of stroke. A significant portion of our cohort met the inclusion criteria for major randomized clinical trials for SGLT2i, and estimated reduction in the HHF events was substantial.
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Affiliation(s)
- Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiraku Kumamaru
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shiori Nishimura
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Nakatani
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Nao Ichihara
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Yamamoto
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiki Miyachi
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroaki Miyata
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan.,Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
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14
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Ma CM, Wang N, Su QW, Yan Y, Yin FZ. The Performance of CURB-65 and PSI for Predicting In-Hospital Mortality of Community-Acquired Pneumonia in Patients with Type 2 Diabetes Compared with the Non-Diabetic Population. Diabetes Metab Syndr Obes 2021; 14:1359-1366. [PMID: 33790603 PMCID: PMC8001112 DOI: 10.2147/dmso.s303124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/08/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To compare the performance of CURB-65 and Pneumonia Severity Index (PSI) for predicting in-hospital mortality of community-acquired pneumonia (CAP) between patients with and without type 2 diabetes (T2DM). METHODS A retrospective study was conducted on 2365 CAP patients in The First Hospital of Qinhuangdao, China. The primary outcome was in-hospital mortality. The area under curves (AUCs) was used to evaluate the abilities of CRB-65, CURB-65, and PSI class for predicting in-hospital mortality in patients with CAP. RESULTS Among CAP patients, 127 patients (5.4%) died, 80 patients were without diabetes, and 47 patients had T2DM. In-hospital mortality increased with the risk stratification defined as CURB-65 and PSI class in both non-diabetes and T2DM patients (P<0.05). The AUCs for predicting in-hospital mortality were 0.728~0.798 in patients without T2DM (CRB-65: 0.728, CURB-65: 0.757 and PSI class: 0.798) and 0.641~0.716 in patients with T2DM (CRB-65: 0.641, CURB-65: 0.677 and PSI class: 0.716)(P<0.001). The AUC of the PSI class was lower in patients with T2DM than in patients without T2DM (P<0.05). CONCLUSION CURB-65 and PSI class are correlated with in-hospital mortality of CAP in patients with and without T2DM. Compared with non-diabetes patients, the predictive performance of CURB-65 and PSI class decreased in patients with T2DM. A prediction model for evaluating the CAP severity in the T2DM population should be developed by future studies.
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Affiliation(s)
- Chun-Ming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China
| | - Ning Wang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Quan-Wei Su
- Department of Internal Medicine, Chengde Medical College, Chengde, Hebei, People’s Republic of China
| | - Ying Yan
- Department of Internal Medicine, Chengde Medical College, Chengde, Hebei, People’s Republic of China
| | - Fu-Zai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China
- Correspondence: Fu-Zai Yin Email
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15
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Chen HF, Chang YH, Lo HJ, Isfandiari MA, Martini S, Hou WH, Li CY. Incidence of idiopathic cardiomyopathy in patients with type 2 diabetes in Taiwan: age, sex, and urbanization status-stratified analysis. Cardiovasc Diabetol 2020; 19:177. [PMID: 33054769 PMCID: PMC7558694 DOI: 10.1186/s12933-020-01144-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background The epidemiology of diabetes and idiopathic cardiomyopathy have limited data. We investigated the overall and the age-, sex-, and urbanization-specific incidence and relative hazard of idiopathic cardiomyopathy in association with type 2 diabetes and various anti-diabetic medications used in Taiwan. Methods A total of 474,268 patients with type 2 diabetes were identified from ambulatory care and inpatient claims in 2007–2009 from Taiwan’s National Health Insurance (NHI) database. We randomly selected 474,266 age-, sex-, and diagnosis date-matched controls from the registry of NHI beneficiaries. All study subjects were linked to ambulatory care and inpatient claims (up to the end of 2016) to identify the possible diagnosis of idiopathic cardiomyopathy. The person-year approach with Poisson assumption was used to estimate the incidence, and Cox proportional hazard regression model with Fine and Gray’s method was used to estimate the relative hazards of idiopathic cardiomyopathy in relation to type 2 diabetes. Results The overall incidence of idiopathic cardiomyopathy for men and women patients, respectively, was 3.83 and 2.94 per 10,000 person-years, which were higher than the corresponding men and women controls (2.00 and 1.34 per 10,000 person-years). Compared with the control group, patients with type 2 diabetes were significantly associated with an increased hazard of idiopathic cardiomyopathy (adjusted hazard ratio [aHR]: 1.60, 95% confidence interval [CI]: 1.45–1.77] in all age and sex stratifications except in those men aged > 64 years. Patients with type 2 diabetes aged < 45 years confronted the greatest increase in the hazard of idiopathic cardiomyopathy, with an aHR of 3.35 (95% CI 2.21–5.06) and 3.48 (95% CI 1.60–7.56) for men and women, respectively. The usage of some anti-diabetic medications revealed lower risks of idiopathic cardiomyopathy. Conclusions In Taiwan, diabetes increased the risk of idiopathic cardiomyopathy in both sexes and in all age groups, except in men aged > 64 years. Younger patients were vulnerable to have higher HRs of idiopathic cardiomyopathy. Some anti-diabetic medications may reduce the risks of cardiomyopathy.
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Affiliation(s)
- Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,School of Medicine and Department of Public Health, College of Medicine, Fujen Catholic University, New Taipei City, Taiwan
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsien-Jung Lo
- Department of Cardiology, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | | | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.,Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia. .,Department of Public Health, College of Public Health, China Medical University, Taichung City, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung City, Taiwan.
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16
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Kodama S, Fujihara K, Horikawa C, Sato T, Iwanaga M, Yamada T, Kato K, Watanabe K, Shimano H, Izumi T, Sone H. Diabetes mellitus and risk of new-onset and recurrent heart failure: a systematic review and meta-analysis. ESC Heart Fail 2020; 7:2146-2174. [PMID: 32725969 PMCID: PMC7524078 DOI: 10.1002/ehf2.12782] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Despite mounting evidence of the positive relationship between diabetes mellitus (DM) and heart failure (HF), the entire context of the magnitude of risk for HF in relation to DM remains insufficiently understood. The principal reason is because new‐onset HF (HF occurring in participants without a history of HF) and recurrent HF (HF re‐occurring in patients with a history of HF) are not discriminated. This meta‐analysis aims to comprehensively and separately assess the risk of new‐onset and recurrent HF depending on the presence or absence of DM. We systematically searched cohort studies that examined the relationship between DM and new‐onset or recurrent HF using EMBASE and MEDLINE (from 1 Jan 1950 to 28 Jul 2019). The risk ratio (RR) for HF in individuals with DM compared with those without DM was pooled with a random‐effects model. Seventy‐four and 38 eligible studies presented data on RRs for new‐onset and recurrent HF, respectively. For new‐onset HF, the pooled RR [95% confidence interval (CI)] of 69 studies that examined HF as a whole [i.e. combining HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)] was 2.14 (1.96–2.34). The large between‐study heterogeneity (I2 = 99.7%, P < 0.001) was significantly explained by mean age [pooled RR (95% CI) 2.60 (2.38–2.84) for mean age < 60 years vs. pooled RR (95% CI) 1.95 (1.79–2.13) for mean age ≥ 60 years] (P < 0.001). Pooled RRs (95% CI) of seven and eight studies, respectively, that separately examined HFpEF and HFrEF risk were 2.22 (2.02–2.43) for HFpEF and 2.73 (2.71–2.75) for HFrEF. The risk magnitudes between HFpEF and HFrEF were not significantly different in studies that examined both HFpEF and HFrEF risks (P = 0.86). For recurrent HF, pooled RR (95% CI) of the 38 studies was 1.39 (1.33–1.45). The large between‐study heterogeneity (I2 = 80.1%, P < 0.001) was significantly explained by the proportion of men [pooled RR (95% CI) 1.53 (1.40–1.68) for < 65% men vs. 1.32 (1.25–1.39) for ≥65% men (P = 0.01)] or the large pooled RR for studies of only participants with HFpEF [pooled RR (95% CI), 1.73 (1.32–2.26) (P = 0.002)]. Results indicate that DM is a significant risk factor for both new‐onset and recurrent HF. It is suggested that the risk magnitude is large for new‐onset HF especially in young populations and for recurrent HF especially in women or individuals with HFpEF. DM is associated with future HFpEF and HFrEF to the same extent.
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Affiliation(s)
- Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuya Fujihara
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Chika Horikawa
- Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata, Japan
| | - Takaaki Sato
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Midori Iwanaga
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.,Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takaho Yamada
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Kiminori Kato
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenichi Watanabe
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Shimano
- Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tohru Izumi
- Department of Cardiology, Niigata Minami Hospital, Niigata, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan.,Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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17
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Chang YH, Lu TH, Hsu IL, Chen BL, Li CY. Risk of 30-day mortality and its association with alcohol concentration level among driver victims of motor vehicle crashes: comparison of population- and hospital-based designs. J Epidemiol Community Health 2020; 74:815-823. [PMID: 32546546 DOI: 10.1136/jech-2020-213953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 05/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although blood alcohol concentration (BAC) is undoubtedly associated with increased risk of injury among driver victims involved in motor vehicle crashes (MVCs), some studies noted that high BAC was associated with reduced risk of mortality after injury. In addition, most of the previous studies included only injured patients admitted, which may lead to potential selection bias arising from exclusion of those with minor injury and those who died at the accident scene of MVC. METHOD The population-based design included 2586 driver victims with BAC equivalent >0 and 10 307 matched controls (BAC equivalent =0) selected from the Police-reported Traffic Accident Registry from 1 July to 31 December 2016 in Taiwan. The hospital-based design comprised a subset sample, which included 517 driver victims with BAC equivalent >0 and 662 with BAC equivalent =0 hospitalised on the same day the MVCs occurred. Conditional logistic regression models with adjustment for potential confounders were used to estimate the ORs and 95% CIs of 30-day mortality associated with BAC equivalent level. RESULTS In the population-based design, a positive dose-gradient relationship was observed between BAC equivalent level and 30-day mortality, with a covariate-adjusted OR of 3.77 (95% CI 1.84 to 7.72), 6.19 (95% CI 3.13 to 12.26) and 7.75 (95% CI 4.51 to 13.32) for low, moderate and high BAC equivalent levels, respectively. By contrast, the hospital-based design revealed no significant association between 30-day mortality and alcohol concentration regardless of the BAC equivalent level. CONCLUSION The association between BAC equivalent level and short-term mortality could have been overlooked in hospital-based studies that excluded MVC-related deaths outside hospital settings.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bae-Ling Chen
- College of Intelligence, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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18
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Butler J, Handelsman Y, Bakris G, Verma S. Use of sodium–glucose co‐transporter‐2 inhibitors in patients with and without type 2 diabetes: implications for incident and prevalent heart failure. Eur J Heart Fail 2020; 22:604-617. [DOI: 10.1002/ejhf.1708] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/18/2019] [Accepted: 11/13/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Javed Butler
- University of Mississippi Medical Center Jackson MS USA
| | | | - George Bakris
- Department of Medicine The University of Chicago Medicine Chicago IL USA
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital University of Toronto Toronto ON Canada
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19
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Christensen RH, von Scholten BJ, Lehrskov LL, Rossing P, Jørgensen PG. Epicardial adipose tissue: an emerging biomarker of cardiovascular complications in type 2 diabetes? Ther Adv Endocrinol Metab 2020; 11:2042018820928824. [PMID: 32518616 PMCID: PMC7252363 DOI: 10.1177/2042018820928824] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/03/2020] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes (T2D) is associated with an increased risk of cardiovascular disease and heart failure, which highlights the need for improved understanding of factors contributing to the pathophysiology of these complications as they are the leading cause of mortality in T2D. Patients with T2D have high levels of epicardial adipose tissue (EAT). EAT is known to secrete inflammatory factors, lipid metabolites, and has been proposed to apply mechanical stress on the cardiac muscle that may accelerate atherosclerosis, cardiac remodeling, and heart failure. High levels of EAT in patients with T2D have been associated with atherosclerosis, diastolic dysfunction, and incident cardiovascular events, and this fat depot has been suggested as an important link coupling diabetes, obesity, and cardiovascular disease. Despite this, the predictive potential of EAT in general, and in patients with diabetes, is yet to be established, and, up until now, the clinical relevance of EAT is therefore limited. Should this link be established, importantly, studies show that this fat depot can be modified both by pharmacological and lifestyle interventions. In this review, we first introduce the role of adipose tissue in T2D and present mechanisms involved in the pathophysiology of EAT and pericardial adipose tissue (PAT) in general, and in patients with T2D. Next, we summarize the evidence that these fat depots are elevated in patients with T2D, and discuss whether they might drive the high cardiometabolic risk in patients with T2D. Finally, we discuss the clinical potential of cardiac adipose tissues, address means to target this depot, and briefly touch upon underlying mechanisms and future research questions.
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Affiliation(s)
| | | | - Louise Lang Lehrskov
- Center for Inflammation and Metabolism/Center for Physical Activity Research, Rigshospitalet, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ohkuma T, Komorita Y, Peters SAE, Woodward M. Diabetes as a risk factor for heart failure in women and men: a systematic review and meta-analysis of 47 cohorts including 12 million individuals. Diabetologia 2019; 62:1550-1560. [PMID: 31317230 PMCID: PMC6677875 DOI: 10.1007/s00125-019-4926-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The prevalence of diabetes and heart failure is increasing, and diabetes has been associated with an increased risk of heart failure. However, whether diabetes confers the same excess risk of heart failure in women and men is unknown. The aim of this study was to conduct a comprehensive systematic review with meta-analysis of possible sex differences in the excess risk of heart failure consequent to diabetes. Our null hypothesis was that there is no such sex difference. METHODS A systematic search was conducted in PubMed for population-based cohort studies published between January 1966 and November 2018. Studies were selected if they reported sex-specific estimates of RRs for heart failure associated with diabetes, and its associated variability, which were adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain pooled sex-specific RRs and women-to-men ratio of RRs (RRRs) for heart failure associated with diabetes. RESULTS Data from 47 cohorts, involving 12,142,998 individuals and 253,260 heart failure events, were included. The pooled multiple-adjusted RR for heart failure associated with type 1 diabetes was 5.15 (95% CI 3.43, 7.74) in women and 3.47 (2.57, 4.69) in men, leading to an RRR of 1.47 (1.44, 1.90). Corresponding pooled RRs for heart failure associated with type 2 diabetes were 1.95 (1.70, 2.22) in women and 1.74 (1.55, 1.95) in men, with a pooled RRR of 1.09 (1.05, 1.13). CONCLUSIONS/INTERPRETATION The excess risk of heart failure associated with diabetes is significantly greater in women with diabetes than in men with diabetes. PROSPERO registration: CRD42019135246.
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Affiliation(s)
- Toshiaki Ohkuma
- The George Institute for Global Health, University of New South Wales, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.
| | - Yuji Komorita
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Hayes House, 75 George Street, Oxford, OX1 2BQ, UK.
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
- The George Institute for Global Health, University of Oxford, Hayes House, 75 George Street, Oxford, OX1 2BQ, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Christensen RH, Hansen CS, von Scholten BJ, Jensen MT, Pedersen BK, Schnohr P, Vilsbøll T, Rossing P, Jørgensen PG. Epicardial and pericardial adipose tissues are associated with reduced diastolic and systolic function in type 2 diabetes. Diabetes Obes Metab 2019; 21:2006-2011. [PMID: 31050126 DOI: 10.1111/dom.13758] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/19/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the association of epicardial (EAT) and pericardial (PAT) adipose tissues with myocardial function in type 2 diabetes (T2D). EAT and PAT were measured by ultrasound in 770 patients with T2D and 234 age- and sex-matched non-diabetic controls. Echocardiography was performed, including tissue Doppler imaging and 2D speckle tracking. Patients with T2D versus controls had increased EAT (4.6 ± 1.8 mm vs. 3.4 ± 1.2 mm, P < 0.0001) and PAT (6.3 ± 2.8 mm vs. 5.3 ± 2.4 mm, P < 0.0001). EAT and PAT were associated with structural cardiac measures both in T2D patients and controls (all P < 0.043), but only in T2D patients with functional measures: PAT was associated with impaired global longitudinal strain [beta coefficient (SE)] [0.11% (0.04), P = 0.002], while EAT was associated with reduced diastolic function by lateral early diastolic myocardial velocity (e'lat ) [-0.31 (0.05) cm/s, P = 0.001], mitral inflow velocities: peak early (E)/peak atrial (A) ratio [-0.02 (0.01), P = 0.001] and lateral E/e'lat [0.36 (0.10), P < 0.001]. However, no interaction was found between diabetes status and PAT (P = 0.75) or EAT (P = 0.45). Adipose tissue in intimate relation to the myocardium is higher in patients with T2D versus controls and is associated with functional myocardial measures in T2D.
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Affiliation(s)
- Regitse H Christensen
- Centre for Inflammation and Metabolism/Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- The Diabetes Complications Research Group, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Christian S Hansen
- The Diabetes Complications Research Group, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Magnus T Jensen
- Department of Cardiology, Glostrup-Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, Gentofte, Denmark
| | - Bente K Pedersen
- Centre for Inflammation and Metabolism/Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Peter Schnohr
- Department of Cardiology, Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Tina Vilsbøll
- The Diabetes Complications Research Group, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Rossing
- The Diabetes Complications Research Group, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter G Jørgensen
- Department of Cardiology, Herlev-Gentofte Hospital, Gentofte, Denmark
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Ma CM, Yin FZ. The mortality in infectious inpatients with type 2 diabetes compared with non-diabetic population: Infection in type 2 diabetes. Medicine (Baltimore) 2019; 98:e16025. [PMID: 31192954 PMCID: PMC6587657 DOI: 10.1097/md.0000000000016025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to determine the mortality in infectious inpatients with type 2 diabetes mellitus (T2DM) compared with non-diabetic population.A retrospective study was conducted on 13,916 infectious inpatients in The First Hospital of Qinhuangdao. Diabetic types were classified using International classification of Diseases-10. Mortality records were collected.The mortality was higher in patients with T2DM than patients without T2DM (T2DM 4.3% vs non-diabetes 1.7%, χ = 59.560, P < .001). In multiple logistic regression analysis, T2DM was an independent risk factor of death in infectious inpatients (OR = 1.539, 95% CI: 1.181∼2.006, P = .001). The mortalities between those with T2DM and those without T2DM were stratified by age. The mortalities of patients with T2DM were 0.0% in ∼39 years, 0.0% in 40 to 49 years, 2.7% in 50 to 59 years, 3.1% in 60 to 69 years, 4.1% in 70 to 79 years and 8.7% in 80∼ years groups. The mortalities of patients without T2DM were 0.2% in ∼39 years, 0.1% in 40 to 49 years, 0.6% in 50 to 59 years, 1.0% in 60 to 69 years, 3.1% in 70 to 79 years and 5.9% in 80∼ years groups. T2DM was an independent risk factor of death only in 60 to 69 years groups (OR = 2.323, 95% CI: 1.234∼4.372, P = .009).The increase of mortality appears earlier in patients with T2DM. Infectious inpatients with T2DM are at increased risk of death and brings heavy economic burden to patients, society and government.
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Affiliation(s)
- Chun-Ming Ma
- Department of Internal Medicine, Hebei Medical University
| | - Fu-Zai Yin
- Department of Internal Medicine, Hebei Medical University
- Department of Endocrinology, The First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao, Hebei Province, PR China
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Ko MC, Lin WH, Martini S, Chang YH, Chiu CT, Li CY. A cohort study of age and sex specific risk of pyogenic liver abscess incidence in patients with type 2 diabetes mellitus. Medicine (Baltimore) 2019; 98:e15366. [PMID: 31027123 PMCID: PMC6831277 DOI: 10.1097/md.0000000000015366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
To investigate the age-sex-specific incidence and relative risk of pyogenic liver abscess (PLA) in patients with type 2 diabetes mellitus (T2DM), and to assess the joint effects of T2DM and other clinical risk factors for PLA on PLA incidence. We used a population-based cohort design with Taiwan's National Health Insurance claim data. Study subjects included 613,921 T2DM patients and 614,613 controls identified in 2000 and were followed to the end of 2010. Cox regression model was employed to calculate the hazard ratio (HR) and 95% confidence interval (CI) of PLA in relation to T2DM. Over an 11-year follow-up, 5336 T2DM and 1850 controls were admitted for PLA, representing a cumulative incidence of 0.87% and 0.30%, respectively. T2DM was significantly associated with increased hazard of PLA (HR, 2.88; 95% CI, 2.73-3.04). We also found that age and gender may significantly modify the relationship between T2DM and PLA, with a higher HR noted in males patients and those aged <45 years. Biliary tract diseases (HR, 8.60; 95% CI, 7.87-9.40) and liver cirrhosis (HR, 7.52; 95% CI, 6.58-8.59) may add substantially additional risk to the incidence of PLA in T2DM patients. The increased risk of PLA in T2DM was greater in male and younger patients. Careful management of biliary tract diseases and liver cirrhosis may also help reduce the incidence of PLA in T2DM patients.
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Affiliation(s)
- Ming-Chung Ko
- Department of Urology, Taipei City Hospital
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei
| | - Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Chang-Ta Chiu
- Department of Dentistry, An Nan Hospital, China Medical University, Tainan
| | - Chung-Yi Li
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Department of Public Health, College of Medicine, National Cheng Kung University
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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Lee CK, Choi SK, Shin DA, Yi S, Ha Y, Kim KN, Kim I. Influence of diabetes mellitus on patients with lumbar spinal stenosis: A nationwide population-based study. PLoS One 2019; 14:e0213858. [PMID: 30875413 PMCID: PMC6420006 DOI: 10.1371/journal.pone.0213858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/02/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the relationship between comorbidities, medical cost, and surgical outcome in patients with lumbar spinal stenosis (LSS) and diabetes mellitus (DM). Methods Data on patients with LSS (n = 14,298) were collected from the Korean National Health Insurance Service database from 2005 to 2007. After 8 years of follow-up, a “DM group” (n = 3,478) and a “non-DM group” (n = 10,820) were compared according to outcome measures. Cox proportional hazard regressions were performed to examine the relationship between DM, hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), cerebrovascular disease (CbVD), and surgery for LSS. The admission rate and medical cost as well asthe overall survival rate for those who underwent lumbar surgery were also assessed among patients with DM and LSS. Results Mortality was about 1.35 times higher in the DM group than in the non-DM group. Patients with DM and comorbidities including HTN (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.25–1.56; p<0.001), CVD (HR, 1.53; 95% CI, 1.36–1.73; p<0.001), CKD (HR, 3.18; 95% CI, 2.7–3.76; p<0.001), and CbVD (HR, 1.69; 95% CI, 1.49–1.91; p<0.001) showed an increased risk of mortality. The mean hospitalization time and average medical cost of patients with DM who underwent lumbar surgery were 60.8 days, and 7,127 USD, respectively. This was 31.3 days longer, and 6,207 USD higher, respectively, than those of patients with DM who underwent conservative treatment for LSS. Within the DM group, the survival rate of surgical management of LSS had a significant tendency for positive prognosis compared with those administered conservative treatment (p = 0.046). Conclusions In patients with LSS, DM was associated both with poor prognosis (most significantly in those with CKD), and increased medical cost in those who underwent surgery. Nevertheless, surgical treatment for LSS in patients with DM was related to favorable prognosis compared with conservative treatment.
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Affiliation(s)
- Chang Kyu Lee
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
| | - Sun Kyu Choi
- Department of Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Insoo Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea
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