Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men

Epidemiological trends in diabetic renal complications in United States adults: A center for disease control and prevention wide-ranging online data for epidemiologic research analysis (1999-2020)

BACKGROUND

Renal complications of diabetes mellitus pose a significant public health challenge, contributing to substantial morbidity and mortality globally. Understanding temporal trends and regional disparities in mortality related to diabetic nephropathy is crucial for guiding targeted interventions and policy decisions.

AIM

To display the trends and disparities of diabetic nephropathy related mortality.

METHODS

A retrospective analysis was conducted using death certificate data from the center for disease control and prevention (CDC) wide-ranging online data for epidemiologic research analysis (WONDER) database, spanning from 1999 to 2020, to investigate mortality related to renal complications of diabetes in adults aged 35 or above. Age-adjusted mortality rate (AAMR) per 100000 persons and annual percent change (APC) were computed, with stratification by year, sex, race/ethnicity, and geographic region.

RESULTS

Between 1999 and 2020, a total of 525804 deaths occurred among adults aged 35 to 85+ years due to renal-related issues associated with diabetes. AAMR for renal-related deaths in adult diabetic patients showed a consistent increase from 1.6 in 1999 to 34.9 in 2020 (average APC [AAPC]: 17.23; 95% confidence interval [CI]: 13.35-28.79). Throughout the study period, men consistently had higher AAMR (overall AAMR for men: 17.8; 95%CI: 17.7-17.9). In 1999, the AAMR for men was 1.8, increasing to 44.2 by 2020 (AAPC: 17.54; 95%CI: 13.09-29.53), while for women, it was 1.6 in 1999 and rose to 27.6 by 2020 (AAPC: 15.55; 95%CI: 13.35-21.10). American Indian/Alaska Native adults exhibited the highest overall AAMR (36.1; 95%CI: 35.2-36.9), followed by Black/African American (25.5; 95%CI: 25.3-25.7). The highest mortality was observed in the Western (AAMR: 16.6; 95%CI: 16.5-16.7), followed by the Midwestern region (AAMR: 14.4; 95%CI: 14.314.4). Significant variations in AAMR were observed among different states, with Oklahoma recording the highest (21.2) and Connecticut the lowest (7). The CDC WONDER database could potentially have omissions or inaccuracies. It does not provide data outside of the available variables. Furthermore, dataset after 2020 was not included in this study.

CONCLUSION

Our findings highlight an alarming rise in mortality related to renal complications of diabetes among United States adults over the past two decades, with concerning disparities across demographic and geographic factors. These results underscore the urgent need for targeted interventions, policies, and protocols to address the growing burden of diabetic nephropathy and substantially reduce mortality rates in the United States. This will help improve the overall health outcome in the United States by identifying communities at risk and implementing tailored assistance to them.

Identification of risk factors for diabetes in Chinese middle-aged and elderly adults

This study aimed to identify and analyze the factors associated with the prevalence of diabetes among Chinese adults, using data from the China Health and Retirement Longitudinal Study (CHARLS). Data from the CHARLS cohort, with a mean age of 63.3 years, were analyzed using SPSS software. Descriptive statistics were performed for the overall population, as well as urban and rural subgroups. Logistic regression models were employed to assess the association between diabetes and variables such as age, gender, smoking, alcohol consumption, hypertension, and mental health disorders. Paired-sample t-tests were conducted to evaluate changes in diabetes prevalence across 2015, 2018, and 2020. The average of diabetes increased from 1.08 in 2015 to 1.15 in 2020, with a statistically significant difference (P < 0.001). Paired-sample t-tests showed significant differences between 2020 and 2018, as well as between 2018 and 2015 (P < 0.001). Logistic regression analysis identified hypertension (aOR = 0.447, 95% CI: 0.410-0.488, P < 0.001) and chronic disease (aOR = 0.024, 95% CI: 0.013-0.042, P < 0.001) as key risk factors for diabetes. Mild physical exercise was a protective factor (aOR = 0.813, 95% CI: 0.708-0.935, P < 0.01), while smoking (aOR = 1.220, 95% CI: 1.088-1.369, P < 0.001) and alcohol consumption (aOR = 1.125, 95% CI: 1.020-1.242, P < 0.05) increased the risk. Smoking and alcohol had a greater impact in urban areas, while hypertension and mental health disorders were more influential in rural areas. This study demonstrates that age, gender, smoking, alcohol consumption, hypertension, and mental disorders significantly influence the risk of diabetes among Chinese adults aged 45 and above. Distinct risk factors were identified between urban and rural populations, highlighting the necessity for tailored intervention strategies. The longitudinal analysis from 2015 to 2020 revealed a substantial increase in diabetes prevalence, underscoring the critical need for sustained and targeted public health efforts.

The Burden of Diabetes in the Southeastern Coastal Region of China From 1990 to 2019 and Projections for 2030: A Systematic Analysis of the 2019 Global Burden of Disease Study

AIM

This study examined the diabetes burden in Fujian Province, China, from 1990 to 2019, comparing it with China and global levels to inform policymakers.

MATERIALS AND METHODS

We used data from GBD 2019 to analyse diabetes prevalence, death, and disability-adjusted life-years (DALYs). We assessed the average annual percentage change (AAPC) and estimated the impact of 17 risk factors. An age-period-cohort model evaluated age, period, and cohort effects on diabetes metrics. Bayesian models forecasted prevalence and DALYs for 2020-2030, with frontier analysis linking DALYs to per capita GDP.

RESULTS

In 2019, Fujian Province had approximately 2,359,179 diabetes cases with a prevalence rate of 4423.82 (95% UI 4004.12-4864.55) per 100,000 and an age-standardised DALYs of 475.00 (375.63-589.49) per 100,000, both lower than China and global averages. From 1990 to 2019, Fujian Province's age-standardised mortality rate remained higher than the China average, but the gap narrowed compared with 1990. Elderly males showed a pronounced increase in mortality. The period effect indicated a turning point during 2005-2009. DALYs increased among men and decreased among women over cohorts. By 2030, the DALYs rate is projected to decrease by 6.59%. Frontier analysis showed that compared with the same economic level, the effective difference in diabetes disease burden in Fujian Province was small, but there was room for improvement.

CONCLUSION

From 1990 to 2019, Fujian Province's age-standardised diabetes prevalence slightly increased, while mortality and DALYs declined. Significant gender and age disparities existed, highlighting the need for targeted strategies for elderly males. Fujian Province's success in diabetes management can provide a model for other regions.

Alcohol Consumption and Cardiovascular Disease: A Narrative Review of Evolving Perspectives and Long-Term Implications

Cardiovascular illnesses remain the primary cause of death, accounting for at least 17.9 million fatalities per year and posing a significant public health problem because of its extensive predominance and effect on healthcare systems. The etiology of cardiovascular disease is complex and involves several environmental and lifestyle factors. Alcohol use is a highly important determinant because of its dual-edged effect on cardiovascular health. Multiple studies indicate that moderate alcohol consumption may have certain advantages, such as slight enhancements in lipid profiles. Conversely, excessive alcohol intake is associated with serious negative consequences, including cardiomyopathy, hypertension, arrhythmias, and even mortality. The aim of this study is to provide a comprehensive analysis of the several effects of alcohol on cardiovascular health and their understanding within the medical field over time. It uses an interpretative narrative review methodology and analyzes studies that focus on genetic risk factors, gender differences, and shifts in paradigms in recent years. This article highlights the need for obtaining a thorough understanding of the effects of alcohol on cardiovascular health to support public health guidelines and clinical practice, and it underscores the significance of including alcohol consumption into the broader context of cardiovascular risk management and identifies important subjects for further study.

Development and validation of a risk assessment tool for uncontrolled type 2 diabetes among patients in South Karnataka, India

Introduction

Diabetes is a chronic medical condition with severe complications mainly caused due to unhealthy lifestyles in genetically susceptible individuals. This study attempts to develop a non-invasive risk assessment tool to identify patients with uncontrolled type 2 diabetes mellitus (T2DM) in southern India.

Methodology

An exploratory study was conducted among 545 patients with T2DM in the Mysuru district, South India for 6 months. A prevalidated questionnaire was used to collect data. Univariate and multivariate logistic regression analysis was performed to develop the risk score. Receiver-operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the cut-off for the risk score. The risk score is specifically designed for the population of South Karnataka, India.

Results

Out of the 545 study participants, the prevalence of uncontrolled diabetes was 59.9%. Physical activity, duration of diabetes, diabetic diet, regular health check-ups, history of hypertension, smoking history and alcohol consumption were factors significantly associated with uncontrolled diabetes (p<0.05). For an optimum cut-off point of >13.50, the risk assessment model showed a moderate sensitivity of 71.3%, specificity of 61%, positive predictive value of 73.2% and negative predictive value of 58.3%. The ROC curve was plotted for the model with an AUC of 0.726 (95% CI 0.683 to 0.769).

Conclusion

This study developed 'Diabetes Care', a simple web-based, non-invasive and inexpensive tool for identifying individuals at risk of developing uncontrolled T2DM in the future.

Pros and cons of live kidney donation in prediabetics: A critical review and way forward

There is shortage of organs, including kidneys, worldwide. Along with deceased kidney transplantation, there is a significant rise in live kidney donation. The prevalence of prediabetes (PD), including impaired fasting glucose and impaired glucose tolerance, is on the rise across the globe. Transplant teams frequently come across prediabetic kidney donors for evaluation. Prediabetics are at risk of diabetes, chronic kidney disease, cardiovascular events, stroke, neuropathy, retinopathy, dementia, depression and nonalcoholic liver disease along with increased risk of all-cause mortality. Unfortunately, most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period. There is lack of prospective long-term studies to know about the real risk of complications after donation. Furthermore, there are variations in recommendations from various guidelines across the globe for donations in prediabetics, leading to more confusion among clinicians. This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients. This review focuses on pathophysiological changes of PD in kidneys, potential complications of PD, other risk factors for development of type 2 diabetes, a review of guidelines for kidney donation, the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.

The association of a healthy lifestyle index and imaging-based body fat distribution with glycemic status and Type 2 diabetes in the Multi Ethnic Cohort: a cross-sectional analysis

INTRODUCTION

As several behaviors captured by the Lifestyle Risk Factor Index (LSRI) are protective against Type 2 diabetes (T2D) and may affect body fat distribution, we examined its relation with both outcomes.

METHODS

In a subset of the Multiethnic Cohort, participants from five ethnic groups (60-77 years) were assigned LSRI scores (one point each for consuming <1 (women)/<2 (men) alcoholic drinks/day, ≥1.5 physical activity hours/week, not smoking, and adhering to ≥3/7 dietary recommendations). All participants completed an extensive Quantitative Food Frequency Questionnaire to allow estimation of adherence to intake recommendations for fruits, vegetables, refined and whole grains, fish, processed and non-processed meat. Glycemic/T2D status was classified according to self-reports and fasting glucose. We estimated prevalence odds ratios (POR) of LSRI with glycemic/T2D status and DXA- and MRI-based body fat distribution using logistic regression.

RESULTS

Of 1713 participants, 43% had normoglycemia, 30% Pre-T2D, 9% Undiagnosed T2D, and 18% T2D. Overall, 39% scored 0-2, 49% 3, and 12% 4 LSRI points. T2D prevalence was 55% (POR 0.45; 95% confidence intervals 0.27, 0.76) lower for 4 vs. 0-2 LSRI points with weaker associations for abnormal glycemic status. Despite the low adherence to dietary recommendations (22%), this was the only component related to lower T2D prevalence. The inverse LSRI-T2D association was only observed among Latinos and Japanese Americans in ethnic-specific models. Visceral fat measures were higher in T2D patients and attenuated the LSRI-T2D association.

CONCLUSION

These findings support the role of a healthy lifestyle, especially diet, in T2D prevention with differences across ethnicity.

Sex-specific, non-linear and congener-specific association between mixed exposure to polychlorinated biphenyls (PCBs) and diabetes in U.S. adults

BACKGROUND

Whether and to what extent the impact of exposure to various polychlorinated biphenyls (PCBs) congeners on diabetes, as well as the important contributors, have remained unclear.

OBJECTIVE

We aimed to investigate the association patterns between PCBs mixture and diabetes, identify the critical congeners, and explore the potential modifiers.

METHODS

The present study included 5900 U.S. adults from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2016. Weighted logistic regression, restricted cubic spline regression, weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) were applied to estimate the linear and non-linear associations of single and mixed PCB exposure with diabetes. Subgroup analyses were also conducted to explore potential sex differences.

RESULTS

In the weighted logistic regression model, total PCBs were positively associated with diabetes (OR = 1.33, P < 0.025), and significant non-linear associations were observed using RCS analyses. The non-linear positive association between PCBs mixed exposure and diabetes was likewise found in the WQS and BKMR results. PCB180, PCB194, PCB196, and PCB167 were with the highest weights in the WQS, and PCB209 and PCB66 were with the highest posterior inclusion probabilities in the BKMR. Additionally, exposure to total PCBs and most of individual PCB congeners were significantly associated with elevated risk of in females (OR = 1.74; P for trend < 0.001), while fewer significant associations were observed in males.

CONCLUSION

The present study highlighted the importance of the long-term surveillance of PCBs and the need to enhance protective measures against them. Notably, these associations were non-linear, congener-specific, and significantly stronger in females than males, especially at relatively high levels of PCBs exposure. Further prospective and mechanistic studies were warranted to ascertain the causal effects between PCBs mixture and diabetes.

Trends in cardiovascular risk factors control among US adults by glycemic statuses, 2007-2018

AIMS

Understanding the national trends in cardiovascular risk factors control of individuals with prediabetes and diabetes is critical for diabetes prevention and management. Our study aims to estimate how cardiovascular risk factors changed in US adults with different glycemic statuses between 2007-2008 and 2017-2018.

METHODS AND RESULTS

This was a serial cross-sectional study based on the National Health and Nutrition Examination Surveys (between 2007-2008 and 2017-2018 cycle). Non-pregnant American participants aged 20 years or older were included. Cardiovascular risk factors including weight, blood pressure, plasma cholesterol, and smoking by glycemic statuses were estimated. A total of 33 040 American adults were included. From 2007-2008 to 2017-2018, the age-adjusted proportions of individuals who reached weight control (body mass index <30 kg/m2) of both normoglycemia group and prediabetes group had a significant decrease over the study period, while the trend in participants with diabetes was not significant (mean difference: -5.34%, 95% confidence interval: -15.28%, 4.59%; P for trend = 0.298). The age-adjusted means of total cholesterol of all three groups decreased during the study decade (P for trend < 0.010), with participants with diabetes maintaining the lowest level. Individuals with high total cholesterol were more likely to receive statin therapy in the diabetes group. Notably, prediabetes participants had the highest level of total cholesterol and low-density lipoprotein cholesterol and were less likely to achieve lipid control with statin therapy. Sensitivity analysis with the second definition of prediabetes and diabetes resulted in a consistent trend.

CONCLUSIONS

In this nationally representative cross-sectional study, we systematically estimated the cardiovascular risk factors control in American adults and found poor weight control in the normoglycemia and prediabetes group. Despite the significant decrease trend of plasma total cholesterol in all groups, the high cholesterol level in the prediabetes group deserves special concern.

Association between changes in carbohydrate intake and long term weight changes: prospective cohort study

OBJECTIVE

To comprehensively examine the associations between changes in carbohydrate intake and weight change at four year intervals.

DESIGN

Prospective cohort study.

SETTING

Nurses' Health Study (1986-2010), Nurses' Health Study II (1991-2015), and Health Professionals Follow-Up Study (1986-2014).

PARTICIPANTS

136 432 men and women aged 65 years or younger and free of diabetes, cancer, cardiovascular disease, respiratory disease, neurodegenerative disorders, gastric conditions, chronic kidney disease, and systemic lupus erythematosus before baseline.

MAIN OUTCOME MEASURE

Weight change within a four year period.

RESULTS

The final analyses included 46 722 women in the Nurses' Health Study, 67 186 women in the Nurses' Health Study II, and 22 524 men in the Health Professionals Follow-up Study. On average, participants gained 1.5 kg (5th to 95th centile -6.8 to 10.0) every four years, amounting to 8.8 kg on average over 24 years. Among men and women, increases in glycemic index and glycemic load were positively associated with weight gain. For example, a 100 g/day increase in starch or added sugar was associated with 1.5 kg and 0.9 kg greater weight gain over four years, respectively, whereas a 10 g/day increase in fiber was associated with 0.8 kg less weight gain. Increased carbohydrate intake from whole grains (0.4 kg less weight gain per 100 g/day increase), fruit (1.6 kg less weight gain per 100 g/day increase), and non-starchy vegetables (3.0 kg less weight gain per 100 g/day increase) was inversely associated with weight gain, whereas increased intake from refined grains (0.8 kg more weight gain per 100 g/day increase) and starchy vegetables (peas, corn, and potatoes) (2.6 kg more weight gain per 100 g/day increase) was positively associated with weight gain. In substitution analyses, replacing refined grains, starchy vegetables, and sugar sweetened beverages with equal servings of whole grains, fruit, and non-starchy vegetables was associated with less weight gain. The magnitude of these associations was stronger among participants with overweight or obesity compared with those with normal weight (P<0.001 for interaction). Most of these associations were also stronger among women.

CONCLUSIONS

The findings of this study highlight the potential importance of carbohydrate quality and source for long term weight management, especially for people with excessive body weight. Limiting added sugar, sugar sweetened beverages, refined grains, and starchy vegetables in favor of whole grains, fruit, and non-starchy vegetables may support efforts to control weight.

Hepatocyte Toll-Like Receptor 4 Mediates Alcohol-Induced Insulin Resistance in Mice

Accumulating evidence has demonstrated the association between alcohol overconsumption and the development of insulin resistance. However, the underlying mechanisms are not completely understood. To investigate the requirement and sufficiency of hepatocyte toll-like receptor 4 (TLR4) in alcohol-induced insulin resistance, we used two mouse models (Tlr4fl/fl and Tlr4LoxTB) that allow ablation of TLR4 only in hepatocytes (Tlr4LKO) and restoration of endogenous TLR4 expression in hepatocytes on a TLR4-null background (Tlr4LoxTB × Alb-Cre), respectively. A Lieber-DeCarli feeding model was used to induce glucose intolerance and insulin resistance in mice. Glucose tolerance test, insulin tolerance test, and insulin signaling experiments were performed to examine systemic and tissue-specific insulin sensitivity. We found that alcohol-fed hepatocyte TLR4 deficient mice (Tlr4LKO) had lower blood glucose levels in response to intraperitoneal injection of insulin. Moreover, increased phosphorylation of glycogen synthase kinase-3β (GSK3β) was observed in the liver of Tlr4LKO mice after chronic alcohol intake. In contrast, when hepatic TLR4 was reactivated in mice (Tlr4LoxTB × Alb-Cre), alcohol feeding caused glucose intolerance in these mice compared with littermate controls (Tlr4LoxTB). In addition, AKT phosphorylation was dramatically reduced in the liver and epididymal white adipose tissue (eWAT) of alcohol-fed Tlr4LoxTB × Alb-Cre mice, which was similar to that of mice with whole-body TLR4 reactivation (Tlr4LoxTB × Zp3-Cre). Collectively, these findings suggest that hepatocyte TLR4 is both required and sufficient in the development of insulin resistance induced by alcohol overconsumption.

The relationship of smoking with gestational diabetes: a large population-based study and a matched comparison

RESEARCH QUESTION

Is smoking associated with an increased risk for gestational diabetes (GDM)?

DESIGN

A retrospective population-based study using data from the United States Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A dataset of all deliveries that took place between 2004 and 2014 (inclusive) was created. The population was divided into two groups according to smoking status and matched 1:1 for age, obesity, race, insurance type, thyroid disease, drug use and chronic hypertension. Delivery outcomes were compared between the two matched groups and the control group of non-smokers as a whole. A multivariate logistic analysis was performed adjusting for any statistically significant confounding baseline effects not matched for.

RESULTS

The study identified 9,096,788 births between 2004 and 2014, of which 443,590 (4.9%) were maternal smokers. When compared with the entire group of non-smokers as controls, there was an increased risk of GDM, adjusted odd ratio (aOR) 1.10 (95% confidence interval [CI] 1.07-1.14, P < 0.001). This relationship was of a mild nature and there were many confounding variables that differed between the groups. As such a matched control group was developed to compare the risk of GDM in the smokers and non-smokers. An increased risk for GDM among smokers remained, with an aOR of 1.07 (95% CI 1.05-1.10, P < 0.001).

CONCLUSIONS

The current data suggest that smoking is a small but significant risk factor for GDM with an aOR of 1.07.

Association between smoking and glycemic control in men with newly diagnosed type 2 diabetes: a retrospective matched cohort study

BACKGROUND

Longitudinal data on the association between smoking and glycemic control in men with newly diagnosed type 2 diabetes (T2DM) is scarce. Therefore, this study aimed to examine the extent of the association between smoking and glycemic control in this population.

METHODS

The retrospective cohort study identified 3044 eligible men with T2DM in a medical centre in Taiwan between 2002 and 2017. Smokers (n = 757) were matched 1:1 with non-smokers using propensity score-matching. All of them were followed for one year. Glycated haemoglobin (HbA1c) levels were measured at 0, 3, 6, 9, and 12 months after enrolment. Generalised estimating equations were used to assess smoking status-by-time interaction to determine the difference in HbA1c reduction between the two cohorts. All analyses were performed in 2020.

RESULTS

The estimated maximal difference in HbA1c reduction between smokers and non-smokers was 0.33% (95% CI, 0.05-0.62%) at 3 months of follow-up. For patients with body mass index (BMI) <25 kg/m², the difference in HbA1c reduction between smokers and non-smokers was much larger (0.74%, 95% CI, 0.35-1.14%) than in those with a higher BMI.

CONCLUSIONS

Our findings show that smoking was independently associated with unfavourable glycemic control among men with newly diagnosed T2DM, and such a detrimental association could be stronger in men with a lower BMI.

Trend of metabolic risk factors among the population aged 25-64 years for non-communicable diseases over time in Vietnam: A time series analysis using national STEPs survey data

Introduction

The study aims to examine the trends of 4 metabolic NCDs risk factors including raised blood pressure, increased blood glucose, elevated blood lipids and overweight/obesity over the last 10 years in Vietnam as well as examine these trends among different sub-population by geographical area, gender, and age groups.

Methods

The study combined the national representative data from three rounds of STEPs survey in Vietnam conducted in 2010, 2015, and 2020 on people aged 25-64 years. The overall prevalence of each metabolic factor together with 95% CI for each time point as well as the stratified prevalence by rural/urban, male/female, and 4 separated age groups were calculated and considered the sampling weight. Cochran-Armitage test for trend was used to test for the differences in the prevalence over time.

Results

The prevalence of hypertension, overweight/obesity, hyperglycemia, and hyperlipidemia among the population aged 25-64 years old was 28.3, 20.57, 6.96, and 15.63%, respectively in the year 2020. All NCD metabolic risk factors examined in this analysis show significantly increasing trends over time. For most age groups, the increasing burden of NCD metabolic risk factors was more significant during the period 2015-2020 compared to the period 2010-2015. Male population and population aged 55-64 experienced the most dramatic changes in the burden of all NCD metabolic risk factors.

Conclusion

To reverse the increasing trend of NCD metabolic factors in Vietnam, intervention, and policy need to apply a comprehensive life course approach.

Epidemiology of Poor Glycaemic Control among Patients with Type 2 Diabetes Mellitus in Terengganu State of Malaysia

Background: Type 2 diabetes mellitus (T2DM) is among the most common non-communicable diseases worldwide and Malaysia. Poor glycaemic control among T2DM patients lead to serious life-long complications. Therefore, it is imperative to study the prevalence of poor glycaemic control and its risk factors to facilitate public health physicians and clinicians in developing the best strategies to optimize glycaemic control among T2DM patients. Materials and Methods: A comparative cross-sectional study between groups of good glycaemic control and poor glycaemic control was conducted among type 2 diabetes mellitus (T2DM) patients who fulfilled study criteria in Terengganu state of Malaysia. Eligible samples in the National Diabetes Registry registered from 1st January 2021 until 31st December 2021 were included into the study. Descriptive statistics, simple and multiple logistic regressions were employed for data analysis. Result: A total of 17,165 samples were recruited in the descriptive part of the study. The prevalence of patients with poor glycaemic control in Terengganu state was 65.3% (95% CI: 0.62, 0.67). In the inferential part of the study, a total 3,700 samples were randomly selected. Multivariable analysis using multiple logistic regression revealed age, duration of diabetes, body mass index, cigarette smoking, presence of retinopathy and presence of hypertension were the significant factors associated with poor glycaemic control among T2DM patients in Terengganu state with an adjusted odds ratio (AOR) of 0.95 (95%CI:0.94, 0.96); p<0.001), AOR 1.15 (95%CI:1.13, 1.17; p<0.001), AOR 1.03 (95%CI:1.01, 1.04; p<0.001), AOR 1.45 (95%CI:1.01, 2.10; p=0.047), AOR 1.32 (95%CI:1.01, 1.73; p=0.043) and AOR 1.39 (95%CI:1.16, 1.67; p<0.001) respectively. Conclusion: Strategies focusing on the identified risk factors may improve diabetes mellitus management and avert life-long diabetic complications.

Health effects associated with smoking: a Burden of Proof study

As a leading behavioral risk factor for numerous health outcomes, smoking is a major ongoing public health challenge. Although evidence on the health effects of smoking has been widely reported, few attempts have evaluated the dose-response relationship between smoking and a diverse range of health outcomes systematically and comprehensively. In the present study, we re-estimated the dose-response relationships between current smoking and 36 health outcomes by conducting systematic reviews up to 31 May 2022, employing a meta-analytic method that incorporates between-study heterogeneity into estimates of uncertainty. Among the 36 selected outcomes, 8 had strong-to-very-strong evidence of an association with smoking, 21 had weak-to-moderate evidence of association and 7 had no evidence of association. By overcoming many of the limitations of traditional meta-analyses, our approach provides comprehensive, up-to-date and easy-to-use estimates of the evidence on the health effects of smoking. These estimates provide important information for tobacco control advocates, policy makers, researchers, physicians, smokers and the public.

BMI mediates the association of family medical history with self-reported hypertension and diabetes among older adults: Evidence from baseline wave of the longitudinal aging study in India

Background

This study explored the association between family history of hypertension and diabetes with their diagnosis among older Indian adults. The study further examined the role of body mass index (BMI) as a potential mediator in these associations.

Methods

Data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1 were used. The sample for the study included 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis has been conducted to assess the prevalence of self-reported hypertension and diabetes. Further, multivariable logistic regression models were used to test the research hypotheses of this study. The Karlson-Holm-Breen (KHB) mediation analysis was conducted to recover the direct and indirect effects of BMI in the association of family medical history and diagnosis of hypertension and diabetes.

Results

A proportion of 32.70% of older adults were diagnosed with hypertension and 14.23% of older adults were diagnosed with diabetes. A proportion of 19.48% and 14.69% of older adults had a family history of hypertension and diabetes, respectively. Also, 16.57% and 5.53% of older adults were overweight and obese, respectively in the current study. Older adults who had family history of hypertension had higher odds of being diagnosed with hypertension [aOR: 2.23, CI: 2.07-2.39] than those who had no such family history. This association was mediated by BMI (percent mediated: 6.31%). Similarly, older adults who had family history of diabetes had higher odds of being diagnosed with diabetes [aOR: 2.63, CI: 2.41-2.88] than those who had no such family history. This association was mediated by BMI (percent effect mediated: 6.66%).

Conclusion

The study highlights the relevance of using family medical history data along with information on BMI as potential source for the control and management of hypertension and diabetes among older population.

Substance use and common contributors to morbidity: A genetics perspective

Excessive substance use and substance use disorders (SUDs) are common, serious and relapsing medical conditions. They frequently co-occur with other diseases that are leading contributors to disability worldwide. While heavy substance use may potentiate the course of some of these illnesses, there is accumulating evidence suggesting common genetic architectures. In this narrative review, we focus on four heritable medical conditions - cardiometabolic disease, chronic pain, depression and COVID-19, which are commonly overlapping with, but not necessarily a direct consequence of, SUDs. We find persuasive evidence of underlying genetic liability that predisposes to both SUDs and chronic pain, depression, and COVID-19. For cardiometabolic disease, there is greater support for a potential causal influence of problematic substance use. Our review encourages de-stigmatization of SUDs and the assessment of substance use in clinical settings. We assert that identifying shared pathways of risk has high translational potential, allowing tailoring of treatments for multiple medical conditions. FUNDING: SSR acknowledges T29KT0526, T32IR5226 and DP1DA054394; RLK acknowledges AA028292; AA acknowledges DA054869 & K02DA032573. The funders had no role in the conceptualization or writing of the paper.

Health Impacts of the Built and Social Environments, and Travel Behavior: The Case of the Sunshine State

As physical inactivity statistics for the U.S. population show an alarming trend, many health problems have been increasing among Americans in recent decades. Thus, identification of the factors that influence people’s physical activity levels and health outcomes has become ever more essential to promote public health. The built envSFironment is among the main factors that impact individuals’ health outcomes. However, little is known about the health impacts of built environment factors at large geographical scales such as those of the metropolitan area of residence. Further, the health impacts of travel behavior such as telecommuting and teleshopping remain unclear. This study uses an ecological model framework to probe the roles of travel behavior and built as well as social environments at different spatial levels in health. Instrumental variable binary probit models have been developed to examine the complex interlinks between measures of travel behavior, physical activity levels, built and social environment characteristics, and individuals’ health outcomes. Findings indicate that built and social environment factors at different spatial levels, including the metropolitan area, are correlated with individuals’ health outcomes. Additionally, the findings suggest that increased levels of telecommuting and teleshopping within communities may lead to unfavorable health outcomes. The findings shed light on the most promising policy interventions that can promote public health through modifications targeting people’s travel choices as well as the built and social environments within urban areas.

Frequency and association of self-reported oral cancer among individuals with type 2 diabetes at a tertiary care diabetes centre in South India - A retrospective study

AIM

To assess the frequency of self-reported oral cancer and associated factors among individuals with type 2 diabetes (T2D) at a tertiary care diabetes centre in South India.

METHODS

Individuals with T2D who reported that they had oral cancer were included from the Diabetes Electronic Medical Records (DEMR) database. To assess the association of oral cancer with T2D, a retrospective nested case-control study design was adopted. Individuals with T2D and oral cancer diagnosed after the diagnosis of T2D (n = 78) were considered 'cases', while T2D without oral cancer were considered 'controls' (312) [in a ratio of 1:4 for cases and controls]. The cases and controls were matched for age, gender and duration of diabetes. Logistic regression was used to model predictors of oral cancer in T2D patients.

RESULTS

Oral cancer was reported in 78 out of 379,138 (0.02%) individuals with T2D registered at the centre. Logistic regression analysis showed that a HbA1c value ≥ 9% had a significant association with oral cancer with an odds ratio of 2.3 (95% CI: 1.2-4.6) after adjusting for confounding factors. Among individuals with T2D, higher frequency of oral cancer prevalence and risk was observed among those who used any form of tobacco (32.6%, OR = 2.52, 95% CI: 1.5-4.3), consumed alcohol (29.2%, OR = 2.01, 95% CI: 1.2-3.3), and those with hypertension (23.9%, OR = 2.05, 95% CI: 1.2-3.6) and hypertriglyceridemia (24.7%, OR = 1.66, 95% CI: 1.01-2.7). Significant independent predictors of oral cancer among T2D were tobacco use (OR = 2.06, 95% CI: 1.1-4.00), high HbA1c (OR = 1.3, 95% CI: 1.03-1.5), hypertension (OR = 2.3, 95% CI: 1.3-4.2) and insulin use (OR = 1.8, 95% CI: 1.03-3.2).

CONCLUSIONS

Regular dental check-ups as part of the follow-up for individuals with T2D will identify and diagnose oral cancer earlier. Further research is required to assess the physiological and biological mechanisms leading to oral cancer in individuals with T2D.

Time trends in type 2 diabetes mellitus incidence across the BRICS from 1990 to 2019: an age-period-cohort analysis

BACKGROUND

The incidence rate of type 2 diabetes mellitus (T2DM) is rapidly increasing in Brazil, Russia, India, China, and South Africa (BRICS). The present study analyzed trends in T2DM incidence rate across the BRICS and associations with age, period, and birth cohort.

METHODS

The incidence rate was estimated by the data obtained from GBD 2019 (Global Burden of Disease Study 2019) and was analyzed with the age-period-cohort framework. Incidence rates of T2DM (1990-2019) were collected for each 5-year age group (from 25 to 29 to 85-89 age group) stratified by gender from the Global Burden of Disease 2019 Study.

RESULTS

In 2019, the the incidence rate of T2DM was 280.2 per 100,000 across the BRICS. Between 1990 and 2019, the incidence rate of T2DM among the BRICS population increased by 83.3%. In each period, as age increases, the incidence rate of T2DM in China and Russia first increased and then decreased, while the incidence rate of T2DM in Brazil, India and South Africa first increased and then decreased slightly with age group. Deteriorating period and cohort risks for incidence rate of T2DM were generally found across the BRICS.

CONCLUSIONS

The number of diabetic patients in the BRICS countries has continued to increase and the growth rate has been stable in the past 30 years, which is dependent on age and some other environmental factors. Some possible factors influencing T2DM incidence are analyzed and hypotheses generated through the age and period effects.

Life-Course Influence of Adolescent Behaviour Problems on Type 2 Diabetes in Midlife: Results from 1958 British Birth Cohort Study

PURPOSE

To assess whether there is a long-term relationship between childhood behaviour problems and type 2 diabetes in midlife. The study will also investigate whether any of such relationship is independent of other factors which may be associated with type 2 diabetes.

DESIGN

Cohort study.

PARTICIPANTS

A total of 9377 members of the 1958 British birth cohort participated in the biomedical survey at age 45 years. The cohort has been followed up at regular intervals in childhood (age 7, 11 and 16 years) and adulthood (23, 33, 42 and 45 years).

PREDICTOR VARIABLES

Information regarding childhood behaviour collected during follow-ups at ages 7, 11 and 16 years.

MAIN OUTCOME VARIABLES

Type 2 diabetes assessed using HbA1c at age 45 years.

RESULTS

Unadjusted estimates show that teachers reported adolescent behaviour problems at age of 16 are associated with increased risk of type 2 diabetes in midlife. After adjustment for potential confounders and mediators in childhood and adulthood, a relationship was observed between the severity of adolescent behaviour problems and type 2 diabetes risk in midlife (mild behaviour problems: OR 2.17, 95% CI 1.11-4.23; severe behaviour problems: OR 4.40, 95% CI 1.14-16.99). However, no such relationship was observed between behaviour problems at 7 and 11 years and type 2 diabetes in midlife.

CONCLUSION

There is an association between adolescent behaviour problems and an increased risk of type 2 diabetes in midlife. Further molecular/genetic studies are required to understand the biological basis for this observed association.

Role of interluekin-6 and insulin resistance as screening markers for metabolic syndrome in patients of chronic obstructive pulmonary disease. A hospital based cross-sectional study

Chronic obstructive pulmonary disease (COPD) is usually associated with a variety of extra-pulmonary manifestations. Metabolic syndrome (MetS) is one such entity that has been scarcely studied in Indian patients. Availability of a good screening marker may help in timely detection of this co morbidity in COPD patients. We conducted a cross sectional study to evaluate the prevalence of MetS among COPD patients and to evaluate the role of Interleukin-6 and insulin resistance (as measured by HOMA-IR) as screening markers for MetS in COPD. A total of 100 stable COPD patients were evaluated for MetS using US National Cholesterol Education Program Adult Treatment Panel III (2005) guidelines. Interleukin-6 and HOMA-IR (for insulin resistance) were measured and compared between COPD patients with and without MetS. ROC analysis was done to find the best cut-off value and sensitivity and specificity of both the molecules in detecting MetS. In the results, the mean age of the study cohort was 59.9+8.7yrs (males=93). Forty five COPD patients (45%) fulfilled the criteria for MetS. Patients with MetS were comparatively younger (57.9+9.5 v/s 61.6+7.8 years; p=0.037) but had longer duration of preceding COPD (9.9+2.8 v/s 6.0+2.2 years; p<0.001) as compared to those without MetS. Both IL-6 and HOMA index were statistically higher (p<0.05) in COPD-MetS patients as compared to the other group. At cutoff value of 36.3 pg/ml for IL-6 and 1.61 for HOMA index, IL-6 and HOMA-IR had sensitivity 91.1% and 82.2% respectively in detecting MetS among COPD patients. To conclude, metabolic syndrome is a common comorbidity seen in COPD patients. Interleukin-6 has a better sensitivity than HOMA-IR in screening MetS among COPD patients.

Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that is the most common cause of dementia. Over a third of dementia cases are estimated to be due to potentially modifiable risk factors, thus offering opportunities for both identification of those most likely to be in early disease as well as secondary prevention. Diabetes, hypertension and chronic kidney failure have all been linked to increased risk for AD and dementia and through their high prevalence are particularly apt targets for initiatives to reduce burden of AD. This can take place through targeted interventions of cardiovascular risk factors (shown to improve cognitive outcomes) or novel disease modifying treatments in people with confirmed AD pathology. The success of this approach to secondary prevention depends on the availability of inexpensive and scalable methods for detecting preclinical and prodromal dementia states. Developments in blood-based biomarkers for Alzheimer's disease are rapidly becoming a viable such method for monitoring large at-risk groups. In addition, digital technologies for remote monitoring of cognitive and behavioral changes can add clinically relevant data to further improve personalisation of prevention strategies. This review sets the scene for this approach to secondary care of dementia through a review of the evidence for cardiovascular risk factors (diabetes, hypertension and chronic kidney disease) as major risk factors for AD. We then summarize the developments in blood-based and cognitive biomarkers that allow the detection of pathological states at the earliest possible stage. We propose that at-risk cohorts should be created based on the interaction between cardiovascular and constitutional risk factors. These cohorts can then be monitored effectively using a combination of blood-based biomarkers and digital technologies. We argue that this strategy allows for both risk factor reduction-based prevention programmes as well as for optimisation of any benefits offered by current and future disease modifying treatment through rapid identification of individuals most likely to benefit from them.

Smoking and Neuropsychiatric Disease-Associations and Underlying Mechanisms

Despite extensive efforts to combat cigarette smoking/tobacco use, it still remains a leading cause of global morbidity and mortality, killing more than eight million people each year. While tobacco smoking is a major risk factor for non-communicable diseases related to the four main groups—cardiovascular disease, cancer, chronic lung disease, and diabetes—its impact on neuropsychiatric risk is rather elusive. The aim of this review article is to emphasize the importance of smoking as a potential risk factor for neuropsychiatric disease and to identify central pathophysiological mechanisms that may contribute to this relationship. There is strong evidence from epidemiological and experimental studies indicating that smoking may increase the risk of various neuropsychiatric diseases, such as dementia/cognitive decline, schizophrenia/psychosis, depression, anxiety disorder, and suicidal behavior induced by structural and functional alterations of the central nervous system, mainly centered on inflammatory and oxidative stress pathways. From a public health perspective, preventive measures and policies designed to counteract the global epidemic of smoking should necessarily include warnings and actions that address the risk of neuropsychiatric disease.

Alcohol consumption in patients with nonalcoholic fatty liver disease: yes, or no?

Excessive alcohol intake is an established risk factor for chronic liver disease. At the same time, moderate alcohol intake appears to reduce cardiovascular morbidity. Accordingly, recommendations for alcohol intake in patients with nonalcoholic fatty liver disease (NAFLD), who are at increased risk for liver-related and cardiovascular events, are a point of debate. Some studies have shown beneficial effects of alcohol on cardiovascular and overall mortality in this specific subset of patients. Nonetheless, even light alcohol intake appears to aggravate liver disease and increase the risk of hepatocellular cancer. Therefore, patients with nonalcoholic steatohepatitis or advanced fibrosis should be advised against consuming alcohol. On the other hand, only light alcohol consumption (<10 g/day) might be permitted in patients without significant hepatic fibrosis, provided that they are carefully followed-up. As the research field focusing on NAFLD keeps widening, more prospective studies regarding this specific subject are expected, and may provide a basis for less ambiguous recommendations.

Cardiometabolic Risk Factors leading to Diabetes Mellitus among the Young (YOD) from the 8th Philippine National Nutrition Survey

Objectives

This study looked into the prevalence of diabetes mellitus (DM) and risks for cardiovascular and metabolic diseases among young adults with diabetes (age 20-44 years old, YOD) and late-onset DM (≥45 years old, LOD) in Filipinos.

Methodology

Weighted data from 546,580 adults with DM from the 8^th Philippine National Nutrition and Health Survey (NNHeS) were utilized. Differences in sociodemographic, anthropometric, clinical profiles and metabolic risks were compared between YOD and LOD.

Results

The aggregated prevalence of DM is 5.43% (95%CI, 5.10–5.79), YOD were 2.64% (95% CI, 2.32–3.00) and LOD 9.85% (95%CI, 9.18–10.56). Mean age of YOD was 37,6 years, LOD 59,9 years. The YOD were mostly males (56%), with higher BMI (26.24 kg/m² vs 25 kg/m², p=0.002), lower mean SBP (122.41±19.17 mmHg vs 135.45±22.47 mmHg, p<0.001), more daily smokers (23% vs 14%), and alcoholic beverage drinkers (39% vs 31%). Physical activity was similar between groups (44% vs 51%, p=0.078). However, average total caloric intake (1776.78±758.38 kcal vs 1596.88±639.16 kcal, p=0.023) and carbohydrate intake (306.13±142.16 grams vs 270.53±104.74 g, p=0.014) were higher in YOD. Dietary carbohydrate proportions were higher than recommended (69% vs 68%) for both groups. Young Filipinos had higher risk to develop diabetes when they are obese II (22% vs 12%), current drinker (56% vs 37%), and current smoker (28% vs 18%). Eighty percent of YOD and LOD had metabolic syndrome (MetS). With every unit increase in age and fat intake, the odds of having MetS were raised by 5.4% (95%CI 1%–10%, p=0.029) and 1.6% (95%CI 0.04%-3%, p=0.044), respectively.

Conclusion

Early-onset diabetes mellitus appears to be driven by obesity, MetS and social behaviors. Modifiable risk factors can be improved early to decrease hazards to develop cardiometabolic complications.

Alterations of Amphetamine Reward by Prior Nicotine and Alcohol Treatment: The Role of Age and Dopamine

Evidence suggests that nicotine and alcohol can each serve as a gateway drug. We determined whether prior nicotine and alcohol treatment would alter amphetamine reward. Also, we examined whether age and dopaminergic neurotransmission are important in this regard. Male and female adolescent and adult C57BL/6J mice were tested for baseline place preference. Mice then received six conditioning with saline/nicotine (0.25 mg/kg) twice daily, followed by six conditioning with saline/ethanol (2 g/kg). Control mice were conditioned with saline/saline throughout. Finally, mice were conditioned with amphetamine (3 mg/kg), once in the nicotine-alcohol-paired chamber, and tested for place preference 24 h later. The following day, mice were challenged with amphetamine (1 mg/kg) and tested for place preference under a drugged state. Mice were then immediately euthanized, their brain removed, and nucleus accumbens isolated and processed for the level of dopamine receptors and transporter and glutamate receptors. We observed a greater amphetamine-induced place preference in naïve adolescents than adult mice with no change in state-dependent place preference between the two age groups. In contrast, amphetamine induced a significant place preference in adult but not adolescent mice with prior nicotine-alcohol exposure under the drug-free state. The preference was significantly greater in adults than adolescents under the drugged state. The enhanced response was associated with higher dopamine-transporter and D₁ but reduced D₂ receptors’ expression in adult rather than adolescent mice, with no changes in glutamate receptors levels. These results suggest that prior nicotine and alcohol treatment differentially alters amphetamine reward in adult and adolescent mice. Alterations in dopaminergic neurotransmission may be involved in this phenotype.

Association of risk factors with type 2 diabetes: A systematic review

Diabetes is the leading cause of severe health complications and one of the top 10 causes of death worldwide. To date, diabetes has no cure, and therefore, it is necessary to take precautionary measures to avoid its occurrence. The main aim of this systematic review is to identify the majority of the risk factors for the incidence/prevalence of type 2 diabetes mellitus on one hand, and to give a critical analysis of the cohort/cross-sectional studies which examine the impact of the association of risk factors on diabetes. Consequently, we provide insights on risk factors whose interactions are major players in developing diabetes. We conclude with recommendations to allied health professionals, individuals and government institutions to support better diagnosis and prognosis of the disease.

The association of cortisol curve features with incident diabetes among whites and African Americans: The CARDIA study

INTRODUCTION

A flatter diurnal cortisol curve has been associated with incident diabetes among older white adults. However, this relationship has not been examined among middle-aged individuals or African Americans [AA]. We analyzed the longitudinal association of baseline diurnal cortisol curve features with incident diabetes over a 10 year period in a cohort of AA and white participants who were, on average, 40 years old.

METHODS

Salivary cortisol was collected immediately post-awakening, then subsequently 45 min, 2.5 h, 8 h, and 12 h later, as well as at bedtime. Cortisol curve features included wake-up cortisol; cortisol awakening response (CAR); early, late, and overall decline slopes; bedtime cortisol; and 16 -h area under the curve (AUC). Salivary cortisol (nmol/L) was log-transformed due to positively skewed distributions. Diabetes was defined as fasting plasma glucose ≥ 126 mg/dL or taking diabetes medication. Logistic regression models were used to investigate the association of log-transformed cortisol curve features with incident diabetes. The analysis was stratified by race and adjusted for age, sex, education, depressive symptoms, smoking status, beta-blocker and steroid medication use and BMI.

RESULTS

Among 376 AA and 333 white participants (mean age 40 years), 67 incident diabetes cases occurred over 10 years. After full adjustment for additional covariates, a 1-unit log increase in CAR was associated with a 53 % lower odds of incident diabetes among whites (Odds Ratio [OR] 0.47, 95 % CI: 0.24, 0.90). A 1-SD increase in late decline slope was associated with a 416 % higher odds of incident diabetes among whites (OR 5.16, 95 % CI: 1.32, 20.20). There were no significant associations in AAs.

CONCLUSION

A robust CAR and flatter late decline slope are associated with lower and higher odds of incident diabetes, respectively, among younger to middle-aged whites and may provide a future target for diabetes prevention in this population.

Correlation of PTC Taste Status with Fungiform Papillae Count and Body Mass Index in Smokers and Non-Smokers of Eastern Province, Saudi Arabia

Phenylthiocarbamide (PTC) is a bitter compound that is similar in taste to the polyphenols present in most vegetables and fruits. The human taste response towards this compound influences dietary preference, which has a bearing on an individual's body mass index (BMI). Another factor that influences taste perception is fungiform papillae count. This, in turn, is governed by genetic factors or deleterious habits such as smoking. Establishing a link between all the above factors could lead to a wider understanding of obesity, which is a global health issue. PTC taste response, BMI, and fungiform papillae were recorded and statistically analyzed between two groups-smokers and nonsmokers. There was no statistically significant difference between smokers and nonsmokers with regard to PTC tasting ability. However, there was a significant inverse relationship between BMI and PTC tasting ability and fungiform papillae count both in smokers and nonsmokers. Thus, it can be inferred that as BMI increases, there is a lower likelihood of experiencing the bitter taste of PTC. Additionally, the ability to taste PTC decreases with diminishing numbers of fungiform papillae. Smoking does not affect bitter PTC tasting ability despite negatively affecting fungiform papillae count.

Spatial pattern and determinants of diagnosed diabetes in southern India: evidence from a 2012-13 population-based survey

The diabetes epidemic is expanding rapidly in India, with 69.2 million people living with diabetes in 2015. This study assessed the spatial pattern and determinants of diagnosed diabetes prevalence in the districts of six states and one union territory (UT) in southern India - a region that has a high prevalence of diabetes. Using cross-sectional population-based survey data from the 2012-13 District Level Household and Facility Survey-4, the prevalence and magnitude of diagnosed diabetes at district level for the population aged 18 years and above were computed. Moran's I was calculated to explore the spatial clustering of diagnosed diabetes prevalence. Ordinary Least Square (OLS) and Spatial Lag (SL) regression models were carried out to investigate the spatial determinants of diagnosed diabetes prevalence. The prevalence of diagnosed diabetes was found to be substantially higher than that of self-reported diabetes in southern India (7.64% vs 2.38%). Diagnosed diabetes prevalence in the study area varied from 10.52% in Goa to 4.89% in Telangana. The Moran's I values signified positive moderate autocorrelation. Southern India had 14.15 million individuals with diagnosed diabetes in 2012-13. Bangalore had the highest number of persons with diagnosed diabetes, and Palakkad had the smallest number. In the OLS and SL models, the proportion of people with secondary education and above, wealthy and Christian populations were found to be significant determinants of diagnosed diabetes prevalence. In addition, in the OLS model, the proportion of Scheduled Tribe population showed a negative relationship with diagnosed diabetes prevalence. In order to prevent or postpone the onset age for diabetes, there is a need to raise awareness about diabetes in India.

Genetic and biochemical investigation of the gamma-glutamylcyclotransferase role in predisposition to type 2 diabetes mellitus

Background. Imbalance in the system of redox homeostasis is an important link in the pathogenesis of type 2 diabetes (T2D). Gamma-glutamyl cyclotransferase is an antioxidant defense enzyme directly involved in the metabolism of glutathione, an endogenous antioxidant. The aim of the study was to examine the association of single nucleotide polymorphisms (SNP) rs38420 (G A), rs4270 (T C), rs6462210 (C T) and rs28679 (G A) in GGCT gene with the risk of developing T2D. Materials and Methods. The study included 1022 T2D patients and 1064 healthy volunteers. Genotyping of GGCT gene loci was performed using iPLEX technology on a MassARRAY Analyzer 4 genome time-of-flight mass spectrometer (Agena Bioscience). Results. As a result, we identified for the first time the association of SNP rs4270 in the GGCT gene with the risk of T2D in the Russian population. We have also established genetic and environmental interactions associated with predisposition to the disease: protective effect of gamma-glutamyl cyclotransferase gene was observed only in non-smokers under condition of daily consumption of fresh vegetables and fruits, whereas in persons with insufficient consumption of plant foods, as well as in all smoking patients protective effect of GGCT was not observed. In patients with T2D, the level of hydrogen peroxide and glutathione monomer was sharply increased compared to the controls. SNP rs4270 was also found to be associated with elevated levels of reduced glutathione in the plasma of type 2 diabetics. Conclusion. Thus, for the first time it was established that polymorphic locus rs4270 in the GGCT gene is associated with a predisposition to T2D, but its relationship with the disease is modulated by smoking and fresh plant foods consumption.

Cardiovascular risk of smoking and benefits of smoking cessation

Smoking increases mortality from all causes and has a crucial role in atherosclerotic cardiovascular disease (ASCVD). Active smoking and secondhand smoke exposure determine more than 30% of coronary heart disease (CHD) mortality. The exact mechanisms of cardiovascular damages are not well known, but the detrimental effect of smoking on endothelial function has long been recognized. Smoking elicits oxidative processes, negatively affects platelet function, fibrinolysis, inflammation and vasomotor function; all these proatherogenic effects double the 10-year risk of fatal events in smokers compared to non smokers. An intriguing issue about smoking is the vulnerability of female gender. The mortality from cardiovascular diseases (CVDs) is higher in female than male smokers and female smokers show a 25% higher risk of developing CHD than men with the same exposure to tobacco smoke. This female vulnerability seems to be related to genes involved in thrombin signaling. The effects of smoking cessation have also been extensively studied. Cessation at an early age (40 years) has an impressive 90% reduction in the excess risk of death. In this review we report recent data about the causal link between smoking and CVDs and about the benefits of smoking cessation.

Impacts of ambient air pollution on glucose metabolism in Korean adults: a Korea National Health and Nutrition Examination Survey study

BACKGROUND

Exposure to air pollution was reported to affect glucose metabolism, increasing the risk of diabetes mellitus. We conducted an epidemiological study on glucose metabolism and air pollution by exploring the levels of fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) with changes in ambient air quality, depending on the characteristics of the susceptible population.

METHODS

We carried out a cross-sectional analysis of a nationally representative sample of 10,014 adults (4267 in male and 5747 in female) from the Korea National Health and Nutrition Examination Survey in 2012 and 2013 along with data from the Korean Air Quality Forecasting System. The analysis was performed using a generalized linear model stratified by sex, age, and presence of diabetes. We assessed the changes in FBG and HbA1c associated with exposures to particulate matter (PM₁₀), fine particulate matter (PM_2.5), and nitrogen dioxide (NO₂) after controlling for confounders.

RESULTS

There were 1110 participants with diabetes (557 in male and 553 in female). Overall, the FBG level increased by 7.83 mg/dL (95% confidence interval [CI]: 2.80-12.87) per interquartile range (IQR) increment of NO₂, 5.32 mg/dL (95% CI: 1.22-9.41) per IQR increment of PM₁₀ at a moving average of 0-6 days, and 4.69 mg/dL (95% CI: 0.48-8.91) per IQR increment of PM_2.5 at a moving average of 0-5 days. HbA1c increased by 0.57% (95% CI: 0.04-1.09) per IQR increment of PM₁₀ at a moving average of 0-60 days and 0.34% (95% CI: 0.04-0.63) per IQR increment of PM_2.5 at a moving average of 0-75 days. The change in FBG and HbA1c increased more in the diabetic group, especially in males aged 65 years or more. There was a strong association between elevation in diabetes-related parameters and exposure to air pollution.

CONCLUSIONS

Our study provides scientific evidence supporting that short- and mid-term exposure to air pollution is associated with changes in biological markers related to diabetes. This finding suggests that the impact of air pollution should be reflected in chronic disease management when establishing local health care policies.

The role of pituitary adenylyl cyclase activating polypeptide in affective signs of nicotine withdrawal

Recent evidence implicates endogenous pituitary adenylyl cyclase activating polypeptide (PACAP) in the aversive effect of nicotine. In the present study, we assessed if nicotine-induced conditioned place preference (CPP) or affective signs of nicotine withdrawal would be altered in the absence of PACAP and if there were any sex-related differences in these responses. Male and female mice lacking PACAP and their wild-type controls were tested for baseline place preference on day 1, received conditioning with saline or nicotine (1 mg/kg) on alternate days for 6 days and were then tested for CPP the next day. Mice were then exposed to four additional conditioning and were tested again for nicotine-induced CPP 24 hr later. Controls were conditioned with saline in both chambers and tested similarly. All mice were then, 96 hr later, challenged with mecamylamine (3 mg/kg), and tested for anxiety-like behaviors 30 min later. Mice were then, 2 hr later, forced to swim for 15 min and then tested for depression-like behaviors 24 hr later. Our results showed that male but not female mice lacking PACAP expressed a significant CPP that was comparable to their wild-type controls. In contrast, male but not female mice lacking PACAP exhibited reduced anxiety- and depression-like behaviors compared to their wild-type controls following the mecamylamine challenge. These results suggest that endogenous PACAP is involved in affective signs of nicotine withdrawal, but there is a sex-related difference in this response.

Clinical Characteristics and Associated Risk Factors of Prediabetes in the Southwestern Region of Korea from 2010-2019

This study investigated the clinical characteristics and associated risk factors of prediabetes in the southwestern region of Korea. A total of 323 subjects from 13 prediabetes studies were included in the data analysis. Subjects with prediabetes were divided into the following subtypes: (1) normal glucose tolerance (NGT) with HbA1c 5.7%–6.4%; (2) isolated impaired fasting glucose (I-IFG); (3) isolated impaired glucose tolerance (I-IGT); and (4) combined I-IFG and I-IGT (C-IFG/IGT). Clinical and biochemical variables were compared among subtypes, and multivariate logistic regression analysis was used to identify risk factors for prediabetes subtypes. The overall proportion of subjects with NGT, I-IFG, I-IGT and C-IFG/IGT was 8.4%, 20.7%, 33.1% and 37.8%, respectively. In men, C-IFG/IGT was the most common subtype, while in women, I-IGT was the most common. The parameters related to dysglycemia, atherosclerosis and liver dysfunction were higher in subjects in the C-IFG/IGT subtype than in other subtypes. Multiple linear regression analysis revealed independent risk factors for increased FPG, 2h-PPG and HbA1c levels. This study identified the clinical features and independent risk factors for prediabetes subtypes.

Excess body weight, cigarette smoking, and type II diabetes incidence in the national FINRISK studies

PURPOSE

We identify the individual and joint contributions of excess weight and cigarette smoking to national-level type II diabetes (T2D) incidence and to educational and gender disparities therein filling an important gap in T2D epidemiology.

METHODS

Based on the FINRISK surveys conducted in 1997, 2002, and 2007 and linked to the Finnish National Drug Reimbursement Register through 2011, we used a regression-counterfactual approach to estimate the percentage of diagnosed drug-treated incident T2D cases attributable to excess body weight and cigarette smoking. Body mass index (BMI) and waist circumference were evaluated.

RESULTS

T2D incidence was 10.24 in men and 7.04 in women per 1000 person-years. Excess baseline BMI (≥25.0 kg/m²) explained 69% and 63%, and smoking explained 9% and 14% of T2D incidence, in men and women, respectively. Most of the gender difference was explained by the risk factors. Approximately 90% in men and 98% in women of the higher T2D incidence among those in the lower versus upper third of the educational distribution was explained by excess BMI. The results were similar for waist circumference and lifetime maximum BMI.

CONCLUSIONS

Excess body weight is the main risk factor contributing to national-level T2D incidence and disparities by educational attainment and gender in a high-income population.

Prevalence and Risk Factors for Diabetes Mellitus in A State in South East Nigeria: Results of a Population Based House to House Survey

BACKGROUND

Population based studies on diabetes mellitus (DM) are scarce in Nigeria.

INTRODUCTION

This was a population-based house to house survey aimed at determining the prevalence of DM and assessing the risk factors associated with DM in a state in Southeast Nigeria.

METHODS

This was a cross-sectional observational study in which 1680 adults were recruited using a multistage sampling method to randomly select not more than two suitable participants of both sex in each household from four enumeration areas (EAs) in each local government area (LGA) and the three senatorial zones in the state. A modified World Health Organization (WHO) Stepwise Approach to Surveillance questionnaire was used for data collection and random blood glucose (RBG) was measured after anthropometric assessment. Test statistics used were chi-square, t-test, and logistic regression.

RESULTS

The overall prevalence of DM in this study was 3.3%. A positive family history of DM was significantly higher in patients with diabetes: 18.2% vs. 9.6% (p=0.036). The mean (SD) of weight, body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in patients with DM(p=0.001,<0.001,<0.001,<0.001, respectively).The odd ratio (95% CI) of a person>35years developing DM was 3.89(1.11-13.60). The OR (95% CI) for waist-hip ratio (WHR) was 3.04 (1.02-9.03) and family history of DM had an OR of 2.62(0.88-6.50). The odd of developing DM is positively associated with age>35years, increased WHR, WC, family history of DM, BMI>25Kg/m2, and HC. The odd of developing DM was negatively associated with smoking.

CONCLUSION

The prevalence of DM in this study was 3.3%. A BMI>25 kg/m2, WHR >0.85, family history of DM, HC, and older age were associated with significantly higher prevalence.

The Dose-Response Relationship between Gamma-Glutamyl Transferase and Risk of Diabetes Mellitus Using Publicly Available Data: A Longitudinal Study in Japan

PURPOSE

The purpose of this study was to examine the association between baseline serum gamma-glutamyl transferase (GGT) and incident diabetes mellitus and to explore their dose-response relationship in a cohort of Japanese adults. Patients and Methods. Data were drawn from the NAGALA (NAfld in the Gifu Area, Longitudinal Analysis) study between 2004 and 2015, including hierarchical information on participants ≥18 years of age without diabetes mellitus, preexisting diabetes mellitus, heavy alcohol drinking, or other liver diseases (e.g., hepatitis B/C). The final analytic sample included 15464 participants, 373 of who were diagnosed as diabetes mellitus with a maximum 13-year follow-up. The risk of incident diabetes mellitus according to baseline serum GGT was estimated using multivariable Cox proportional hazards models and a two-piecewise linear regression model was developed to find out the threshold effect.

RESULTS

Being in the highest quintile versus the lowest quintile of GGT levels was associated with an almost twofold increased risk of incident diabetes mellitus (hazard ratio 1.83 (95% CI 1.06, 3.15)), independent of age, gender, smoking status, alcohol intake, BMI, SBP, triglycerides, fatty liver, ALT, AST, and fasting plasma glucose. Further analysis revealed a positive curvilinear association between GGT and incident diabetes mellitus, with a saturation effect predicted at 24 IU/L. When serum GGT level was less than 24 IU/L, the risk of developing diabetes mellitus increased significantly with an increase in serum GGT levels (HR 1.04 (1.02, 1.07), P=0.0017). Besides, the association was more significant in nonsmoking participants than ex- or current-smokers (P=0.0017). Besides, the association was more significant in nonsmoking participants than ex- or current-smokers (P for interaction = 0.0378).

CONCLUSION

Serum GGT level was a significant predictor of subsequent risk of diabetes mellitus, which increased by 4% for every 1 IU/L increase in GGT when GGT was less than 24 IU/L.

The epidemiology of alcohol consumption in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Globally, excessive alcohol consumption is a major public health problem and is associated with social, mental, physical and legal consequences. However, no systematic review and meta-analysis has been performed to report the consolidated magnitude of alcohol consumption in Ethiopia.

METHODS

PubMed, EMBASE, and SCOPUS were systematically searched to identify pertinent studies. Subgroup and sensitivity analysis was conducted and Cochran's Q- and the I2 test were used to assess heterogeneity. Publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots.

RESULTS

We included 26 articles with a total of 42,811 participants. The pooled current and lifetime prevalence of alcohol consumption was 23.86% (95%CI; 17.53-31.60) and 44.16% (95%CI; 34.20-54.62), respectively. The pooled prevalence of hazardous alcohol consumption was 8.94% (95%CI; 3.40-21.50). The prevalence of hazardous alcohol consumption was remarkably higher in men (11.58%) than in women (1.21%). The prevalence of current and lifetime alcohol consumptions among university students were 22.08% & 38.88% respectively. The pooled data revealed that male sex was found to be a significant predictor of hazardous alcohol consumption (OR 10.38; 95%CI 3.86 to 27.88) as well as current (OR 2.45; 95%CI 1.78 to 3.38) and lifetime (OR 2.14; 95%CI 1.39 to 3.29) consumption. The magnitude of alcohol consumption among university students was apparently lower than the magnitude in other population of the country. The current study suggested a remarkable recent increment in the magnitude of hazardous alcohol consumption in Ethiopia.

CONCLUSION

The current study revealed that the prevalence of alcohol consumption in Ethiopia is comparable with the global estimates of alcohol consumption from the World Health Organization (WHO). The prevalence of hazardous alcohol consumption was remarkably higher in men (11.58%) than in women (1.21%). Male sex was found to be a significant predictor of alcohol consumption. The present study also suggested considerable recent increment in the magnitude of hazardous alcohol consumption in Ethiopia.

The role of endogenous pituitary adenylyl cyclase activating polypeptide (PACAP) in nicotine self-administration, reward and aversion

Pituitary adenylyl cyclase activating polypeptide (PACAP) and its receptors (PAC1, VPAC1, and VPAC2) are localized in brain regions implicated in stress response, reward seeking and aversive responses, raising the possibility that PACAP may be involved in motivational effects of nicotine. To test this hypothesis, we used two-bottle choice (TBC) and place conditioning paradigms and assessed if nicotine preference or conditioned place preference (CPP) or aversion (CPA) induced by nicotine would be altered in mice lacking PACAP compared to their wild-type controls. In the TBC paradigm, mice had access to two water bottles during the first week and then one of the water bottles was switched to nicotine solution (20, 40 and then 80 μg/mL). The volume of water and nicotine consumed was measured every day. In the place conditioning paradigm, mice were tested for baseline place preference on day 1, received conditioning with saline versus a low (0.25) or high (1 mg/kg) dose nicotine and, respectively, tested for CPP or CPA 24 h following the last conditioning. We discovered that mice lacking PACAP compared to their wild-type controls exhibited more preference for nicotine over water in the TBC paradigm, particularly at the two higher concentrations of nicotine. While the rewarding action of the low dose nicotine was not altered in mice lacking PACAP, the aversive effect of the high dose nicotine was blunted in these mice compared to their wild-type controls. The present results suggest that endogenous PACAP may play a functional role in nicotine preference and its aversive effect.

Mediation of the association of smoking and microvascular complications by glycemic control in type 1 diabetes

Studies have demonstrated the adverse effects of smoking on the risk of microvascular complications; however, few have also examined the potential mediating effects of glycemic control. Using data from the Diabetes Control and Complications Trial (DCCT 1983–1993), we describe the acute and long-term risks of smoking on glycemic control and microvascular complications in a well-characterized cohort of participants with type 1 diabetes. The DCCT recorded self-reported smoking behaviors, glycemic exposure based on HbA1c, and complications status. Generalized linear mixed models were used to assess whether time-dependent measurements of smoking predict HbA1c levels. Cox proportional hazard models were used to assess time-dependent smoking exposures as predictors of retinopathy and nephropathy. During a mean of 6.5 years of follow-up, current smokers had consistently higher HbA1c values and were at a higher risk of retinopathy and nephropathy compared with former and never smokers. These risk differences were attenuated after adjusting for HbA1c suggesting that the negative association of smoking on glycemic control is partially responsible for the adverse association of smoking on the risk of complications in type 1 diabetes. These findings support the potential for a beneficial effect of smoking cessation on complications in type 1 diabetes.

Diabetes and diabetes care among non-obese South Asian Americans: Findings from a population-based study

AIMS

The aim of this paper is to provide population-based data from California on: (a) the prevalence and the odds of diabetes among non-obese South Asian (SA) Americans compared to non-Hispanic Whites (NHW); (b) to assess the prevalence and odds of optimal medical care including regular eye exams, foot exams, and the monitoring of hemoglobin A1C blood glucose levels; and (c) To identify the factors that are associated with diabetes among SA Americans.

METHODS

The combined 2007, 2009, and 2011 waves of the adult California Health Interview Survey (CHIS) was used to analyze a non-obese (BMI<30) sample of 1251 SA and 72,072 NHW. Chi-square and logistic regression analyses were performed using Stata.

RESULTS

Non-obese SA had more than twice the odds of diabetes in comparison to NHW (OR = 2.50; 1.66, 3.76), even after adjusting for sociodemographic characteristics. Despite their higher propensity for diabetes, there were no significant ethnic differences in the level of optimal care received by those with diabetes. Among non-obese South Asian Americans, the odds of diabetes were higher for older respondents, those without a post-secondary degree, those who were foreign-born, those who had ever smoked, and those with BMI from 25 to 29.99.

CONCLUSIONS

Non-obese SA in California experience a disproportionately higher prevalence of diabetes than their NHW counterparts.

Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia

BACKGROUND

Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts.

OBJECTIVES

To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia.

SEARCH METHODS

We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining.

SELECTION CRITERIA

We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only.

DATA COLLECTION AND ANALYSIS

One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework.

MAIN RESULTS

We included 103 prospective cohort studies. The studies mainly defined IH by IFG5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG5.6, IFG6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG6.1 and IFG5.6. Limited data showed a higher T2DM incidence associated with HbA1c6.0 compared to HbA1c5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018.

AUTHORS' CONCLUSIONS

Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.

Effect of Smoking on Healing Failure After Rotator Cuff Repair

BACKGROUND

No study to date has directly evaluated rotator cuff repair results among smokers.

PURPOSE

To evaluate whether smoking affects healing after arthroscopic rotator cuff repair through propensity score matching (PSM).

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Among 249 patients who underwent arthroscopic repair of full-thickness rotator cuff tears, 34 current heavy smokers were selected with a smoking history >20 pack-years (mean ± SD pack-years, 33.91 ± 12.13). Characteristics between current heavy smokers and nonsmokers were compared. According to the PSM technique, 34 nonsmokers were selected after 1:1 matching for age, fatty infiltration, and tear size-the main prognostic factors of outcomes after rotator cuff repair. Each patient's outcome evaluation was completed anatomically at a minimum of 6 months (magnetic resonance imaging or ultrasonography) and functionally at a minimum of 1 year (pain visual analog scale, range of motion, American Shoulder and Elbow Surgeons, Constant, University of California, Los Angeles, and Simple Shoulder Test scores), and every outcome was analyzed in the matched smoker and nonsmoker groups.

RESULTS

Current heavy smokers had a higher incidence of male sex ( P < .001), heavy manual work ( P = .025), high bone density ( P = .036), and poor tendinosis grade ( P = .028). After adjustment for the confounding variables by PSM, the matched smoker group showed a significantly higher healing failure rate than the matched nonsmoker group (29.4% vs 5.9%, P = .023). However, we failed to detect significant differences in the functional outcomes between the matched groups ( P > .05).

CONCLUSION

Smoking affected healing failure after arthroscopic rotator cuff repair. Attention should be paid to smokers, especially current heavy smokers, in cases of rotator cuff repair surgery.