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Sheng B, Pushpanathan K, Guan Z, Lim QH, Lim ZW, Yew SME, Goh JHL, Bee YM, Sabanayagam C, Sevdalis N, Lim CC, Lim CT, Shaw J, Jia W, Ekinci EI, Simó R, Lim LL, Li H, Tham YC. Artificial intelligence for diabetes care: current and future prospects. Lancet Diabetes Endocrinol 2024; 12:569-595. [PMID: 39054035 DOI: 10.1016/s2213-8587(24)00154-2] [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: 02/02/2024] [Revised: 03/28/2024] [Accepted: 05/16/2024] [Indexed: 07/27/2024]
Abstract
Artificial intelligence (AI) use in diabetes care is increasingly being explored to personalise care for people with diabetes and adapt treatments for complex presentations. However, the rapid advancement of AI also introduces challenges such as potential biases, ethical considerations, and implementation challenges in ensuring that its deployment is equitable. Ensuring inclusive and ethical developments of AI technology can empower both health-care providers and people with diabetes in managing the condition. In this Review, we explore and summarise the current and future prospects of AI across the diabetes care continuum, from enhancing screening and diagnosis to optimising treatment and predicting and managing complications.
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Affiliation(s)
- Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China; Key Laboratory of Artificial Intelligence, Ministry of Education, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Krithi Pushpanathan
- Centre of Innovation and Precision Eye Health, Department of Ophthalmology, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Quan Hziung Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhi Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Samantha Min Er Yew
- Centre of Innovation and Precision Eye Health, Department of Ophthalmology, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore; SingHealth Duke-National University of Singapore Diabetes Centre, Singapore Health Services, Singapore
| | - Charumathi Sabanayagam
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Nick Sevdalis
- Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore
| | | | - Chwee Teck Lim
- Department of Biomedical Engineering, National University of Singapore, Singapore; Institute for Health Innovation and Technology, National University of Singapore, Singapore; Mechanobiology Institute, National University of Singapore, Singapore
| | - Jonathan Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Elif Ilhan Ekinci
- Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School and Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Asia Diabetes Foundation, Hong Kong Special Administrative Region, China
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
| | - Yih-Chung Tham
- Centre of Innovation and Precision Eye Health, Department of Ophthalmology, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
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Wan KS, Moy FM, Mohd Yusoff MF, Mustapha F, Ismail M, Mat Rifin H, Yoga Ratnam KK, Ismail H, Chong KK, Ahmad NA, Hairi NN. Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure. Sci Rep 2024; 14:12625. [PMID: 38824234 PMCID: PMC11144228 DOI: 10.1038/s41598-024-63617-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024] Open
Abstract
Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and 'others' ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.
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Affiliation(s)
- Kim Sui Wan
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Federal Territory of Kuala Lumpur, Malaysia.
| | - Foong Ming Moy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Federal Territory of Kuala Lumpur, Malaysia
| | - Muhammad Fadhli Mohd Yusoff
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Feisul Mustapha
- Disease Control Division, Federal Government Administration Centre, Ministry of Health, 62590, Putrajaya, Malaysia
- Perak State Health Department, Ministry of Health Malaysia, 30000, Ipoh, Perak, Malaysia
| | - Mastura Ismail
- Family Health Development Division, Federal Government Administration Centre, Ministry of Health Malaysia, 62590, Putrajaya, Malaysia
| | - Halizah Mat Rifin
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Kishwen Kanna Yoga Ratnam
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Hasimah Ismail
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Kah Kian Chong
- Medical Department, Hospital Port Dickson, Negeri Sembilan, 71050, Port Dickson, Malaysia
| | - Noor Ani Ahmad
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Federal Territory of Kuala Lumpur, Malaysia
- Faculty of Public Health, Universitas Airlangga, Surabaya City, 60115, East Java, Indonesia
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Song DK, Hong YS, Sung YA, Lee H. Risk factor control and cardiovascular events in patients with type 2 diabetes mellitus. PLoS One 2024; 19:e0299035. [PMID: 38422102 PMCID: PMC10903792 DOI: 10.1371/journal.pone.0299035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Since patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular events, interventions addressing risk factors reduce the incidence of cardiovascular disease (CVD) events. This study aimed to evaluate the difference in the incidence of CVD events according to risk factor control in patients with diabetes with and without cardio-renal disease. METHODS We analyzed 113,909 patients with diabetes and 290,339 without diabetes using data released by the National Health Insurance Service (NHIS). RESULTS Among patients with diabetes with four or five poorly controlled risk factors, hazard ratio for CVD events was 1.19 (95% confidence interval [CI], 1.06-1.34) in patients with cardio-renal disease and 2.31 (95% CI, 1.95-2.74) in patients without cardio-renal disease compared to patients with diabetes without risk factors. In subjects with diabetes and cardio-renal disease, patients with four or five poorly controlled risk factors had a higher risk of CVD mortality compared to subjects without risk factors (hazard ratio, 1.64; 95% CI, 1.18-2.30). CONCLUSION Controlling cardiovascular risk factors reduced the incidence of CVD events in patients with diabetes, especially those without cardio-renal disease. The degree of risk control was strongly associated with CVD mortality in patients with diabetes with baseline cardio-renal disease.
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Affiliation(s)
- Do Kyeong Song
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Sun Hong
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yeon-Ah Sung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyejin Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, Castillo-Martínez L, de la Torre-Saldaña V, Guzman-Olvera E, Bernal-Ceballos F. Impact of a multicomponent integrated care delivery program on diabetes care goals achievement: a primary care quality improvement initiative. Prim Care Diabetes 2023; 17:568-574. [PMID: 37640623 DOI: 10.1016/j.pcd.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
AIM To evaluate the impact of multicomponent integrated care (MIC) delivery program in a primary care real-life setting on diabetes care goals. METHODS Patients with T2D and usual primary care from the public health system in Mexico were invited to participate in a five-month ambulatory MIC quality initiative (DIAbetes Empowerment and Improvement of Care program, DIABEMPIC). RESULTS 841 patients who finished the program and with complete data were analyzed. The patients had a mean decrease in hemoglobin A1c, systolic and diastolic pressure, and LDL-cholesterol of 2.4%, 9 mmHg, 3 mmHg, and 22.5 mg/dL, respectively (p < 0.001). The achievement of the optimal triple target goal increased from 1.8% to 26.7% (p < 0.001). In the adjusted analysis, the diabetes knowledge and global self-care behavior score post-intervention, as well as the increment of global self-care behavior score were associated with the optimal composite risk factor control achievement. CONCLUSION The incorporation of diabetes therapeutic education interventions to improve self-care behaviors along with adequate treatment intensification in diabetes care are fundamental to attaining optimal risk factor control and attenuating disease burden.
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Affiliation(s)
- Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
| | - Teresa Cuatecontzi-Xochitiotzi
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
| | - Lilia Castillo-Martínez
- Department of Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Viridiana de la Torre-Saldaña
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
| | - Eileen Guzman-Olvera
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Servicios de Salud Pública de la Ciudad de México, Mexico
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Li X, Chen H. Characteristics of glucolipid metabolism and complications in novel cluster-based diabetes subgroups: a retrospective study. Lipids Health Dis 2023; 22:200. [PMID: 37990237 PMCID: PMC10662503 DOI: 10.1186/s12944-023-01953-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Glucolipid metabolism plays an important role in the occurrence and development of diabetes mellitus. However, there is limited research on the characteristics of glucolipid metabolism and complications in different subgroups of newly diagnosed diabetes. This study aimed to investigate the characteristics of glucolipid metabolism and complications in novel cluster-based diabetes subgroups and explore the contributions of different glucolipid metabolism indicators to the occurrence of complications and pancreatic function. METHODS This retrospective study included 547 newly diagnosed type 2 diabetes patients. Age, body mass index (BMI), glycated hemoglobin (HbA1C), homeostasis model assessment-2 beta-cell function (HOMA2-β), and homeostasis model assessment-2 insulin resistance (HOMA2-IR) were used as clustering variables. The participants were divided into 4 groups by k-means cluster analysis. The characteristics of glucolipid indicators and complications in each subgroup were analyzed. Regression analyses were used to evaluate the impact of glucolipid metabolism indicators on complications and pancreatic function. RESULTS Total cholesterol (TC), triglycerides (TG), triglyceride glucose index (TyG), HbA1C, fasting plasma glucose (FPG), and 2-h postprandial plasma glucose (2hPG) were higher in the severe insulin-resistant diabetes (SIRD) and severe insulin-deficient diabetes (SIDD) groups. Fasting insulin (FINS), fasting C-peptide (FCP), 2-h postprandial insulin (2hINS), 2-h postprandial C-peptide (2hCP), and the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) were higher in mild obesity-related diabetes (MOD) and SIRD. 2hCP, FCP, and FINS were positively correlated with HOMA2-β, while FPG, TyG, HbA1C, and TG were negatively correlated with HOMA2-β. FINS, FPG, FCP, and HbA1C were positively correlated with HOMA2-IR, while high-density lipoprotein (HDL) was negatively correlated with HOMA2-IR. FINS (odds ratio (OR),1.043;95% confidence interval (CI) 1.006 ~ 1.081), FCP (OR,2.881;95%CI 2.041 ~ 4.066), and TyG (OR,1.649;95%CI 1.292 ~ 2.104) contributed to increase the risk of nonalcoholic fatty liver disease (NAFLD); 2hINS (OR,1.015;95%CI 1.008 ~ 1.022) contributed to increase the risk of atherosclerotic cardiovascular disease (ASCVD); FCP (OR,1.297;95%CI 1.027 ~ 1.637) significantly increased the risk of chronic kidney disease (CKD). CONCLUSIONS There were differences in the characteristics of glucolipid metabolism as well as complications among different subgroups of newly diagnosed type 2 diabetes. 2hCP, FCP, FINS, FPG, TyG, HbA1C, HDL and TG influenced the function of insulin. FINS, TyG, 2hINS, and FCP were associated with ASCVD, NAFLD, and CKD in newly diagnosed T2DM patients.
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Affiliation(s)
- Xinrong Li
- Department of Endocrinology and Metabolism, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu Province, China
| | - Hui Chen
- Department of Endocrinology and Metabolism, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu Province, China.
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Wan KS, Mustapha F, Chandran A, Ganapathy SS, Zakariah N, Ramasamy S, Subbarao GR, Mohd Yusoff MF. Baseline treatments and metabolic control of 288,913 type 2 diabetes patients in a 10-year retrospective cohort in Malaysia. Sci Rep 2023; 13:17338. [PMID: 37833402 PMCID: PMC10576047 DOI: 10.1038/s41598-023-44564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023] Open
Abstract
Diabetes is one of the quickest-growing global health emergencies of the twenty-first century, and data-driven care can improve the quality of diabetes management. We aimed to describe the formation of a 10-year retrospective open cohort of type 2 diabetes patients in Malaysia. We also described the baseline treatment profiles and HbA1c, blood pressure, and lipid control to assess the quality of diabetes care. We used 10 years of cross-sectional audit datasets from the National Diabetes Registry and merged 288,913 patients with the same identifying information into a 10-year open cohort dataset. Treatment targets for HbA1c, blood pressure, LDL-cholesterol, HDL-cholesterol, and triglycerides were based on Malaysian clinical practice guidelines. IBM SPSS Statistics version 23.0 was used, and frequencies and percentages with 95% confidence intervals were reported. In total, 288,913 patients were included, with 62.3% women and 54.1% younger adults. The commonest diabetes treatment modality was oral hypoglycaemic agents (75.9%). Meanwhile, 19.3% of patients had ≥ 3 antihypertensive agents, and 71.2% were on lipid-lowering drugs. Metformin (86.1%), angiotensin-converting enzyme inhibitors (49.6%), and statins (69.2%) were the most prescribed antidiabetic, antihypertensive, and lipid-lowering medications, respectively. The mean HbA1c was 7.96 ± 2.11, and 31.2% had HbA1c > 8.5%. Only 35.8% and 35.2% attained blood pressure < 140/80 mmHg and LDL-cholesterol < 2.6 mmol/L, respectively. About 57.5% and 52.9% achieved their respective triglyceride and HDL-cholesterol goals. In conclusion, data integration is a feasible method in this diabetes registry. HbA1c, blood pressure, and lipids are not optimally controlled, and these findings can be capitalized as a guideline by clinicians, programme managers, and health policymakers to improve the quality of diabetes care and prevent long-term complications in Malaysia.
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Affiliation(s)
- Kim Sui Wan
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Feisul Mustapha
- Disease Control Division, Ministry of Health Malaysia, Federal Government Administration Centre, 62590, Putrajaya, Malaysia
| | - Arunah Chandran
- Disease Control Division, Ministry of Health Malaysia, Federal Government Administration Centre, 62590, Putrajaya, Malaysia
| | - Shubash Shander Ganapathy
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Nurhaliza Zakariah
- Disease Control Division, Ministry of Health Malaysia, Federal Government Administration Centre, 62590, Putrajaya, Malaysia
| | - Sivarajan Ramasamy
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Gunenthira Rao Subbarao
- Medical Development Division, Ministry of Health Malaysia, Federal Government Administration Centre, 62590, Putrajaya, Malaysia
| | - Muhammad Fadhli Mohd Yusoff
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
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Maxey J, Gupta A, Houchens N. Quality and safety in the literature: April 2023. BMJ Qual Saf 2023; 32:235-240. [PMID: 36931631 DOI: 10.1136/bmjqs-2023-015977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Jordan Maxey
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Zhao W, Wang Y, Cao C, Zeng Z, Jin L, Liu Z, Duan M, Dong Y, Zhang J, Shuai Y, Wang N, Zhang Y, Deng G, He J, Zhao X, Zheng W, Yang W, Xiao J. The feasibility and efficacy of a community-based multifactorial intervention to improve the cardiovascular risk factor control among patients with type 2 diabetes: A 2-year cluster randomized trial. Medicine (Baltimore) 2022; 101:e31943. [PMID: 36595814 PMCID: PMC9794231 DOI: 10.1097/md.0000000000031943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
TRIAL DESIGN Our study is to investigate the feasibility and effectiveness of multiple cardiovascular factors intervention (MFI) in type 2 diabetes patients in China's primary care setting. METHODS We performed a cluster randomized trial to compare the proportion of patients achieved the targets between usual care group (control, 9 sites, n = 868) and MFI group (8 sites, n = 739) among patients with type 2 diabetes in primary care setting. Logistic regression model with random effects was used to estimate the association of the effect of intervention and the proportion achieved the targets. RESULTS At baseline, the end of 1 year, and 2 years follow-up, the proportion of patients achieved all 3 target goals (HbA1c < 7.0%, blood pressure < 130/80 mm Hg and low-density lipoprotein cholesterol < 2.6 mmol/L) were 5.7%, 5.9%, 5.7% in the control group and 5.9%, 10.6%, 12.3% in the MFI group. After adjusting sex, age, diabetes duration, body mass index, HbA1c, blood pressure, and low-density lipoprotein cholesterol at baseline, there was no difference between the 2 groups (OR (95% CI): 1.27 (0.38-4.27) and 1.86 (0.79-4.38) for the first year and second year, respectively). When stratified by payment method, the patients with medical insurance or public expenses had a higher proportion achieved target goals (6.9% vs 16.4%, OR (95% CI): 2.30 (1.04-5.08)) in the second year. CONCLUSIONS The controlling of cardiovascular risk factor targets remains suboptimal among patients with type 2 diabetes in primary care setting. MFI in type 2 diabetes improved cardiovascular disease risk profile, especially in the patients with medical insurance.
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Affiliation(s)
- Wenhui Zhao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yanlei Wang
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chenxiang Cao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ziqiang Zeng
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lixia Jin
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhaoxiang Liu
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Min Duan
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yanan Dong
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | | | - Ying Shuai
- China-Japan Friendship Hospital, Beijing, China
| | - Na Wang
- China-Japan Friendship Hospital, Beijing, China
| | - Yajing Zhang
- Beijing Pinggu District Hospital, Beijing, China
| | - Guixia Deng
- Beijing Pinggu District Yukou Community Central Health Center, Beijing, China
| | - Jiquan He
- Beijing Pinggu District Xiagezhuang Township Hospital, Beijing, China
| | - Xinghua Zhao
- Beijing Huairou District Yangsong Township Hospital, Beijing, China
| | - Wenli Zheng
- Beijing Daxing District Yinghai Community Central Health Center, Beijing, China
| | | | - Jianzhong Xiao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- *Correspondence: Jianzhong Xiao, MD, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Changping District, Beijing 102218, China (e-mail: )
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Ares-Blanco S, Polentinos-Castro E, Rodríguez-Cabrera F, Gullón P, Franco M, del Cura-González I. Inequalities in glycemic and multifactorial cardiovascular control of type 2 diabetes: The Heart Healthy Hoods study. Front Med (Lausanne) 2022; 9:966368. [PMID: 36569128 PMCID: PMC9769119 DOI: 10.3389/fmed.2022.966368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022] Open
Abstract
Aim This study aimed to analyze glycemic control and multifactorial cardiovascular control targets in people with type 2 diabetes (T2DM) in primary care according to sex and socioeconomic status (SES). Materials and methods This is an observational, cross-sectional, and multicenter study. We analyzed all the patients with T2DMM aged between 40 and 75 years in Madrid city (113,265) through electronic health records from 01 August 2017 to 31 July 2018. SES was defined by an area-level socioeconomic index stratified by quintiles (1st quintile: more affluent). Outcomes Outcomes included glycemic control (HbA1c ≤ 7%), 3-factor cardiovascular control [HbA1c ≤ 7%, blood pressure (BP), < 140/90 mmHg, LDL < 100 mg/ml] and 4-factor control [HbA1c ≤ 7%, blood pressure (BP) < 140/90 mmHg, LDL < 100 mg/ml, and BMI < 30 kg/m2]. Multilevel logistic regression models analyzed factors associated with suboptimal glycemic control. Results In total 43.2% were women. Glycemic control was achieved by 63% of patients (women: 64.2% vs. men: 62.4%). Being more deprived was associated with suboptimal glycemic control (OR: 1.20, 95% CI: 1.10-1.32); however, sex was not related (OR: 0.97, 95% CI: 0.94-1.01). The optimal 3-factor control target was reached by 10.3% of patients (women: 9.3% vs. men: 11.2%), especially those in the 5th quintile of SES. The 4-factor control was achieved by 6.6% of the sample. In the 3-factor control target, being women was related to the suboptimal 3-factor control target (OR: 1.26, 95% CI: 1.19- 1.34) but only belonging to SES 4th quintile was related to the unachieved target (OR: 1.47, 95% CI: 1.04-2.07). Conclusion Suboptimal glycemic control was associated with being less affluent and suboptimal 3-factor control target was associated with being women.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,*Correspondence: Sara Ares-Blanco,
| | - Elena Polentinos-Castro
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Health Services Research on Chronic Patients Network (REDISSEC and RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Pedro Gullón
- Public Health and Epidemiology Research Group, Universidad de Alcalá, Alcala de Henares, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, Universidad de Alcalá, Alcala de Henares, Spain,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Isabel del Cura-González
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain,Health Services Research on Chronic Patients Network (REDISSEC and RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
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10
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Wan KS, Hairi NN, Mustapha F, Ismail M, Mohd Yusoff MF, Moy FM. Five-year LDL-cholesterol trend and its predictors among type 2 diabetes patients in an upper-middle-income country: a retrospective open cohort study. PeerJ 2022; 10:e13816. [PMID: 36317122 PMCID: PMC9617547 DOI: 10.7717/peerj.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/08/2022] [Indexed: 01/18/2023] Open
Abstract
Background Patients with diabetes have increased risks of cardiovascular diseases (CVD), and their LDL-cholesterol (LDL-C) has to be treated to target to prevent complications. We aim to determine the LDL-C trend and its predictors among patients with type 2 diabetes (T2D) in Malaysia. Methods This was a retrospective open cohort study from 2013 to 2017 among T2D patients in public primary health care clinics in Negeri Sembilan state, Malaysia. Linear mixed-effects modelling was conducted to determine the LDL-C trend and its predictors. The LDL-C target for patients without CVD was <2.6 mmol/L, whereas <1.8 mmol/L was targeted for those with CVD. Results Among 18,312 patients, there were more females (55.9%), adults ≥60 years (49.4%), Malays (64.7%), non-smokers (93.6%), and 45.3% had diabetes for <5 years. The overall LDL-C trend reduced by 6.8% from 2.96 to 2.76 mmol/L. In 2017, 16.8% (95% CI: 13.2-21.0) of patients without CVD and 45.8% (95% CI: 44.8-46.8) of patients with CVD achieved their respective LDL-C targets. The predictors for a higher LDL-C trend were younger adults, Malay and Indian ethnicities, females, dyslipidemia, and diabetes treatment with lifestyle modification and insulin. Longer diabetes duration, obesity, hypertension, retinopathy, statin therapy, achievement of HbA1c target and achievement of BP target were independent predictors for a lower LDL-C trend. Conclusions The LDL-C trend has improved, but there are still gaps between actual results and clinical targets. Interventions should be planned and targeted at the high-risk populations to control their LDL-C.
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Affiliation(s)
- Kim Sui Wan
- Institute for Public Health, National Institutes of Health, Shah Alam, Selangor, Malaysia,Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia,Faculty of Public Health, Universitas Airlangga, Surabaya City, East Java, Indonesia
| | - Feisul Mustapha
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Federal Territory of Putrajaya, Malaysia
| | - Mastura Ismail
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Federal Territory of Putrajaya, Malaysia
| | | | - Foong Ming Moy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
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11
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Abdel-Rahman N, Calderon-Margalit R, Cohen A, Elran E, Golan Cohen A, Krieger M, Paltiel O, Valinsky L, Ben-Yehuda A, Manor O. Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease: A Nationwide Population-Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes. J Am Heart Assoc 2022; 11:e025603. [PMID: 36129044 DOI: 10.1161/jaha.122.025603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking. Methods and Results We conducted a population-based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006-2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011-2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person-years of follow-up, 19 246 patients experienced cardiac disease. An inverse dose-response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low-density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low-density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49-1.72) and 1.23 (95% CI, 1.14-1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50-1.69) for cardiac outcomes. Conclusions Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
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Affiliation(s)
- Nura Abdel-Rahman
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ronit Calderon-Margalit
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | | | - Michal Krieger
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | - Ora Paltiel
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
| | | | | | - Orly Manor
- The Hebrew University of Jerusalem Hadassah Medical School, Braun School of Public Health Jerusalem Israel
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12
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Bi Y, Tian Z, Yan W, Liu M, Zhao Y, Bao H, Yan T, Zhang N, Xia Y, Zhang X. Treatment and control of modifiable cardiovascular risk factors among patients with diabetes mellitus and hypertension in Inner Mongolia: A cross-sectional study. J Clin Hypertens (Greenwich) 2021; 23:2016-2025. [PMID: 34699679 PMCID: PMC8630609 DOI: 10.1111/jch.14375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 01/04/2023]
Abstract
The authors assessed treatment and control of blood glucose, blood pressure (BP), and blood lipids among patients from Inner Mongolia with diabetes mellitus (DM) and hypertension (HTN) and identified the modifiable factors associated with treatment and achievement of blood glucose, BP, and blood lipid targets. The authors used a multistage stratified cluster sampling method according to geographical location and level of economic development in Inner Mongolia. Among patients with DM and HTN, the crude rates of fasting plasma glucose (FPG) treatment and control was 30.76% and 4.73%, respectively. Crude rates of BP treatment and control were 50.81% and 8.70%, respectively. The authors found that treatment rates of HTN and DM and control rates of BP and FPG showed a gradually increasing trend with increased age. Among patients with DM and HTN, the likelihood of treatment for HTN and DM was significantly increased among participants who were older, non‐Mongolian, male, obese, smokers, and those with previous cardiovascular disease. The authors found that control of BP, FPG, and low‐density lipoprotein cholesterol was far from optimal among study participants. Medical and health departments in Inner Mongolia should take appropriate measures to reduce the burden of DM and HTN in the population, such as by promoting and improving the quality of HTN and DM treatment to achieve control goals and reduce the risk of cardiovascular disease.
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Affiliation(s)
- Yanqing Bi
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Zixuan Tian
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Wenyan Yan
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Min Liu
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Yuqian Zhao
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Han Bao
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Tao Yan
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Nan Zhang
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Yuan Xia
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Xingguang Zhang
- Department of Health Statistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
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13
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Usman M, Khunti K, Davies MJ, Gillies CL. Association and relative importance of multiple risk factor control on cardiovascular disease, end-stage renal disease and mortality in people with type 2 diabetes: A population-based retrospective cohort study. Prim Care Diabetes 2021; 15:218-226. [PMID: 32863149 DOI: 10.1016/j.pcd.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the risk of cardiovascular disease (CVD), end-stage renal disease (ESRD), and mortality, when implementing a multifactorial optimal control approach in primary care in the United Kingdom (UK), in individuals with newly diagnosed type 2 diabetes. MATERIALS AND METHODS A retrospective cohort of 53 942 patients were stratified into 1 of the 8 groups according to whether glycated haemoglobin (HbA1c), blood pressure (BP) and total cholesterol (TC) target values were achieved or not from baseline to the date of last follow-up. Those with single or combinations of risk factor control targets achieved, were compared to those who achieved no targets in any of the risk factor. Hazard ratios from the Cox proportional hazards models were estimated against patients who achieved no targets. RESULTS Of 53 942 patients with newly diagnosed type 2 diabetes, 28%, 55%, and 68% were at target levels for HbA1c <48mmol/mol (<6.5%), BP<140/85mm Hg, and TC<5mmol/L respectively, 36%, 40%, and 12% were at target levels for any one, two, or all three risk factors respectively. Being at HbA1c, BP, and TC targets was associated with an overall 47%, 25%, 42%, 55% and 42% reduction in the risk of ischemic heart disease, cerebrovascular disease, ESRD, cardiovascular-mortality, and all-cause-mortality respectively. Among all subgroups, the risk reduction of study outcome events was greater in the subgroups of patients with microalbuminuria, males, smokers, and patients with BMI≥30kg/m2. CONCLUSIONS Optimal levels of HbA1c, BP, and TC occurring together in patients with newly diagnosed type 2 diabetes are uncommon. Achieving multiple risk factor control targets could substantially reduce the risk of CVD, ESRD and mortality.
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Affiliation(s)
- Muhammad Usman
- Diabetes Research Centre, University of Leicester, LE5 4PW Leicester, UK.
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, LE5 4PW Leicester, UK; NIHR Applied Research Collaborations - East Midlands (NIHR ARC - EM), LE5 4PW Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, LE5 4PW Leicester, UK; NIHR Leicester Biomedical Research Centre, LE5 4PW Leicester, UK
| | - Clare L Gillies
- Diabetes Research Centre, University of Leicester, LE5 4PW Leicester, UK
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14
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Yang X, Liu Q, Fan Y, Ding L, Wang R, Hu G, Liu M. Cardiovascular Risk Factor Status in Hospitalized Patients With Type 2 Diabetes in China. Front Endocrinol (Lausanne) 2021; 12:664183. [PMID: 34367063 PMCID: PMC8339370 DOI: 10.3389/fendo.2021.664183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/28/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Controlling blood glucose, blood pressure, and blood lipid is of great importance for patients with type 2 diabetes, not only for cardiovascular disease, but also for other complications. Previous studies mainly focused on the control rate of outpatients, and the results were suboptimal, but few studies aimed at the inpatients. METHOD The present study involved 3,245 hospitalized patients with type 2 diabetes from 2013 to 2017 in the Department of Endocrinology and Metabolism of Tianjin Medical University General Hospital. The percentages of inpatients who attained the goals of the China Diabetes Society and the American Diabetes Association were calculated for major cardiovascular risk factors (HbA1c, blood pressure, and blood lipid). The prevalence of microvascular and macrovascular complications was also assessed. RESULT The percentages of patients who met the Chinese Diabetes Society goals-HbA1c <7%, blood pressure <130/80 mmHg, normal lipids, and all three goals-were 26.7, 14.8, 10.4, and 0.2% in 2013 and 30.5, 16.2, 8.0, and 0.9% in 2017, respectively. The percentage of patients who met all three American Diabetes Association goals (HbA1c<7%, blood pressure <140/90 mmHg, low-density lipoprotein cholesterol <2.6 mmol/L) increased from 4.3% in 2013 to 9.0% in 2017. The prevalence of major diabetes complications including coronary heart disease (31.7 vs. 31.9%), stroke (16.7 vs. 14.8%), diabetic kidney disease (37.9 vs. 35.8%), diabetic retinopathy (48.0 vs. 46.5%), neuropathy (63.1 vs. 61.9%), and diabetic foot (0.8 vs. 1.2%) were stable from 2013 to 2017. CONCLUSION During 2013 to 2017, control rates of major cardiovascular risk factors including HbA1c, blood pressure, and low-density lipoprotein cholesterol were improved among hospitalized patients in Tianjin, China.
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Affiliation(s)
- Xiaoyun Yang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Qian Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Ruodan Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Ming Liu,
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15
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Xi Y, Bao H, Han K, Qiao L, Xu X, Zhu H, Yan T, Niu L, Hang G, Wang W, Zhang X. Evaluating the treatment and control of modifiable cardiovascular disease risk factors among patients with diabetes in the Inner Mongolia, China: A cross-sectional study. Prev Med 2020; 139:106174. [PMID: 32592794 DOI: 10.1016/j.ypmed.2020.106174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 05/24/2020] [Accepted: 06/06/2020] [Indexed: 01/19/2023]
Abstract
Reducing the risk of diabetes has been a great public health challenge in China. In this study, we aimed to estimate the treatment and control of FPG (fasting blood plasma glucose) as well as the other main modifiable cardiovascular disease (CVD) risk factors in patients with diabetes and to identify those characteristics associated with the treatment and control of diabetes, hypertension, and low-density lipoprotein cholesterol (LDL-C). Between 2015 and 2017, participants aged 35 to 75 years from Inner Mongolia in northern China were recruited. A total 13,644 participants with diabetes were enrolled in this study. We calculated rates and 95% confidence intervals for treatment and control of FPG, blood pressure, and LDL-C. We performed multivariate logistic regression to identify characteristics associated with the treatment and control of diabetes as well as hypertension and LDL-C. Overall, the treatment rates of diabetes, hypertension, and dyslipidemia were 30.76%, 50.75%, and 9.17%, respectively. Control rates of FPG, blood pressure, and LDL-C were 4.73%, 4.86%, and 57.83%, respectively. Patients who were younger, Mongol ethnicity and rural residents were less likely to be treated and controlled for diabetes and hypertension. Patients insured by NCMS (new rural cooperative medical scheme) were less likely to be treated and achieve the treatment target of blood pressure. Patients having prior CVD were more likely to be treated and have controlled FPG and blood pressure. Substantial efforts are urgently needed to improve the treatment and control of these modifiable CVD risk factors among patients with diabetes in Inner Mongolia.
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Affiliation(s)
- Yunfeng Xi
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Han Bao
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Ke Han
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Liying Qiao
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Xiaoqian Xu
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Hao Zhu
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Tao Yan
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Liwei Niu
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China
| | - Gai Hang
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China
| | - Wenrui Wang
- The Inner Mongolia Autonomous Region Comprehensive Center or Disease Control and Prevention, Hohhot, PR China.
| | - Xingguang Zhang
- Department of Biostatistics, Public Health College, Inner Mongolia Medical University, Hohhot, PR China..
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16
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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17
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Mata-Cases M, Franch-Nadal J, Gratacòs M, Mauricio D. Therapeutic Inertia: Still a Long Way to Go That Cannot Be Postponed. Diabetes Spectr 2020; 33:50-57. [PMID: 32116454 PMCID: PMC7026756 DOI: 10.2337/ds19-0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the context of type 2 diabetes, the definition of therapeutic inertia should include the failure not only to intensify therapy, but also to deintensify treatment when appropriate and should be distinguished from appropriate inaction in cases justified by particular circumstances. Therapy should be intensified when glycemic control deteriorates to prevent long periods of hyperglycemia, which increase the risk of complications. Strategic plans to overcome therapeutic inertia must include actions focused on patients, prescribers, health systems, and payers. Therapeutic inertia affects the management of glycemia, hypertension, and lipid disorders, all of which increase the risk for cardiovascular diseases. Thus, multifactorial interventions that act on additional therapeutic goals beyond glycemia are needed.
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Affiliation(s)
- Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center Raval Sud, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Mònica Gratacòs
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Dídac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
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Shi R, Zhang T, Sun H, Hu F. Establishment of Clinical Prediction Model Based on the Study of Risk Factors of Stroke in Patients With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2020; 11:559. [PMID: 32982965 PMCID: PMC7479835 DOI: 10.3389/fendo.2020.00559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/09/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: Stroke has sparked global concern as it seriously threatens people's life, bringing about dramatic health burdens on patients, especially for type 2 diabetes mellitus (T2DM) patients. Therefore, a risk scoring model is urgently valuable for T2DM patients to predict the risk of stroke incidence and for positive health intervention. Methods: We randomly divided 4,335 T2DM patients into two groups, training set (n = 3,252) and validation set (n = 1,083), at the ratio of 3:1. Characteristic variables were then selected based on the data of training set through least absolute shrinkage and selection operator regression. Three models were established to verify predictive ability. Foundation model was composed of basic information and physical indicators. Biochemical model consisted of biochemical indexes. Integrated model combined the above two models. Data of three models were then put into logistic regression analysis to form nomogram prediction models. Tools including C index, calibration plot, and curve analysis were implemented to test discrimination, calibration, and clinical use. To select the best predicting model, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were put into effect. Results: Eleven risk factors were determined, including age, duration of T2DM, estimated glomerular filtration rate, systolic blood pressure, diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, triglyceride, body mass index, uric acid, and glycosylated hemoglobin A1c, all with significant P-values through logistic regression analysis. In the training set, areas under the curve of three models were 0.810, 0.819, and 0.884, whereas in the validation set, they were 0.836, 0.832, and 0.909. Through calibration plot, the S:P values in the training set were 0.836, 0.754, and 0.621 and were 0.918, 0.682, and 0.666 separately in the validation set. In terms of the decision curve analysis, the risk thresholds were, respectively, 8-73%, 8-98%, and 8%~ in the training set and 8-70%, 8-90%, and 8-95% in the validation set. With the aid of NRI and IDI, integrated model is proved to be the best model in training set and validation set. Besides, internal validation was conducted on all the subjects in this study, and the C index was 0.890 (0.873-0.907). Conclusion: This study established a model predicting risk of stroke for T2DM patients through a community-based survey.
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Ewid M, Sherif H, Billah SMB, Saquib N, AlEnazy W, Ragab O, Enabi S, Rajab T, Awad Z, Abazid R. Glycated hemoglobin predicts coronary artery disease in non-diabetic adults. BMC Cardiovasc Disord 2019; 19:309. [PMID: 31864310 PMCID: PMC6925462 DOI: 10.1186/s12872-019-01302-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Due to increased CAD risk factors in Saudi Arabia, research on more feasible and predictive biomarkers is needed. We aimed to evaluate glycated hemoglobin (HbA1c) as a predictor of CAD in low-risk profile non-diabetic patients living in the Al Qassim region of Saudi Arabia. METHODS Thirty-eight patients with no history of CAD were enrolled in this cross-sectional study. They provided demographic data, and their HbA1c estimation followed the National Glycohemoglobin Standardization Program parameters. All patients underwent coronary computed tomography angiography (CCTA) for evaluation of chest pain. The extent of coronary artery stenosis (CAS) was quantified as percentage for each patient based on plaques detected in CCTA. RESULTS Mean blood pressure of the patients was (91.2 ± 11.9 mmHg), BMI (28.3 ± 5.8 kg/m2), serum cholesterol level (174 ± 33.1 mg/dl), and HbA1c levels (mean 5.7 ± 0.45, median 5.7 and range 4.7-6.4%). Eighteen patients showed no CAS (47.4%), 12 showed minimal stenosis (31.6%), 3 showed mild stenosis (7.9%), 3 showed moderate stenosis (7.9%) and 2 showed severe stenosis (5.3%). A moderate correlation was detected between HbA1c and CAS percentages (r = 0.47, p < 0.05) as well as between HbA1c and the number of affected coronary vessels (r = 0.53, p < 0.001). CONCLUSION Glycated hemoglobin can be used as a predictive biomarker for CAD in non-diabetic low-risk patients.
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Affiliation(s)
- Mohammed Ewid
- College of Medicine, Sulaiman Al Rajhi Colleges, P.O. Box 777, Al Bukayriah, Qassim 51941, Saudi Arabia
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Hossam Sherif
- College of Medicine, Sulaiman Al Rajhi Colleges, P.O. Box 777, Al Bukayriah, Qassim 51941, Saudi Arabia
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Critical Care, Kasr A. Ainy St, Cairo, 11562 Egypt
| | | | - Nazmus Saquib
- College of Medicine, Sulaiman Al Rajhi Colleges, P.O. Box 777, Al Bukayriah, Qassim 51941, Saudi Arabia
| | - Wael AlEnazy
- College of Medicine, Sulaiman Al Rajhi Colleges, P.O. Box 777, Al Bukayriah, Qassim 51941, Saudi Arabia
| | - Omer Ragab
- College of Medicine, Sulaiman Al Rajhi Colleges, P.O. Box 777, Al Bukayriah, Qassim 51941, Saudi Arabia
| | - Saed Enabi
- College of Medicine, Sulaiman Al Rajhi Colleges, P.O. Box 777, Al Bukayriah, Qassim 51941, Saudi Arabia
| | - Tawfik Rajab
- College of Medicine, Sulaiman Al Rajhi Colleges, P.O. Box 777, Al Bukayriah, Qassim 51941, Saudi Arabia
| | - Zaki Awad
- Prince Sultan Cardiac Center, Ministry of Health, Al Qassim, Qassim 52366, Buraydah, 7430 An Naziyah Saudi Arabia
| | - Rami Abazid
- Prince Sultan Cardiac Center, Ministry of Health, Al Qassim, Qassim 52366, Buraydah, 7430 An Naziyah Saudi Arabia
- Department of Nuclear Medicine, London Health Sciences Center, 800 Commissioners Road East, PO Box 5010, London, ON N6A 5W9 Canada
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Wang L, Fang H, Xia Q, Liu X, Chen Y, Zhou P, Yan Y, Yao B, Wei Y, Jiang Y, Rothman RL, Xu W. Health literacy and exercise-focused interventions on clinical measurements in Chinese diabetes patients: A cluster randomized controlled trial. EClinicalMedicine 2019; 17:100211. [PMID: 31891144 PMCID: PMC6933227 DOI: 10.1016/j.eclinm.2019.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The diabetes patients in China have low health literacy and low levels of physical activities which may result in the poor glycemic control and other clinical outcomes. This study is designed to evaluate the effectiveness of health literacy and exercise-focused interventions on clinical outcomes among Chinese patients with type 2 diabetes (T2DM). METHODS In this cluster randomized controlled trial, 799 T2DM patients with the most recent A1c ≥ 7·5% (58 mmol/mol, or fasting glucose level ≥10 mmol/L) were recruited from 35 clinics in 8 communities in Shanghai, China, and randomized into one standard care (control) arm and three intervention arms receiving interventions focused on health literacy, exercise or both. A1c (primary outcome), blood pressure and lipids (secondary outcomes) were measured at baseline, 3-, 6-, 12-months of intervention period and 12-months after completion of the interventions. This trial is registered with the International Standard RCT Number Register, number ISRCTN76130594. FINDINGS The three intervention groups had more reductions in A1c than the control group, with 0·90% reduction in the health literacy, 0·83% in the exercise and 0·54% in the comprehensive group at 12-months (p<0·001) and these improvements remained even after a 1-year follow-up period post intervention. The risk of suboptimal A1c (≥7·0% or 53 mmol/mol) was also significantly lower in three intervention groups than control group at each follow-up visit, with adjusted risk ratios (RR) ranging from 0.06 to 0.16. However, the control group has greater reductions in low-density lipoprotein (LDL) than the health literacy group from baseline to 12-months (β=0·55, p<0·0001) and from baseline to 24-months (β=0·62, p<0·0001). A higher risk of abnormal LDL was also observed for the health literacy group at 12-months [adjusted risk ratio (RR): 2·22, 95%CI: 1·11-4·44] and 24-months [adjusted risk ratio (RR): 2·37, 95%CI: 1·16-4·87] compared to the control group. No significant benefits in systolic blood pressure (SBP), diastolic blood pressure (DBP) and low-density lipoprotein (HDL) were observed from the interventions compared to the usual care. INTERPRETATION The health literacy and exercise interventions result in significant improvements in A1c. However, no significant benefits in blood pressure and lipids control were observed. These effective interventions may have potential of scaling up in China and other countries to help diabetes patients manage their blood glucose levels. FUNDING This Study was supported by the China Medical Board (CMB) Open Competition Project (No.13-159) and the Social Science Fund of China National Ministry of Education (No.14YJAZH092).
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Affiliation(s)
- Lei Wang
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Hong Fang
- Minhang District Center for Disease Control and Prevention, 962 Zhong Yi Road, Shanghai, China
| | - Qinghua Xia
- Changning District Center for Disease Control and Prevention, 39 Yun Wu Shan Road, Shanghai, China
| | - Xiaona Liu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Yingyao Chen
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Peng Zhou
- Changning District Center for Disease Control and Prevention, 39 Yun Wu Shan Road, Shanghai, China
| | - Yujie Yan
- Minhang District Center for Disease Control and Prevention, 962 Zhong Yi Road, Shanghai, China
| | - Baodong Yao
- Minhang District Center for Disease Control and Prevention, 962 Zhong Yi Road, Shanghai, China
| | - Yan Wei
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
| | - Yu Jiang
- Changning District Center for Disease Control and Prevention, 39 Yun Wu Shan Road, Shanghai, China
| | - Russell L. Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wanghong Xu
- School of Public Health and Key Laboratory of Public Health Safety, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China
- Corresponding author.
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Minato S, Takenouchi A, Kitaoka K, Takeuchi M, Tsuboi A, Kurata M, Fukuo K, Kazumi T. Associations of ABC (Hemoglobin A1c, Blood Pressure and Low-Density Lipoprotein Cholesterol) Goal Achievement With Chronic Kidney Disease in Type 2 Diabetic Patients With Preserved Kidney Function. J Clin Med Res 2019; 11:818-824. [PMID: 31803326 PMCID: PMC6879039 DOI: 10.14740/jocmr4001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/15/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We investigated cross-sectional and prospective associations of ABC (hemoglobin A1c (HbA1c), blood pressure and low-density lipoprotein cholesterol) goal attainment with chronic kidney disease. Cross-sectional association with carotid intima-media thickness (IMT) was evaluated as well. METHODS Prevalence of low estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2) and albuminuria (urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g) were assessed at baseline and after a median follow-up of 6.0 years in 168 patients with type 2 diabetes with preserved kidney function (aged 62.3 years, 53.6% men). Carotid IMT was measured at baseline only. RESULTS At baseline, 47 (28.0%), 45 (26.8%), 63 (37.5%) and 13 (7.7%) patients achieved triple-goal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC targets was associated with lower log ACR (P < 0.01), lower percentage of albuminuria (P = 0.02), and lower carotid IMT (P < 0.01) at baseline. Over 6.0 years, eGFR decreased from 76 ± 16 to 67 ± 18 mL/min/1.73 m2 (P < 0.01) whereas ACR levels did not change. There were 32 patients with incident reduced eGFR, eight with GFR stage progression, 15 with progression of albuminuric stages and five with doubling of ACR within the microalbuminuric range. Achieving more ABC targets decreased the percentage of deterioration of GFR stages (30.8%, 28.6%, 24.4% and 14.9%, respectively, P = 0.01). Achieving two or more (8.9% and 8.5%, respectively) compared with one or less ABC targets (15.4% and 15.9%, respectively) was associated with less deterioration of albuminuria (P < 0.001). Although achieving more ABC targets was associated with lower annual decline in eGFR, the difference was not significant. CONCLUSIONS ABC goal achievement has shown cross-sectional and prospective associations with deterioration of chronic kidney disease in type 2 diabetic patients with preserved kidney function. Cross-sectional association with carotid IMT has been demonstrated as well. Reaching more ABC treatment targets may be important for preventing adverse renal outcomes.
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Affiliation(s)
- Satomi Minato
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan
| | - Akiko Takenouchi
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
| | - Kaori Kitaoka
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mika Takeuchi
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Food Sciences and Nutrition, Faculty of Human Life and Environmental Sciences, Nagoya Women’s University, Nagoya, Japan
| | - Ayaka Tsuboi
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Miki Kurata
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
| | - Tsutomu Kazumi
- Research Institute for Nutrition Sciences, Mukogawa Women’s University, Nishinomiya, Hyogo, Japan
- Diabetes Division, Department of Medicine, Kohnan Kakogawa Hospital, Kakogawa, Hyogo, Japan
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Yamada-Harada M, Fujihara K, Osawa T, Yamamoto M, Kaneko M, Kitazawa M, Matsubayashi Y, Yamada T, Yamanaka N, Seida H, Ogawa W, Sone H. Relationship Between Number of Multiple Risk Factors and Coronary Artery Disease Risk With and Without Diabetes Mellitus. J Clin Endocrinol Metab 2019; 104:5084-5090. [PMID: 30994885 DOI: 10.1210/jc.2019-00168] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/11/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine the degree of control of multiple risk factors under real-world conditions for coronary artery disease (CAD) according to the presence or absence of diabetes mellitus (DM) and to determine whether reaching multifactorial targets for blood pressure (BP), low-density lipoprotein-cholesterol (LDL-C), HbA1c, and current smoking is associated with lower risks for CAD. METHODS We investigated the effects on subsequent CAD of the number of controlled risk factors among BP, LDL-C, HbA1c, and current smoking in a prospective cohort study using a nationwide claims database of 220,894 individuals in Japan. Cox regression examined risks over a 4.8-year follow-up. RESULTS The largest percentage of participants had two risk factors at target in patients with DM (39.6%) and subjects without DM (36.4%). Compared with those who had two targets achieved, the risks of CAD among those who had any one and no target achieved were two and four times greater, respectively, regardless of the presence of DM. The effect of composite control was sufficient to bring CAD risk in patients with DM below that for subjects without DM with any two targets achieved, whereas the risk of CAD in the DM group with all four risk factors uncontrolled was 9.4 times more than in the non-DM group who had achieved two targets. CONCLUSIONS These findings show that composite control of modifiable risk factors has a large effect in patients with and without DM. The effect was sufficient to bring CAD risk in patients with DM below that in the non-DM group who had two targets achieved.
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Affiliation(s)
- Mayuko Yamada-Harada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
- Division of Diabetes and Endocrinology and Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Masahiko Yamamoto
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Masanori Kaneko
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
| | | | | | - Wataru Ogawa
- Division of Diabetes and Endocrinology and Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan
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Katsiki N, Banach M, Mikhailidis DP. Is type 2 diabetes mellitus a coronary heart disease equivalent or not? Do not just enjoy the debate and forget the patient! Arch Med Sci 2019; 15:1357-1364. [PMID: 31749862 PMCID: PMC6855173 DOI: 10.5114/aoms.2019.89449] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
In the last several years there has been a large debate whether patients with type 2 diabetes (T2DM) should be treated as those with high or very high cardiovascular risk, and whether T2DM should be considered as equivalent to coronary heart disease (CHD). It all started in the 2001 in National Cholesterol Education Program - Adult Treatment Panel III recommendations, and the knowledge has changed on this issue at least several times. But the main problem is that due to these inconsistencies and different approaches to the cardiovascular risk of T2DM patients, we have more and more patients with T2DM not effectively treated, and diabetologists mostly focus on glucose (glucocentric approach), often forgetting about the overall cardiovascular risk of those patients. In this review we discuss the above-mentioned topic, try to give some practical suggestions, and raise the issue of whether we should start a discussion on treating all patients with T2DM as those at very high cardiovascular risk, or to at least to try to unify the definition and find such variables/risk factors which are easy to measure to help physicians to treat those patients optimally. We have obviously discussed these issues in the context of new European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) Guidelines 2019.
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Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Division of Endocrinology and Metabolism, Diabetes Center, Medical School, AHEPA University Hospital, Thessaloniki, Greece
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Blom DJ, Santos RD, Daclin V, Mercier F, Ruiz AJ, Danchin N. The challenge of multiple cardiovascular risk factor control outside Western Europe: Findings from the International ChoLesterol management Practice Study. Eur J Prev Cardiol 2019; 27:1403-1411. [PMID: 31533447 PMCID: PMC7457454 DOI: 10.1177/2047487319871735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Comprehensive control of multiple cardiovascular risk factors reduces cardiovascular risk but is difficult to achieve. Design A multinational, cross-sectional, observational study. Methods The International ChoLesterol management Practice Study (ICLPS) investigated achievement of European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline low-density lipoprotein cholesterol (LDL-C) targets in patients receiving lipid-modifying therapy in countries outside Western Europe. We examined the rate of, and association between, control of multiple risk factors in ICLPS participants with dyslipidaemia, diabetes and hypertension (N = 2377). Results Mean (standard deviation) age of patients was 61.4 (10.4) years; 51.3% were male. Type 2 diabetes was the most common form of diabetes (prevalence, 96.9%). The prevalence of metabolic syndrome was 67.8%, obesity 40.4%, atherosclerotic disease 39.6% and coronary artery disease 33.5%. All patients were at high (38.2%) or very high (61.8%) cardiovascular risk according to ESC/EAS guidelines. Body mass index (BMI) was <25 kg/m2 in 20.3% of patients, 62.8% had never smoked and 25.2% were former smokers. Overall, 12.2% achieved simultaneous control of LDL-C, diabetes and blood pressure. Risk factor control was similar across all participating countries. The proportion of patients achieving individual guideline-specified treatment targets was 43.9% for LDL-C, 55.5% for blood pressure and 39.3% for diabetes. Multiple correspondence analysis indicated that control of LDL-C, control of blood pressure, control of diabetes, BMI and smoking were associated. Conclusion Comprehensive control of multiple cardiovascular risk factors in high-risk patients is suboptimal worldwide. Failure to control one risk factor is associated with poor control of other risk factors.
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Affiliation(s)
- Dirk J Blom
- University of Cape Town, Cape Town, South Africa
| | - Raul D Santos
- Heart Institute (InCor), University of Sao Paulo Medical School Hospital and Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Nicolas Danchin
- Cardiology, European Hospital Georges-Pompidou, Paris, France
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Yan ST, Jia JH, Lv XF, Shao YH, Yin SN, Zhang XG, Li CL, Jin MM, Miao XY, Tian H. Glycemic control and comprehensive metabolic risk factors control in older adults with type 2 diabetes. Exp Gerontol 2019; 127:110713. [PMID: 31472256 DOI: 10.1016/j.exger.2019.110713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/12/2019] [Accepted: 08/26/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Older adults with type 2 diabetes are prone to multiple metabolic abnormalities. However, data from these patients on comprehensive metabolic risk factors control are limited. METHODS The present study included 2736 older adults aged 60 to 90 years with type 2 diabetes from 114 hospitals across 22 provinces in China. Metabolic abnormalities, including hypertension, dyslipidemia, hyperuricemia, and obesity, were recorded. Comprehensive metabolic risk factors control included the control of hemoglobin A1c (HbA1c) level, blood pressure, serum lipids level, serum uric acid level, and body mass index. The target glycemic control was defined as HbA1c <7%. RESULTS The proportion of older adults who achieved the HbA1c target was 23.0%. The glycemic control rate increased with the number of metabolic abnormalities increased. The patients who had all four metabolic abnormalities had 4.05 times (95% confidence interval: 2.16, 7.61) the odd to meet glycemic target than those with none of metabolic abnormalities. However, only 4.6% of patients met the targets for all 5 metabolic risk factors. The comprehensive rate of all 5 factors in control decreased from 13.4% to 0% with the number of metabolic abnormalities increased. CONCLUSION The glycemic control rate and the comprehensive metabolic risk factors control rate were 23.0% and 4.6%, respectively. As the number of metabolic abnormalities increased, the number of risk factor targets achieved decreased. Our findings suggest that a strategy for comprehensive control is urgently needed in older adults with type 2 diabetes, especially in those with co-existing metabolic abnormalities.
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Affiliation(s)
- Shuang-Tong Yan
- Department of Endocrinology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jun-Hong Jia
- Department of Endocrinology, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Feng Lv
- Department of Endocrinology, Army General Hospital of Chinese PLA, Beijing, China
| | - Ying-Hong Shao
- Outpatient Department, Chinese PLA General Hospital, Beijing, China
| | - Shi-Nan Yin
- Department of Endocrinology, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xing-Guang Zhang
- Department of Endocrinology, Army General Hospital of Chinese PLA, Beijing, China
| | - Chun-Lin Li
- Department of Endocrinology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Meng-Meng Jin
- Department of Endocrinology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xin-Yu Miao
- Department of Endocrinology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hui Tian
- Department of Endocrinology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Mwita JC, Francis JM, Omech B, Botsile E, Oyewo A, Mokgwathi M, Molefe-Baikai OJ, Godman B, Tshikuka JG. Glycaemic, blood pressure and low-density lipoprotein-cholesterol control among patients with diabetes mellitus in a specialised clinic in Botswana: a cross-sectional study. BMJ Open 2019; 9:e026807. [PMID: 31340960 PMCID: PMC6661581 DOI: 10.1136/bmjopen-2018-026807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Control of glycaemic, hypertension and low-density lipoprotein-cholesterol (LDL-C) among patients with type 2 diabetes mellitus (T2DM) is vital for the prevention of cardiovascular diseases. The current study was an audit of glycaemic, hypertension and LDL-C control among ambulant patients with T2DM in Botswana. Also, the study aimed at assessing factors associated with attaining optimal glycaemic, hypertension and LDL-C therapeutic goals. DESIGN A cross-sectional study. SETTING A specialised public diabetes clinic in Gaborone, Botswana. PARTICIPANTS Patients with T2DM who had attended the clinic for ≥3 months between August 2017 and February 2018. PRIMARY OUTCOME MEASURE The proportion of patients with optimal glycaemic (HbA1c<7%), hypertension (blood pressure <140/90 mm Hg) and LDL-C (<1.8 mmol/L) control. RESULTS The proportions of patients meeting optimal targets were 32.3% for glycaemic, 54.2% for hypertension and 20.4% for LDL-C. Age≥ 50 years was positively associated with optimal glycaemic control (adjusted OR [AOR] 5.79; 95% CI 1.08 to 31.14). On the other hand, an increase in diabetes duration was inversely associated with optimal glycemic control (AOR 0.91; 95% CI 0.85 to 0.98). Being on an ACE inhibitor was inversely associated with optimal hypertension control (AOR 0.35; 95% CI 0.14 to 0.85). Being female was inversely associated with optimal LDL-C control (AOR 0.24; 95% CI (0.09 - 0.59). CONCLUSION Patients with T2DM in Gaborone, Botswana, presented with suboptimal control of recommended glycaemic, hypertension and LDL-C targets. These findings call for urgent individual and health systems interventions to address key determinants of the recommended therapeutic targets among patients with diabetes in this setting.
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Affiliation(s)
- Julius Chacha Mwita
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Joel M Francis
- Wits Reproductive Health and HIV Institute, Wits Health Consortium Pty Ltd, Johannesburg, South Africa
- Global Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Bernard Omech
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Elizabeth Botsile
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Aderonke Oyewo
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Matshidiso Mokgwathi
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Onkabetse Julia Molefe-Baikai
- Internal Medicine, University of Botswana, Gaborone, Botswana
- Internal Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Brian Godman
- Health Economics, University of Liverpool, Liverpool, UK
- Laboratory of Medicine, Division of Clinical Pharmacology, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Jose-Gaby Tshikuka
- Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Faculty of Health Sciences, National Pedagogical University, Kinshasa, Congo (the Democratic Republic of the)
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Ma CM, Liu XL, Lu N, Wang R, Lu Q, Yin FZ. Hypertriglyceridemic waist phenotype and abnormal glucose metabolism: a system review and meta-analysis. Endocrine 2019; 64:469-485. [PMID: 31065910 DOI: 10.1007/s12020-019-01945-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/29/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study was to perform a meta-analysis to assess the relationship between hypertriglyceridemic-waist (HTW) phenotype and abnormal glucose metabolism. METHODS The data sources were PubMed and EMBASE up to June 2018. Studies providing the relationship between HTW phenotype and abnormal glucose metabolism were included. RESULTS In total, 48 eligible studies that evaluated 2,42,879 subjects were included in the meta-analysis. In the general population, the pooled odds ratios (ORs) for elevated blood glucose and diabetes related to HTW phenotype was 2.32 (95% confidence interval (CI): 1.98-2.71) and 2.69 (95% CI: 2.40-3.01), respectively. In cohort studies, the pooled OR for diabetes related to HTW phenotype was 2.89 (95% CI: 1.97-4.25) in subjects without diabetes. The levels of homeostasis model assessment of insulin resistance (HOMA-IR) in the HTW population were increased with values of mean differences (MD) 1.12 (95% CI: 0.81-1.43. P < 0.00001, I2 = 99%) in the general population and 0.89 (95% CI: 0.75-1.04, P < 0.00001, I2 = 67%) in subjects without diabetes. CONCLUSION HTW phenotype was closely associated with increased risk of abnormal glucose metabolism. There was also a significant correlation between HTW phenotype and insulin resistance.
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Affiliation(s)
- Chun-Ming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Xiao-Li Liu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Na Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Fu-Zai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China.
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28
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Xie Y, Wang Y, Ding H, Guo M, Wang X, Dong Q, Cui M. Highly glycosylated CD147 promotes hemorrhagic transformation after rt-PA treatment in diabetes: a novel therapeutic target? J Neuroinflammation 2019; 16:72. [PMID: 30953513 PMCID: PMC6449915 DOI: 10.1186/s12974-019-1460-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/25/2019] [Indexed: 01/13/2023] Open
Abstract
Background Diabetes is known to be a main risk factor of post-stroke hemorrhagic transformation following recombinant tissue plasminogen activator (rt-PA) therapy. However, the mechanism through which diabetes exacerbates hemorrhagic transformation is insufficiently understood. We aimed to verify that CD147, the extracellular matrix metalloproteinase (MMP) inducer, played a vital role in the progress. Methods We performed middle cerebral artery occlusion on diabetic and non-diabetic rats, with or without rt-PA treatment, and then compared the glycosylation level of CD147, caveolin-1, MMPs activities, and blood-brain barrier (BBB) permeability. In vitro, tunicamycin treatment and genetic tools were used to produce non-glycosylated and lowly glycosylated CD147. An endogenous glucagon-like peptide-1 receptor (GLP-1R) agonist was used to downregulate the glycosylation of CD147 in vivo. Results Compared with non-diabetic rats, diabetic rats expressed higher levels of highly glycosylated CD147 in endothelium and astrocytes following rt-PA treatment accompanied by higher activity of MMPs and BBB permeability, in the middle cerebral artery occlusion model. Caveolin-1 was also overexpressed and co-localized with CD147 in astrocytes and endothelium in diabetic rats. In vitro, advanced glycation end products increased the expression of highly glycosylated CD147 in astrocytes and endothelial cells. Downregulating the glycosylation of CD147 lowered the activity of MMPs and promoted the expression of tight junction proteins. The expression of caveolin-1 in endothelial cells and astrocytes was not inhibited by tunicamycin, which revealed that caveolin-1 was an upstream of CD147. In vivo, GLP-1R agonist downregulated the glycosylation of CD147 and further reduced the activity of MMPs and protected the BBB in diabetic rats. Conclusion CD147 is essential for diabetes-associated rt-PA-induced hemorrhagic transformation, and downregulation of CD147 glycosylation is a promising therapy for neurovascular-unit repair after rt-PA treatment of patients with diabetes. Electronic supplementary material The online version of this article (10.1186/s12974-019-1460-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanan Xie
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Yingzhe Wang
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Hongyan Ding
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Min Guo
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xun Wang
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China. .,The State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China. .,Department of Neurology, Jing'an District Centre Hospital of Shanghai, Shanghai, China.
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
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29
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Nørgaard CH, Mosslemi M, Lee CJY, Torp-Pedersen C, Wong ND. The Importance and Role of Multiple Risk Factor Control in Type 2 Diabetes. Curr Cardiol Rep 2019; 21:35. [PMID: 30887139 DOI: 10.1007/s11886-019-1123-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The importance of composite risk factor control for reducing CVD risk in type 2 diabetes (T2DM) has gained increased attention and here we review the latest findings in the field. RECENT FINDINGS The Steno-2 study was the first to show that early intensive risk factor control could improve risk factor status and halve the CVD risk in patients with diabetes with lasting impact. A range of observational studies have added further insight to the importance of multiple risk factor control showing an incremental association between number of risk factors controlled and reduction in CVD risk. Noteworthy, a Swedish population-based study recently showed that optimal risk factor status in patients with T2DM was associated with a CVD risk similar to the general population. Early intensive intervention to achieve optimal risk factor control reduces CVD risk and should be of principal focus in T2DM management.
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Affiliation(s)
- Caroline Holm Nørgaard
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark. .,Heart Disease Prevention Program, University of California Irvine, Irvine, CA, USA.
| | - Mitra Mosslemi
- Heart Disease Prevention Program, University of California Irvine, Irvine, CA, USA
| | - Christina J-Y Lee
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.,Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nathan D Wong
- Heart Disease Prevention Program, University of California Irvine, Irvine, CA, USA.,Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
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30
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Lv F, Cai X, Hu D, Pan C, Zhang D, Xu J, Ji L. Characteristics of Newly Diagnosed Type 2 Diabetes in Chinese Older Adults: A National Prospective Cohort Study. J Diabetes Res 2019; 2019:5631620. [PMID: 31828163 PMCID: PMC6885297 DOI: 10.1155/2019/5631620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
AIM To investigate the metabolic profiles of newly diagnosed type 2 diabetes (NEW2D) in Chinese older adults (≥65 years) and assess the proportion of patients who achieved the targeted goals of blood glucose, blood pressure, and blood lipid. METHODS NEW2D study was an observational, longitudinal, prospective cohort study involving patients who were diagnosed with type 2 diabetes (T2D) within the past 6 months and had a follow-up of 12 months. Participants were divided into younger NEW2D group (aged 20-65 years old) and older NEW2D group (aged ≥65 years old) according to age of diabetes onset. The baseline metabolic profiles were compared and the proportion of patients achieving adequate control of blood glucose, blood pressure, and blood lipids in reference to target goals were assessed during treatment. RESULTS The older NEW2D (n = 1362) had a lower BMI, HbA1c%, diastolic blood pressure, triglyceride, low-density lipoprotein cholesterol (LDL-C), and total cholesterol, higher systolic blood pressure, and high-density lipoprotein cholesterol levels at baseline. 47.8%, 66.7%, and 39.4% reached the target of HbA1c < 7.0%, BP < 140/90 mmHg, and LDL - C < 2.6 mmol/L, respectively. After 12 months, the proportion achieving above three targets increased to 70.2%, 76.1%, and 47.5%, respectively. The proportions of patients achieving three combined therapeutic targets doubled from 13.5% to 26.7%. CONCLUSION The older NEW2D patients have special metabolic profiles compared with younger patients. The control of cardiovascular disease risk factors was suboptimal in older adults with type 2 diabetes.
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Affiliation(s)
- Fang Lv
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Dayi Hu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Changyu Pan
- Department of Endocrinology and Metabolism, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Danyi Zhang
- VitalStrategic Research Institute, Shanghai, China
| | - Jie Xu
- VitalStrategic Research Institute, Shanghai, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
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31
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Direito A, Rawstorn J, Mair J, Daryabeygi-Khotbehsara R, Maddison R, Tai ES. Multifactorial e- and mHealth interventions for cardiovascular disease primary prevention: Protocol for a systematic review and meta-analysis of randomised controlled trials. Digit Health 2019; 5:2055207619890480. [PMID: 31803491 PMCID: PMC6876157 DOI: 10.1177/2055207619890480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/27/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Cardiovascular diseases (CVD) are a leading cause of mortality and disease burden. Preventative interventions to augment the population-level adoption of health lifestyle behaviours that reduce CVD risk are a priority. Face-to-face interventions afford individualisation and are effective for improving health-related behaviours and outcomes, but they are costly and resource intensive. Electronic and mobile health (e- and mHealth) approaches aimed at modifying lifestyle risk factors may be an effective and scalable approach to reach many individuals while preserving individualisation. This systematic review aims to (a) determine the effectiveness of multifactorial e- and mHealth interventions on CVD risk and on lifestyle-related cardiometabolic risk factors and self-management behaviours among adults without CVD; and (b) describe the evidence on adverse events and on the cost-effectiveness of these interventions. METHODS Methods were detailed prior to the start of the review in order to improve conduct and prevent inconsistent decision making throughout the review. This protocol was prepared following the PRISMA-P 2015 statement. MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, Cochrane Public Health Group Specialised Register and CENTRAL electronic databases will be searched between 1991 and September 2019. Eligibility criteria are: (a) population: community-dwelling adults; (b) intervention/comparison: randomised controlled trials comparing e- or mHealth CVD risk preventative interventions with usual care; and (c) outcomes: modifiable CVD risk factors. Selection of study reports will involve two authors independently screening titles and abstracts, followed by a full-text review of potentially eligible reports. Two authors will independently undertake data extraction and assess risk of bias. Where appropriate, meta-analysis of outcome data will be performed. DISCUSSION This protocol describes the pre-specified methods for a systematic review that will provide quantitative and narrative syntheses of current multifactorial e- and mHealth CVD preventative interventions. A systematic review and meta-analysis will be conducted following the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and reported according to PRISMA guidelines.
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Affiliation(s)
- Artur Direito
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Australia
| | | | | | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Australia
| | - E Shyong Tai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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32
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Wan EYF, Yu EYT, Chin WY, Fung CSC, Kwok RLP, Chao DVK, Chan KH, Hui EMT, Tsui WWS, Tan KCB, Fong DYT, Lam CLK. Ten-year risk prediction models of complications and mortality of Chinese patients with diabetes mellitus in primary care in Hong Kong: a study protocol. BMJ Open 2018; 8:e023070. [PMID: 30327405 PMCID: PMC6194459 DOI: 10.1136/bmjopen-2018-023070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is a major disease burden worldwide because it is associated with disabling and lethal complications. DM complication risk assessment and stratification is key to cost-effective management and tertiary prevention for patients with diabetes in primary care. Existing risk prediction functions were found to be inaccurate in Chinese patients with diabetes in primary care. This study aims to develop 10-year risk prediction models for total cardiovascular diseases (CVD) and all-cause mortality among Chinese patients with DM in primary care. METHODS AND ANALYSIS A 10-year cohort study on a population-based primary care cohort of Chinese patients with diabetes, who were receiving care in the Hospital Authority General Outpatient Clinic on or before 1 January 2008, were identified from the clinical management system database of the Hospital Authority. All patients with complete baseline risk factors will be included and followed from 1 January 2008 to 31 December 2017 for the development and validation of prediction models. The analyses will be carried out separately for men and women. Two-thirds of subjects will be randomly selected as the training sample for model development. Cox regressions will be used to develop 10-year risk prediction models of total CVD and all-cause mortality. The validity of models will be tested on the remaining one-third of subjects by Harrell's C-statistics and calibration plot. Risk prediction models for diabetic complications specific to Chinese patients in primary care will enable accurate risk stratification, prioritisation of resources and more cost-effective interventions for patients with DM in primary care. ETHICS AND DISSEMINATION The study was approved by the Institutional Review Board of the University of Hong Kong-the Hospital Authority Hong Kong West Cluster (reference number: UW 15-258). TRIAL REGISTRATION NUMBER NCT03299010; Pre-results.
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Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | | | - Ruby Lai Ping Kwok
- Department of Primary and Community Services, Hospital Authority Head Office, Hospital Authority, Hong Kong
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Healthcare, Kowloon East Cluster, Hospital Authority, Hong Kong
| | - King Hong Chan
- Department of Family Medicine & Primary Healthcare, Kowloon Central Cluster, Hospital Authority, Hong Kong
| | - Eric Ming-Tung Hui
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Wendy Wing Sze Tsui
- Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong
| | | | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Rawshani A, Rawshani A, Franzén S, Sattar N, Eliasson B, Svensson AM, Zethelius B, Miftaraj M, McGuire DK, Rosengren A, Gudbjörnsdottir S. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2018; 379:633-644. [PMID: 30110583 DOI: 10.1056/nejmoa1800256] [Citation(s) in RCA: 791] [Impact Index Per Article: 131.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with diabetes are at higher risk for death and cardiovascular outcomes than the general population. We investigated whether the excess risk of death and cardiovascular events among patients with type 2 diabetes could be reduced or eliminated. METHODS In a cohort study, we included 271,174 patients with type 2 diabetes who were registered in the Swedish National Diabetes Register and matched them with 1,355,870 controls on the basis of age, sex, and county. We assessed patients with diabetes according to age categories and according to the presence of five risk factors (elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure). Cox regression was used to study the excess risk of outcomes (death, acute myocardial infarction, stroke, and hospitalization for heart failure) associated with smoking and the number of variables outside target ranges. We also examined the relationship between various risk factors and cardiovascular outcomes. RESULTS The median follow-up among all the study participants was 5.7 years, during which 175,345 deaths occurred. Among patients with type 2 diabetes, the excess risk of outcomes decreased stepwise for each risk-factor variable within the target range. Among patients with diabetes who had all five variables within target ranges, the hazard ratio for death from any cause, as compared with controls, was 1.06 (95% confidence interval [CI], 1.00 to 1.12), the hazard ratio for acute myocardial infarction was 0.84 (95% CI, 0.75 to 0.93), and the hazard ratio for stroke was 0.95 (95% CI, 0.84 to 1.07). The risk of hospitalization for heart failure was consistently higher among patients with diabetes than among controls (hazard ratio, 1.45; 95% CI, 1.34 to 1.57). In patients with type 2 diabetes, a glycated hemoglobin level outside the target range was the strongest predictor of stroke and acute myocardial infarction; smoking was the strongest predictor of death. CONCLUSIONS Patients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. (Funded by the Swedish Association of Local Authorities and Regions and others.).
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Affiliation(s)
- Aidin Rawshani
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Araz Rawshani
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Stefan Franzén
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Naveed Sattar
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Björn Eliasson
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Ann-Marie Svensson
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Björn Zethelius
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Mervete Miftaraj
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Darren K McGuire
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Annika Rosengren
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Soffia Gudbjörnsdottir
- From the Department of Molecular and Clinical Medicine, Institute of Medicine (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Health Metrics Unit, Sahlgrenska Academy (S.F.), University of Gothenburg, and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, and the Department of Public Health and Caring Sciences-Geriatrics, Uppsala University, and the Swedish Medical Products Agency, Uppsala (B.Z.) - all in Sweden; the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.); and the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.)
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Ng IHY, Cheung KKT, Yau TTL, Chow E, Ozaki R, Chan JCN. Evolution of Diabetes Care in Hong Kong: From the Hong Kong Diabetes Register to JADE-PEARL Program to RAMP and PEP Program. Endocrinol Metab (Seoul) 2018; 33:17-32. [PMID: 29589385 PMCID: PMC5874192 DOI: 10.3803/enm.2018.33.1.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 12/14/2022] Open
Abstract
The rapid increase in diabetes prevalence globally has contributed to large increases in health care expenditure on diabetic complications, posing a major health burden to countries worldwide. Asians are commonly observed to have poorer β-cell function and greater insulin resistance compared to the Caucasian population, which is attributed by their lower lean body mass and central obesity. This "double phenotype" as well as the rising prevalence of young onset diabetes in Asia has placed Asians with diabetes at high risk of cardiovascular and renal complications, with cancer emerging as an important cause of morbidity and mortality. The experience from Hong Kong had demonstrated that a multifaceted approach, involving team-based integrated care, information technological advances, and patient empowerment programs were able to reduce the incidence of diabetic complications, hospitalizations, and mortality. System change and public policies to enhance implementation of such programs may provide solutions to combat the burgeoning health problem of diabetes at a societal level.
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Affiliation(s)
- Ivy H Y Ng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - Kitty K T Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Tiffany T L Yau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Elaine Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Risa Ozaki
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
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35
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Relation between HbA 1c and incident cardiovascular disease over a period of 6 years in the Hong Kong population. DIABETES & METABOLISM 2018; 44:415-423. [PMID: 29449147 DOI: 10.1016/j.diabet.2018.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
AIM The current trend on diabetes management advocates replacing the paradigm from a uniform to an individualized patient-centered haemoglobin A1c (HbA1c) target, but there is no consensus on the optimal HbA1c level. The study aimed at examining the association between HbA1c and the risk of cardiovascular diseases (CVD) for diabetic patients with different characteristics, in order to identify patient-centered treatment targets. METHODS A retrospective cohort study was conducted on 115,782 Chinese adult primary care patients with type 2 diabetes mellitus (DM) but no known CVD history, who were prescribed antidiabetic medications in 2010-2011. The cumulative mean HbA1c over a median follow-up period of 5.8 years was used to evaluate the relationship between HbA1c and CVD incidence using Cox analysis. Subgroup analyses were conducted by stratifying different baseline characteristics including gender, age, smoking status, diabetes duration, body mass index, Charlson's comorbidity index and DM treatment modalities. RESULTS For patients with a DM duration of<2years, an exponential relationship between HbA1c and risk of CVD was identified, suggesting that there was no threshold HbA1c level for CVD risk. For other diabetic patients, an HbA1c level of 6.8-7.2% was associated with a minimum risk for CVD and a J-shaped curvilinear association between HbA1c. The risk of CVD increased in patients with HbA1c<6.5% or ≥7.5%. CONCLUSION Among Chinese primary care patients at the early (<2years) disease stage, lower HbA1c targets (<6.5%) may be warranted to prevent CVD events whilst for all others, excessively lower HbA1c levels may not necessarily better and can potentially be harmful.
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