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Baker CJ, Min D, Marsh-Wakefield F, Siwan E, Gerofi J, Wang X, Hocking SL, Colagiuri S, Johnson NA, Twigg SM. Circulating CD31 + Angiogenic T cells are reduced in prediabetes and increase with exercise training. J Diabetes Complications 2024; 38:108868. [PMID: 39299028 DOI: 10.1016/j.jdiacomp.2024.108868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 09/02/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
AIMS To investigate circulating angiogenic cells in adults with prediabetes and the effect of a structured exercise program. METHODS A cohort of adults with overweight/obesity and either normal glucose (NG) or prediabetes were randomised to receive exercise (Exercise) (as twice weekly supervised combined high intensity aerobic exercise and progressive resistance training, and once weekly home-based aerobic exercise) or an unsupervised stretching intervention (Control) for 12 weeks. Circulating angiogenic T cells, muscle strength, and cardiovascular disease risk factors, including blood lipids, arterial stiffness, central haemodynamic responses, and cardiorespiratory fitness (VO2peak) in those with prediabetes (n = 35, 16 Control, 19 Exercise) and NG (n = 37, 17 Control, 20 Exercise) were analysed at baseline and after the 12-week intervention. RESULTS At baseline, compared with NG those with prediabetes demonstrated reduced VO2peak, angiogenic CD31+CD8+ T cells and VEGFR2+CD4+ T cells, and increased systolic blood pressure. CD31+ T cells were negatively correlated with cardiovascular disease (CVD) risk. Compared with Control, exercise training increased muscle strength, VO2peak, and CD31+CD4+ and CD31+CD8+ T cells in NG and prediabetes. CONCLUSIONS Circulating angiogenic CD31+ T cells are decreased in people with prediabetes and are enhanced with exercise training. Exercise increases CD31+ T cells, and through this mechanism it is proposed that it may reduce CVD risk. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry number: ACTRN12617000552381.
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Affiliation(s)
- Callum J Baker
- Greg Brown Diabetes & Endocrinology Research Laboratory, Charles Perkins Centre, University of Sydney, Sydney, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Danqing Min
- Greg Brown Diabetes & Endocrinology Research Laboratory, Charles Perkins Centre, University of Sydney, Sydney, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Felix Marsh-Wakefield
- Liver Injury and Cancer Program, Centenary Institute, Sydney, NSW, Australia; Human Cancer and Viral Immunology Laboratory, The University of Sydney, Sydney, NSW, Australia
| | - Elisha Siwan
- Greg Brown Diabetes & Endocrinology Research Laboratory, Charles Perkins Centre, University of Sydney, Sydney, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - James Gerofi
- Greg Brown Diabetes & Endocrinology Research Laboratory, Charles Perkins Centre, University of Sydney, Sydney, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Xiaoyu Wang
- Greg Brown Diabetes & Endocrinology Research Laboratory, Charles Perkins Centre, University of Sydney, Sydney, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Samantha L Hocking
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia; Boden Initiative, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Stephen Colagiuri
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Boden Initiative, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Nathan A Johnson
- Boden Initiative, Charles Perkins Centre, University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen M Twigg
- Greg Brown Diabetes & Endocrinology Research Laboratory, Charles Perkins Centre, University of Sydney, Sydney, Australia; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.
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Bablis P, Day RR, Pollard H. Treatment of type 2 diabetes and stress using neuro-emotional technique: case report. Front Endocrinol (Lausanne) 2024; 15:1382757. [PMID: 39050563 PMCID: PMC11266090 DOI: 10.3389/fendo.2024.1382757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.
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Affiliation(s)
- Peter Bablis
- Department of Maternal and Child Health and Precision Medicine, University Research Institute, Athens, Greece
- Department of Integrative and Complementary Medicine, Universal Health, Sydney, NSW, Australia
| | - Ryan R. Day
- Department of Integrative and Complementary Medicine, Universal Health, Sydney, NSW, Australia
| | - Henry Pollard
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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Gonzalez-Lopez C, Fenelon A, Lipska KJ, Denary W, Schlesinger P, Esserman D, Keene D. Association Between Rental Assistance Programs and Undiagnosed Diabetes Among U.S. J Gen Intern Med 2024; 39:1625-1631. [PMID: 38351417 PMCID: PMC11255160 DOI: 10.1007/s11606-024-08673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/02/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Rental assistance programs have been linked to better housing quality, stability, healthcare access, and reduced likelihood of uncontrolled diabetes. However, its direct association with diabetes screening is uncertain. OBJECTIVE To determine whether federal rental assistance programs are associated with lower odds of undiagnosed diabetes. DESIGN We used a quasi-experimental approach, comparing outcomes among adults receiving rental assistance to those who entered assisted housing within 2 years after their health data were collected. We test the a priori hypothesis that rental assistance will be associated with decreased odds of undiagnosed diabetes. PARTICIPANTS Participants in the National Health and Nutrition Examination Survey 1999-2018 who received rental assistance and who had diabetes. INTERVENTION Current rental assistance participation, including specific housing programs. MAIN MEASURES Undiagnosed diabetes based on having hemoglobin A1c ≥ 6.5% but answering no to the survey question of being diagnosed with diabetes. KEY RESULTS Among 435 eligible adults (median age 54.5 years, female 68.5%, non-Hispanic white 32.5%), 80.7% were receiving rental assistance programs at the time of the interview, and 19.3% went on to receive rental assistance within 2 years. The rates of undiagnosed diabetes were 15.0% and 25.3% among those receiving rental assistance programs vs. those in the future assistance group (p-value = 0.07). In an adjusted logistic regression model, adults receiving rental assistance had lower odds of undiagnosed diabetes (OR 0.52, 95% CI 0.28-0.94) than those in future assistance groups. Sex, race and ethnic group, educational level, and poverty ratio were not significantly associated with having undiagnosed diabetes, but individuals aged 45-64 years had significantly lower odds of undiagnosed diabetes (OR 0.21, 95% CI 0.08-0.53) compared with those aged 18-44. CONCLUSIONS Rental assistance was linked to lower odds of undiagnosed diabetes, suggesting that affordable housing programs can aid in early recognition and diagnosis, which may improve long-term outcomes.
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Affiliation(s)
- Carolina Gonzalez-Lopez
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Section of Endocrinology, Yale University, 333 Cedar Street, P.O. Box 208020, New Haven, CT, 06520, USA.
| | - Andrew Fenelon
- School of Public Health, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Kasia J Lipska
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Whitney Denary
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Penelope Schlesinger
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Danya Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Gudjonsdottir H, Tynelius P, Stattin NS, Méndez DY, Lager A, Brynedal B. Undiagnosed type 2 diabetes is common - intensified screening of established risk groups is imperative in Sweden: the SDPP cohort. BMC Med 2024; 22:168. [PMID: 38637767 PMCID: PMC11027361 DOI: 10.1186/s12916-024-03393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Undiagnosed type 2 diabetes (T2D) is a global problem. Current strategies for diagnosis in Sweden include screening individuals within primary healthcare who are of high risk, such as those with hypertension, obesity, prediabetes, family history of diabetes, or those who smoke daily. In this study, we aimed to estimate the proportion of individuals with undiagnosed T2D in Stockholm County and factors associated with T2D being diagnosed by healthcare. This information could improve strategies for detection. METHODS We used data from the Stockholm Diabetes Prevention Programme (SDPP) cohort together with information from national and regional registers. Individuals without T2D aged 35-56 years at baseline were followed up after two ten-year periods. The proportion of diagnosed T2D was based on register information for 7664 individuals during period 1 and for 5148 during period 2. Undiagnosed T2D was assessed by oral glucose tolerance tests at the end of each period. With logistic regression, we analysed factors associated with being diagnosed among individuals with T2D. RESULTS At the end of the first period, the proportion of individuals with T2D who had been diagnosed with T2D or not was similar (54.0% undiagnosed). At the end of the second period, the proportion of individuals with T2D was generally higher, but they were less likely to be undiagnosed (43.5%). The likelihood of being diagnosed was in adjusted analyses associated with overweight (OR=1.85; 95% CI 1.22-2.80), obesity (OR=2.73; 95% CI 1.76-4.23), higher fasting blood glucose (OR=2.11; 95% CI 1.67-2.66), and self-estimated poor general health (OR=2.42; 95% CI 1.07-5.45). Socioeconomic factors were not associated with being diagnosed among individuals with T2D. Most individuals (>71%) who developed T2D belonged to risk groups defined by having at least two of the prominent risk factors obesity, hypertension, daily smoking, prediabetes, or family history of T2D, including individuals with T2D who had not been diagnosed by healthcare. CONCLUSIONS Nearly half of individuals who develop T2D during 10 years in Stockholm County are undiagnosed, emphasizing a need for intensified screening of T2D within primary healthcare. Screening can be targeted to individuals who have at least two prominent risk factors.
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Affiliation(s)
- Hrafnhildur Gudjonsdottir
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Per Tynelius
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nouha Saleh Stattin
- Academic Primary Healthcare Centre, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Diego Yacamán Méndez
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Boel Brynedal
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Talukder A, Sara SS, Hossain MT, Nath CD, Rahman R, Hussain S, Sarma H, Huda MN. Rural and urban differences in the prevalence and determinants of Type-2 diabetes in Bangladesh. PLoS One 2024; 19:e0298071. [PMID: 38603719 PMCID: PMC11008877 DOI: 10.1371/journal.pone.0298071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/18/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE To estimate the prevalence of Type 2 Diabetes (T2D) in urban and rural settings and identify the specific risk factors for each location. METHOD We conducted this study using data from the 2017-18 Bangladesh Demographic and Health Survey (BDHS), sourced from the DHS website. The survey employed a stratified two-stage sampling method, which included 7,658 women and 7,048 men aged 18 and older who had their blood glucose levels measured. We utilized chi-square tests and ordinal logistic regression to analyze the association between various selected variables in both urban and rural settings and their relationship with diabetes and prediabetes. RESULTS The prevalence of T2D was 10.8% in urban areas and 7.4% in rural areas, while pre-diabetes affected 31.4% and 27% of the populations in these respective settings. The study found significant factors influencing diabetes in both urban and rural regions, particularly in the 55-64 age group (Urban: AOR = 1.88, 95% CI [1.46, 2.42]; Rural: AOR = 1.87, 95% CI [1.54, 2.27]). Highly educated individuals had lower odds of T2D, while wealthier and overweight participants had higher odds in both areas. In rural regions, T2D risk was higher among caffeinated drink consumers and those not engaged in occupation-related physical activity, while these factors did not show significant influence in urban areas. Furthermore, urban participants displayed a significant association between T2D and hypertension. CONCLUSION Our study outlines a comprehensive strategy to combat the increasing prevalence of T2D in both urban and rural areas. It includes promoting healthier diets to control BMI level, encouraging regular physical activity, early detection through health check-ups, tailored awareness campaigns, improving healthcare access in rural regions, stress management in urban areas, community involvement, healthcare professional training, policy advocacy like sugary drink taxation, research, and monitoring interventions. These measures collectively address the T2D challenge while accommodating the distinct features of urban and rural settings.
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Affiliation(s)
- Ashis Talukder
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, Bangladesh
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Sabiha Shirin Sara
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Md. Tanvir Hossain
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Chuton Deb Nath
- Mass Communication and Journalism Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Riaz Rahman
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Sadiq Hussain
- Examination Branch, Dibrugarh University, Dibrugarh, India
| | - Haribondhu Sarma
- Research Fellow, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Md. Nazmul Huda
- Translational Health Research Institute, Western Sydney University, Campbell Town, NSW, Australia
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Luca SA, Bungau RM, Lazar S, Potre O, Timar B. To What Extent Does Cardiovascular Risk Classification of Patients with Type 2 Diabetes Differ between European Guidelines from 2023, 2021, and 2019? A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:334. [PMID: 38399621 PMCID: PMC10890196 DOI: 10.3390/medicina60020334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Type 2 Diabetes (T2DM) is intricately associated with an increased cardiovascular (CV) risk, highlighting the imperative for tailored intervention in the prevention and management of CV diseases. To assess the CV risk and subsequent interventions in patients with diabetes, the European Society of Cardiology (ESC) has been consistently developing and updating specific guidelines for risk assessment and patient management since 2019. The 2023 risk classification method has significantly changed, introducing a novel probability-based assessment through the implementation of SCORE2-Diabetes instrument. This marks a shift from the risk factor-based classification employed in the 2019 and 2021 methods, representing an innovative approach in risk assessment for individuals with T2DM. This study aims to evaluate the differences in the CV risk classification among hospitalized patients with T2DM using the three proposed methods within the Romanian population, a European population considered to be at very high cardiovascular risk. Materials and Methods: in a consecutive-case, population-based study design, 70 patients hospitalized with T2DM from a European population characterized by very high CV risk were assessed for CV risk using the three proposed methods. The differences between these classifications were subsequently analyzed. Results: In the study group, according to 2023 classification, one patient (1.4%) was classified with moderate CV risk, eight (11.4%) with high cardiovascular risk, and sixty-one (87.2%) with very high cardiovascular risk. A total of 36 patients (51.4%) were classified differently compared to 2021 criteria, the differences being statistically significant (p = 0.047), while 13 (18.6%) were different compared to 2019 criteria, the differences being statistically non-significant (p = 0.731). By comparing the 2021 to the 2019 ESC Guidelines recommendations, 40 patients had a one-step decrease in cardiovascular risk category, from very high to high risk. Conclusions: Most patients included in the analysis were classified as very high CV risk (87.2%). Within a European population characterized by very high CV risk, the SCORE2-Diabetes instrument proves to be a valuable tool, contributing to most step-ups in CV risk classes within the 2023 classification. In a very-high-risk demographic, the 2023 algorithm resulted in different classifications in contrast to the 2021 method but similar classifications observed with the 2019 method.
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Affiliation(s)
- Silvia Ana Luca
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Centre for Molecular Research in Nephrology and Vascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (B.T.)
| | - Raluca Malina Bungau
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300736 Timisoara, Romania;
| | - Sandra Lazar
- Centre for Molecular Research in Nephrology and Vascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (B.T.)
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ovidiu Potre
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Multidisciplinary Research Centre for Malignant Hematological Diseases (CCMHM), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Timar
- Centre for Molecular Research in Nephrology and Vascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.L.); (B.T.)
- Department of Diabetes, “Pius Brinzeu” Emergency Hospital, 300736 Timisoara, Romania;
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Alosi B, Curtis DS. Racial and Ethnic Disparities in Blood Pressure and Glycemic Control in the US Community Health Center Patient Population. J Prim Care Community Health 2024; 15:21501319241226766. [PMID: 38270076 PMCID: PMC10812092 DOI: 10.1177/21501319241226766] [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: 10/11/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE To describe blood pressure and glycemic control by racial/ethnic group in the US Community Health Center (CHC) patient population, and whether center characteristics, proxying for higher resource levels and better quality of care, were associated with greater rates of controlled cardiometabolic conditions. METHODS Data came from the Uniform Data System, representing aggregate patient clinical data for individual health centers in 2019. Descriptive analyses were conducted weighting by health center patient populations to produce race-specific national rates of blood pressure and glycemic control, and linear regression is used to test whether cardiometabolic control rates varied by center characteristics. RESULTS Hypertension was controlled for 67.2% of non-Hispanic White, 66.9% of Hispanic, and 56.7% of non-Hispanic Black patients. Diabetes was controlled for 70.7% of non-Hispanic White, 65.7% of Hispanic, and 66.1% of non-Hispanic Black patients. The rate of blood pressure control was 2.54 to 3.99 percentage points higher across racial/ethnic groups in health centers that adopted a patient-centered medical home (PCMH) model of care relative to non-PCMH centers, while glycemic control was 1.08 to 2.27 pp. higher as a function of PCMH certification. Results for other center characteristics did not show consistent patterns across racial groups or outcomes. CONCLUSION This study documented racial and ethnic health disparities in the CHC patient population after major expansion of the CHC program. CHCs with PCMH certification have improved clinical outcomes among patients with hypertension and diabetes across racial/ethnic groups relative to centers without this certification.
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Banerjee M, Pal R, Maisnam I, Mukhopadhyay S. GLP-1 receptor agonists, SGLT2 inhibitors and noncardiovascular mortality in type 2 diabetes: Insights from a meta-analysis. Diabetes Metab Syndr 2024; 18:102943. [PMID: 38211482 DOI: 10.1016/j.dsx.2024.102943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Type-2 diabetes (T2D) poses a higher risk of noncardiovascular mortality in addition to the burden of cardiovascular mortality. The well-established cardiovascular benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) could solely explain their apparent effects on all-cause mortality in T2D. The present meta-analysis aims to pool their effects on noncardiovascular mortality in T2D and summarize the recent evidence on plausible pathways mediating these effects. METHODS PubMed, Embase, Web of Science, and clinical trial registries were searched for randomized controlled trials (RCTs) with ≥1-year duration in adults with T2D reporting both cardiovascular and all-cause mortality in treatment versus placebo arms (PROSPERO: CRD42022337559). Noncardiovascular mortality was calculated by subtracting cardiovascular mortality events from all-cause mortality and risk ratios (RRs) were calculated. Random-effects meta-analysis was done. GRADE framework was used to assess evidence quality. RESULTS We identified 17 eligible RCTs pooling data retrieved from 109,892 patients. Randomization to GLP-1 RA treatment versus placebo was associated with reduced noncardiovascular mortality (RR = 0.90; 95%CI: 0.81-0.99; I2 = 0 %; p < 0.05), consistent with their effects on cardiovascular mortality (RR = 0.88; 95%CI: 0.81-0.95; I2 = 0 %; p < 0.01) in T2D. Compared to placebo, SGLT2i significantly reduced noncardiovascular mortality (RR = 0.90; 95%CI: 0.82-0.99; I2 = 0 %; p < 0.05) along with cardiovascular mortality (RR = 0.84; 95%CI: 0.77-0.92; I2 = 28 %; p < 0.001). Subgroup analysis showed no significant effects of heart failure or renal function on treatment benefits of SGLT2i on noncardiovascular mortality (p value > 0.2 for subgroup differences). CONCLUSION The impact of GLP-1RAs and SGLT2i on mortality in people with T2D extends beyond their cardiovascular benefits.
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Affiliation(s)
- Mainak Banerjee
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, 700020, India.
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Indira Maisnam
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, 700020, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, 700020, India.
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Brønnum-Hansen H, Davidsen M, Andersen I. Impact of the association between education and obesity on diabetes-free life expectancy. Eur J Public Health 2023; 33:968-973. [PMID: 37615997 PMCID: PMC10710352 DOI: 10.1093/eurpub/ckad153] [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] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The purpose of the study was to quantify the association between body weight and health by estimating the expected lifetime with and without diabetes (diabetes-free life expectancy) at age 30 and 65. In addition, the diabetes-free life expectancy was stratified by educational level. METHODS Life tables by sex, level of education and obese/not obese were constructed using nationwide register data and self-reported data on body weight and height and diabetes from the Danish National Health Survey in 2021. Diabetes-free life expectancies were estimated by Sullivan's method. RESULTS The difference in life expectancy between not obese 30-year-old men with a long and a short education was 5.7 years. For not obese women, the difference was 4.1 years. For obese men and women, the difference in life expectancy at age 30 was 7.0 and 5.2 years. Women could expect more years without and fewer years with diabetes than men regardless of body weight and educational level. Diabetes-free life expectancy differed by 6.9 years between not obese 30-year-old men with a short and a long education and by 7.7 years for obese men with a short and a long education. For women, the differences were 5.9 and 6.6 years. CONCLUSION The results demonstrate an association of obesity and educational level with life expectancy and diabetes-free life expectancy. There is a need for preventive efforts to reduce educational inequality in life expectancy and diabetes-free life expectancy. Structural intervention will particularly benefit overweight people with short education.
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Affiliation(s)
- Henrik Brønnum-Hansen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ingelise Andersen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Mhlaba L, Mpanya D, Tsabedze N. HbA1c control in type 2 diabetes mellitus patients with coronary artery disease: a retrospective study in a tertiary hospital in South Africa. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1258792. [PMID: 38028982 PMCID: PMC10645148 DOI: 10.3389/fcdhc.2023.1258792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Background Type 2 diabetes mellitus (T2DM) patients with coronary artery disease (CAD) have an increased risk of recurrent cardiovascular events. These patients require optimal glucose control to prevent the progression of atherosclerotic cardiovascular disease (ASCVD). Contemporary guidelines recommend an HbA1c ≤7% to mitigate this risk. The aim of this study was to evaluate HbA1c control in T2DM patients with angiographically proven ASCVD. Methods We conducted a cross-sectional, retrospective study on consecutive T2DM patients with acute and chronic coronary syndromes managed in a tertiary academic hospital in South Africa. Glycaemic control was assessed by evaluating the glycated haemoglobin (HbA1c) level measured at index presentation with acute and chronic coronary syndromes and during the most recent follow-up visit. Results The study population comprised 262 T2DM patients with a mean age of 61.3 ± 10.4 years. At index presentation, 110 (42.0%) T2DM patients presented with ST-segment elevation myocardial infarction, 69 (26.3%) had non-ST-segment elevation myocardial infarction, 43 (16.4%) had unstable angina, and 40 (15.3%) had stable angina. After a median duration of 16.5 months (IQR: 7-29), 28.7% of the study participants had an HbA1c ≤7%. On multivariable logistic regression analysis, females were less likely to have poor glycaemic control (HbA1c above 7%) [odds ratio (OR): 0.42, 95% confidence interval (CI): 0.19-0.95, p=0.038]. Also, T2DM patients prescribed metformin monotherapy (OR: 0.34, 95% CI: 0.14-0.82, p=0.017) and patients with ST-segment depression on the electrocardiogram (OR: 0.39, 95% CI: 0.16-0.96, p=0.041) were less likely to have poor glycaemic control. Conclusion After a median duration of 16.5 months, only 28.7% of T2DM patients with CAD had an HbA1c ≤7%. This finding underscores the substantial unmet need for optimal diabetes control in this very high-risk group.
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González-Juanatey C, Anguita-Sánchez M, Barrios V, Núñez-Gil I, Gómez-Doblas JJ, García-Moll X, Lafuente-Gormaz C, Rollán-Gómez MJ, Peral-Disdier V, Martínez-Dolz L, Rodríguez-Santamarta M, Viñolas-Prat X, Soriano-Colomé T, Muñoz-Aguilera R, Plaza I, Curcio-Ruigómez A, Orts-Soler E, Segovia-Cubero J, Fanjul V, Marín-Corral J, Cequier Á. Impact of Advanced Age on the Incidence of Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Stable Coronary Artery Disease in a Real-World Setting in Spain. J Clin Med 2023; 12:5218. [PMID: 37629262 PMCID: PMC10456002 DOI: 10.3390/jcm12165218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) without myocardial infarction (MI) or stroke are at high risk for major cardiovascular events (MACEs). We aimed to provide real-world data on age-related clinical characteristics, treatment management, and incidence of major cardiovascular outcomes in T2DM-CAD patients in Spain from 2014 to 2018. We used EHRead® technology, which is based on natural language processing and machine learning, to extract unstructured clinical information from electronic health records (EHRs) from 12 hospitals. Of the 4072 included patients, 30.9% were younger than 65 years (66.3% male), 34.2% were aged 65-75 years (66.4% male), and 34.8% were older than 75 years (54.3% male). These older patients were more likely to have hypertension (OR 2.85), angina (OR 1.64), heart valve disease (OR 2.13), or peripheral vascular disease (OR 2.38) than those aged <65 years (p < 0.001 for all comparisons). In general, they were also more likely to receive pharmacological and interventional treatments. Moreover, these patients had a significantly higher risk of MACEs (HR 1.29; p = 0.003) and ischemic stroke (HR 2.39; p < 0.001). In summary, patients with T2DM-CAD in routine clinical practice tend to be older, have more comorbidities, are more heavily treated, and have a higher risk of developing MACE than is commonly assumed from clinical trial data.
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Affiliation(s)
| | - Manuel Anguita-Sánchez
- Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, 14014 Cordoba, Spain;
| | | | - Iván Núñez-Gil
- Cardiology Department, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain;
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Juan José Gómez-Doblas
- IBIMA (Instituto de Investigación Biomédica de Málaga), Hospital Universitario Virgen de la Victoria, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), 29010 Malaga, Spain;
| | - Xavier García-Moll
- Hospital Universitario Santa Creu i Sant Pau, 08041 Barcelona, Spain; (X.G.-M.); (X.V.-P.)
| | | | | | | | - Luis Martínez-Dolz
- Hospital Universitario y Politécnico La Fe, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), IIS La Fe, 46026 Valencia, Spain;
| | | | - Xavier Viñolas-Prat
- Hospital Universitario Santa Creu i Sant Pau, 08041 Barcelona, Spain; (X.G.-M.); (X.V.-P.)
| | - Toni Soriano-Colomé
- Hospital Vall d’Hebron, CIBERCV (Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares), 08035 Barcelona, Spain;
| | | | | | | | - Ernesto Orts-Soler
- Hospital General Universitario de Castellón, 12004 Castellon de la Plana, Spain;
| | | | - Víctor Fanjul
- Savana Research SL, 28013 Madrid, Spain; (V.F.); (J.M.-C.)
| | | | - Ángel Cequier
- Hospital Universitario de Bellvitge, IDIBELL (Instituto de Investigación Biomédica de Bellvitge), Universidad de Barcelona, 08007 Barcelona, Spain;
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Rosella LC, Kornas K, Negatu E, Zhou L. Variations in all-cause mortality, premature mortality and cause-specific mortality among persons with diabetes in Ontario, Canada. BMJ Open Diabetes Res Care 2023; 11:11/3/e003378. [PMID: 37130629 PMCID: PMC10163552 DOI: 10.1136/bmjdrc-2023-003378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Patients with diabetes have a higher risk of mortality compared with the general population. Large population-based studies that quantify variations in mortality risk for patients with diabetes among subgroups in the population are lacking. This study aimed to examine the sociodemographic differences in the risk of all-cause mortality, premature mortality, and cause-specific mortality in persons diagnosed with diabetes. RESEARCH DESIGN AND METHODS We conducted a population-based cohort study of 1 741 098 adults diagnosed with diabetes between 1994 and 2017 in Ontario, Canada using linked population files, Canadian census, health administrative and death registry databases. We analyzed the association between sociodemographics and other covariates on all-cause mortality and premature mortality using Cox proportional hazards models. A competing risk analysis using Fine-Gray subdistribution hazards models was used to analyze cardiovascular and circular mortality, cancer mortality, respiratory mortality, and mortality from external causes of injury and poisoning. RESULTS After full adjustment, individuals with diabetes who lived in the lowest income neighborhoods had a 26% (HR 1.26, 95% CI 1.25 to 1.27) increased hazard of all-cause mortality and 44% (HR 1.44, 95% CI 1.42 to 1.46) increased risk of premature mortality, compared with individuals with diabetes living in the highest income neighborhoods. In fully adjusted models, immigrants with diabetes had reduced risk of all-cause mortality (HR 0.46, 95% CI 0.46 to 0.47) and premature mortality (HR 0.40, 95% CI 0.40 to 0.41), compared with long-term residents with diabetes. Similar HRs associated with income and immigrant status were observed for cause-specific mortality, except for cancer mortality, where we observed attenuation in the income gradient among persons with diabetes. CONCLUSIONS The observed mortality variations suggest a need to address inequality gaps in diabetes care for persons with diabetes living in the lowest income areas.
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Affiliation(s)
- Laura C Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Kathy Kornas
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ednah Negatu
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Srisubat A, Kittrongsiri K, Sangroongruangsri S, Khemvaranan C, Shreibati JB, Ching J, Hernandez J, Tiwari R, Hersch F, Liu Y, Hanutsaha P, Ruamviboonsuk V, Turongkaravee S, Raman R, Ruamviboonsuk P. Cost-Utility Analysis of Deep Learning and Trained Human Graders for Diabetic Retinopathy Screening in a Nationwide Program. Ophthalmol Ther 2023; 12:1339-1357. [PMID: 36841895 PMCID: PMC10011252 DOI: 10.1007/s40123-023-00688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/10/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Deep learning (DL) for screening diabetic retinopathy (DR) has the potential to address limited healthcare resources by enabling expanded access to healthcare. However, there is still limited health economic evaluation, particularly in low- and middle-income countries, on this subject to aid decision-making for DL adoption. METHODS In the context of a middle-income country (MIC), using Thailand as a model, we constructed a decision tree-Markov hybrid model to estimate lifetime costs and outcomes of Thailand's national DR screening program via DL and trained human graders (HG). We calculated the incremental cost-effectiveness ratio (ICER) between the two strategies. Sensitivity analyses were performed to probe the influence of modeling parameters. RESULTS From a societal perspective, screening with DL was associated with a reduction in costs of ~ US$ 2.70, similar quality-adjusted life-years (QALY) of + 0.0043, and an incremental net monetary benefit of ~ US$ 24.10 in the base case. In sensitivity analysis, DL remained cost-effective even with a price increase from US$ 1.00 to US$ 4.00 per patient at a Thai willingness-to-pay threshold of ~ US$ 4.997 per QALY gained. When further incorporating recent findings suggesting improved compliance to treatment referral with DL, our analysis models effectiveness benefits of ~ US$ 20 to US$ 50 depending on compliance. CONCLUSION DR screening using DL in an MIC using Thailand as a model may result in societal cost-savings and similar health outcomes compared with HG. This study may provide an economic rationale to expand DL-based DR screening in MICs as an alternative solution for limited availability of skilled human resources for primary screening, particularly in MICs with similar prevalence of diabetes and low compliance to referrals for treatment.
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Affiliation(s)
- Attasit Srisubat
- Department of Medical Services, Ministry of Public Health, Nonthaburi, Thailand
| | - Kankamon Kittrongsiri
- Social, Economic and Administrative Pharmacy (SEAP) Graduate Program, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sermsiri Sangroongruangsri
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
| | - Chalida Khemvaranan
- Department of Research and Technology Assessment, Lerdsin Hospital, Bangkok, Thailand
| | | | | | | | | | | | - Yun Liu
- Google LLC, Mountain View, CA, USA
| | - Prut Hanutsaha
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Saowalak Turongkaravee
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Rajiv Raman
- Sri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand.
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Bosnić Z, Babič F, Anderková V, Štefanić M, Wittlinger T, Majnarić LT. A Critical Appraisal of the Diagnostic and Prognostic Utility of the Anti-Inflammatory Marker IL-37 in a Clinical Setting: A Case Study of Patients with Diabetes Type 2. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3695. [PMID: 36834391 PMCID: PMC9966907 DOI: 10.3390/ijerph20043695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The role of the cytokine interleukin-37 (IL-37) has been recognized in reversing inflammation-mediated metabolic costs. The aim was to evaluate the clinical utility of this cytokine as a diagnostic and prognostic marker in patients with type 2 diabetes (T2D). METHODS We included 170 older (median: 66 years) individuals with T2D (females: 95) and classified as primary care attenders to assess the association of factors that describe patients with plasma IL-37 levels (expressed as quartiles) using multinomial regression models. We determined the diagnostic ability of IL-37 cut-offs to identify diabetes-related complications or patient subgroups by using Receiver Operating Characteristic analysis (c-statistics). RESULTS Frailty status was shown to have a suppressive effect on IL-37 circulating levels and a major modifying effect on associations of metabolic and inflammatory factors with IL-37, including the effects of treatments. Situations in which IL-37 reached a clinically significant discriminating ability included the model of IL-37 and C-Reactive Protein in differentiating among diabetic patients with low-normal/high BMI ((<25/≥25 kg/m2), and the model of IL-37 and Thyroid Stimulating Hormone in discriminating between women with/without metabolic syndrome. CONCLUSIONS The study has revealed limitations in using classical approaches in determining the diagnostic and prognostic utility of the cytokine IL-37 in patients with T2D and lain a foundation for new methodology approaches.
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Affiliation(s)
- Zvonimir Bosnić
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Huttlerova 4, 31000 Osijek, Croatia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, 06601 Košice, Slovakia
| | - Viera Anderková
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, 06601 Košice, Slovakia
| | - Mario Štefanić
- Department of Nuclear Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Huttlerova 4, 31000 Osijek, Croatia
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital, University of Göttingen, 38642 Goslar, Germany
| | - Ljiljana Trtica Majnarić
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Huttlerova 4, 31000 Osijek, Croatia
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Shirin Sara S, Talukder A, Lee KY, Basak N, Rahman Razu S, Haq I, Nath CD. Dynamic changes in prevalence of type 2 diabetes along with associated factors in Bangladesh: Evidence from two national cross-sectional surveys (BDHS 2011 and BDHS 2017-18). Diabetes Metab Syndr 2023; 17:102706. [PMID: 36657306 DOI: 10.1016/j.dsx.2023.102706] [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: 08/07/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Prevalence of type 2 diabetes has been rising rapidly especially in low- and middle-income countries. The purpose of this study is to analyze the prevalence of type 2 diabetes in 2011 and 2017-18, and the risk factors based on the Bangladesh Demographic and Health Surveys (BDHS). METHODS The study comprised of data from the BDHS 2011 and the BDHS 2017-18 with 7565 (50.6% female) and 12,299 respondents (56.9% female) respectively. The plasma blood glucose was classified into normal, pre-diabetes, and diabetes categories. While univariate analysis was performed to determine the data, Chi-square and gamma analyses were used for bivariate estimation of the correlation between diabetes status and other comorbidities. Multinomial and ordinal logistic regression were also performed to trace the link between diabetes and various risk factors. RESULTS The 2011 BDHS survey indicated that nearly half of the participants (47.6%) had pre-diabetic condition, while 10.2% were diagnosed with diabetes. On the other hand, the BDHS 2017-18 demonstrated that 28.6% and 8.6% of participants had pre-diabetes and diabetes, respectively. Results of inferential statistics showed that gender (p<0.05), age, wealth status, physical activity, BMI (p<0.01), and caffeinated beverages (p<0.05), were significantly linked with diabetes status. CONCLUSION According to our findings, older people and people with lower education are more likely to develop diabetes. BMI` Physically active, wealth status, diet and lifestyle were significant predictors of type 2 diabetes. Healthy lifestyle, physical activities, proper knowledge and awareness can reduce the risk of T2D.
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Affiliation(s)
- Sabiha Shirin Sara
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh.
| | - Ashis Talukder
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh.
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | - Nayan Basak
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh.
| | | | - Iqramul Haq
- Department of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka, 1207, Bangladesh.
| | - Chuton Deb Nath
- Mass Communication and Journalism Discipline, Khulna University, Khulna, 9208, Bangladesh.
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Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study. J Am Acad Orthop Surg 2023; 31:81-86. [PMID: 36580049 DOI: 10.5435/jaaos-d-21-01055] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Multiple comorbidities in hip fracture patients are associated with increased mortality and complications. The goal of this study was to characterize the relationship between specific patient factors including comorbidities and outcomes in geriatric hip fractures, including length of stay, unplanned ICU admission, discharge disposition, complications, and mortality. METHODS This is a retrospective review of a trauma database from five Level 1 and Level 2 trauma centers of patients with hip fractures of the femoral neck and intertrochanteric region who underwent treatment using hip pinning, hemiarthroplasty, total hip arthroplasty, cephalomedullary nailing, or dynamic hip screw fixation. Mortality was the primary outcome variable (including in-hospital mortality, 30-day mortality, 60-day mortality, and 90-day mortality). Secondary outcome variables included in-hospital adverse events, unplanned transfer to the ICU, postoperative length of stay, and discharge disposition. Regression analyses were used for evaluation of relationships between comorbidities as independent variables and primary and secondary outcomes as dependent variables. RESULTS Two thousand three hundred patients were included. The mortality was 1.8%, 7.0%, 10.9%, and 14.1% for in-hospital, 30-day, 60-day, and 90-day mortality, respectively. Diabetes and cognitive impairment present on admission were associated with mortality at all-time intervals. COPD was the only comorbidity that signaled in-hospital adverse event with an odds ratio of 1.67 (P = 0.012). No patient factors, time to surgery, or comorbidities signaled unplanned ICU transfer. Patients with renal failure and COPD had longer hospital stays after surgery. CONCLUSION Geriatric hip fractures continue to have high short-term morbidity and mortality. Identifying patients with increased odds of early mortality and adverse events can help teams optimize care and outcomes. Patients with diabetes, cognitive impairment, renal failure, and COPD may benefit from continued and improved medical optimization during the perioperative period as well as being more closely managed by a medicine team without delaying time to the operating room.
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Tsotra F, Kappel M, Peristeris P, Bader G, Levi E, Lister N, Malhotra A, Ostwald DA. The societal impact of early intensified treatment in patients with type 2 diabetes mellitus. J Comp Eff Res 2022; 11:1185-1199. [PMID: 36170017 DOI: 10.2217/cer-2022-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The current study estimates the societal impact of early intensified treatment compared with initial monotherapy with subsequent treatment intensification in newly diagnosed adults with type 2 diabetes mellitus in Mexico. Methods: An individual patient-level simulation and a static cohort model were employed to simulate the treatment pathway and the probability of experiencing complications of diabetes. The avoided number of events was translated into avoided productivity losses, which were monetized using wages. Results: Patients on early intensified treatment experienced approximately 13,000 fewer complication events over 10 years. This was translated into a societal impact of $54 million (USD). Conclusion: Early treatment intensification is likely to be of particular benefit to health outcomes and productivity losses.
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Affiliation(s)
| | | | | | | | | | - Nicola Lister
- Novartis Global Health & Sustainability, Johannesburg, South Africa
| | | | - Dennis A Ostwald
- WifOR Institute, Darmstadt, Germany.,SIBE, Graduate School of the Faculty for Leadership & Management, Steinbeis University, Berlin, Germany
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Serum Cystatin-C is linked to increased prevalence of diabetes and higher risk of mortality in diverse middle-aged and older adults. PLoS One 2022; 17:e0270289. [PMID: 36094936 PMCID: PMC9467319 DOI: 10.1371/journal.pone.0270289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/06/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Type 2 Diabetes Mellitus (henceforth diabetes) affects roughly 35 million individuals in the US and is a major risk factor for cardiovascular and kidney disease. Serum Cystatin-C is used to monitor renal function and detect kidney damage. Recent research has focused on linking Cystatin-C to cardiovascular risk and disease, but most findings focus on small sample sizes and generalize poorly to diverse populations, thus limiting epidemiological inferences. The aim of this manuscript is to study the association between Cystatin-C, diabetes, and mortality and test for possible sex or racial/ethnic background modifications in these relationships. Methods We analyzed 8-years of biennial panel data from Health and Retirement Study participants 50-years and older who self-identified as White (unweighted N (uN) = 5,595), Black (uN = 867), or Latino (uN = 565) for a total of uN = 7,027 individuals. We modeled diabetes and death over 8-years as function of baseline Cystatin-C (log transformed) adjusting for covariates and tested modifications in associations by race/ethnic background and sex. Results Mean log Cystatin-C at visit 1 was 0.03±0.32 standard deviation. A 10% increase in Cystatin-C levels was associated with 13% increased relative risk of diabetes at baseline (11% and 9% by years 4 and 8). A 10% increase in Cystatin-C was highly associated with increased relative risk of death (28% and 31% by years 4 and 8). These associations were present even after adjusting for possible confounders and were not modified by sex or racial/ethnic background. Conclusion Despite differential risks for diabetes and mortality by racial/ethnic groups, Cystatin-C was equally predictive of these outcomes across groups. Cystatin-C dysregulations could be used as a risk indicator for diabetes and as a warning sign for accelerated risk of mortality.
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Davies MJ, Drexel H, Jornayvaz FR, Pataky Z, Seferović PM, Wanner C. Cardiovascular outcomes trials: a paradigm shift in the current management of type 2 diabetes. Cardiovasc Diabetol 2022; 21:144. [PMID: 35927730 PMCID: PMC9351217 DOI: 10.1186/s12933-022-01575-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/14/2022] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in patients with type 2 diabetes (T2D). Historical concerns about cardiovascular (CV) risks associated with certain glucose-lowering medications gave rise to the introduction of cardiovascular outcomes trials (CVOTs). Initially implemented to help monitor the CV safety of glucose-lowering drugs in patients with T2D, who either had established CVD or were at high risk of CVD, data that emerged from some of these trials started to show benefits. Alongside the anticipated CV safety of many of these agents, evidence for certain sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have revealed potential cardioprotective effects in patients with T2D who are at high risk of CVD events. Reductions in 3-point major adverse CV events (3P-MACE) and CV death have been noted in some of these CVOTs, with additional benefits including reduced risks of hospitalisation for heart failure, progression of renal disease, and all-cause mortality. These new data are leading to a paradigm shift in the current management of T2D, with international guidelines now prioritising SGLT2 inhibitors and/or GLP-1 RAs in certain patient populations. However, clinicians are faced with a large volume of CVOT data when seeking to use this evidence base to bring opportunities to improve CV, heart failure and renal outcomes, and even reduce mortality, in their patients with T2D. The aim of this review is to provide an in-depth summary of CVOT data-crystallising the key findings, from safety to efficacy-and to offer a practical perspective for physicians. Finally, we discuss the next steps for the post-CVOT era, with ongoing studies that may further transform clinical practice and improve outcomes for people with T2D, heart failure or renal disease.
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Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - François R Jornayvaz
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Centre, Geneva University Hospital/Geneva University, Geneva, Switzerland
| | - Zoltan Pataky
- Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Centre, Geneva University Hospital/Geneva University, Geneva, Switzerland
| | - Petar M Seferović
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia.
- Serbian Academy of Sciences and Arts, Belgrade, Serbia.
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Iyen B, Vinogradova Y, Akyea RK, Weng S, Qureshi N, Kai J. Ethnic disparities in mortality among overweight or obese adults with newly diagnosed type 2 diabetes: a population-based cohort study. J Endocrinol Invest 2022; 45:1011-1020. [PMID: 35025081 PMCID: PMC8995280 DOI: 10.1007/s40618-021-01736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Ethnic variation in risk of type 2 diabetes is well established, but its impact on mortality is less well understood. This study investigated the risk of all-cause and cardiovascular mortality associated with newly diagnosed type 2 diabetes in White, Asian and Black adults who were overweight or obese. METHODS This population-based cohort study used primary care records from the UK Clinical Practice Research Datalink, linked with secondary care and death registry records. A total of 193,528 obese or overweight adults (BMI of 25 or greater), with ethnicity records and no pre-existing type 2 diabetes were identified between 01 January 1995 and 20 April 2018. Multivariable Cox proportional hazards regression estimated hazards ratios (HR) for incident type 2 diabetes in different ethnic groups. Adjusted hazards ratios for all-cause and cardiovascular mortality were determined in individuals with newly diagnosed type 2 diabetes. RESULTS During follow-up (median 9.8 years), the overall incidence rate of type 2 diabetes (per 1,000 person-years) was 20.10 (95% CI 19.90-20.30). Compared to Whites, type 2 diabetes risk was 2.2-fold higher in Asians (HR 2.19 (2.07-2.32)) and 30% higher in Blacks (HR 1.34 (1.23-1.46)). In individuals with newly diagnosed type 2 diabetes, the rates (per 1,000 person-years) of all-cause mortality and cardiovascular mortality were 24.34 (23.73-24.92) and 4.78 (4.51-5.06), respectively. Adjusted hazards ratios for mortality were significantly lower in Asians (HR 0.70 (0.55-0.90)) and Blacks (HR 0.71 (0.51-0.98)) compared to Whites, and these differences in mortality risk were not explained by differences in severity of hyperglycaemia. CONCLUSIONS/INTERPRETATION Type 2 diabetes risk in overweight and obese adults is greater in Asian and Black compared to White ethnic populations, but mortality is significantly higher in the latter. Greater attention to optimising screening, disease and risk management appropriate to all communities with type 2 diabetes is needed.
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Affiliation(s)
- B Iyen
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK.
| | - Y Vinogradova
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - R K Akyea
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - S Weng
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - N Qureshi
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | - J Kai
- Primary Care Stratified Medicine, Population Health and Lifespan Sciences, University of Nottingham, Nottingham, UK
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21
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Lavikainen P, Mattila E, Absetz P, Harjumaa M, Lindström J, Järvelä-Reijonen E, Aittola K, Männikkö R, Tilles-Tirkkonen T, Lintu N, Lakka T, van Gils M, Pihlajamäki J, Martikainen J. Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial. J Med Internet Res 2022; 24:e31530. [PMID: 35200147 PMCID: PMC8914749 DOI: 10.2196/31530] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. OBJECTIVE We aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors. METHODS This is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors. RESULTS More than half (1022/1926, 53.1%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9%), weekly usage (731/1926, 38.0%), twice weekly usage (208/1926, 10.8%), and daily usage (83/1926, 4.3%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months. CONCLUSIONS Distinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-019-6574-y.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Elina Mattila
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Pilvikki Absetz
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Elina Järvelä-Reijonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kirsikka Aittola
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Reija Männikkö
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tanja Tilles-Tirkkonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Niina Lintu
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Lakka
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd, Espoo, Finland
| | - Jussi Pihlajamäki
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Endocrinology and Clinical Nutrition, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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22
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Jalkanen K, Aarnio E, Lavikainen P, Lindström J, Peltonen M, Laatikainen T, Martikainen J. Pharmacy-based screening to detect persons at elevated risk of type 2 diabetes: a cost-utility analysis. BMC Health Serv Res 2021; 21:916. [PMID: 34482831 PMCID: PMC8418722 DOI: 10.1186/s12913-021-06948-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Early identification of people at elevated risk of type 2 diabetes (T2D) is an important step in preventing or delaying its onset. Pharmacies can serve as a significant channel to reach these people. This study aimed to assess the potential health economic impact of screening and recruitment services in pharmacies in referring people to preventive interventions. Methods A decision analytic model was constructed to perform a cost-utility analysis of the expected national health economic consequences (in terms of costs and quality-adjusted life years, QALYs) of a hypothetical pharmacy-based service where people screened and recruited through pharmacies would participate in a digital lifestyle program. Cost-effectiveness was considered in terms of net monetary benefit (NMB). In addition, social return on investment (SROI) was calculated as the ratio of the intervention and recruitment costs and the net present value of expected savings. Payback time was the time taken to reach the break-even point in savings. In the base scenario, a 20-year time horizon was applied. Probabilistic and deterministic sensitivity analyses were applied to study robustness of the results. Results In the base scenario, the expected savings from the pharmacy-based screening and recruitment among the reached target cohort were 255.3 m€ (95% CI − 185.2 m€ to 717.2 m€) in pharmacy visiting population meaning 1412€ (95% CI − 1024€ to 3967€) expected savings per person. Additionally, 7032 QALYs (95% CI − 1344 to 16,143) were gained on the population level. The intervention had an NMB of 3358€ (95% CI − 1397€ to 8431€) using a cost-effectiveness threshold of 50,000 €/QALY. The initial costs were 122.2 m€ with an SROI of 2.09€ (95% CI − 1.52€ to 5.88€). The expected payback time was 10 and 8 years for women and men, respectively. Results were most sensitive for changes in effectiveness of the intervention and selected discount rate. Conclusions T2D screening and recruitment to prevention programs conducted via pharmacies was a dominant option providing both cost savings and QALY gains. The highest savings can be potentially reached by targeting recruitment at men at elevated risk of T2D. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06948-6.
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Affiliation(s)
- Kari Jalkanen
- Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Emma Aarnio
- Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Piia Lavikainen
- Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Jaana Lindström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Markku Peltonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Faculty of Medicine, P.O. Box 1627, 70211, Kuopio, Finland.,Chronic Disease Epidemiology and Prevention Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint Municipal Authority for North Karelia Health and Social Services (Siun Sote), Joensuu, Finland
| | - Janne Martikainen
- Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
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23
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Petelina TI, Musikhina NA, Avdeeva KS, Sharoyan YA, Gapon LI, Gorbatenko EA, Zueva EV, Valeeva LL. Gender characteristics of lipid profile parameters and markers of vascular inflammation in patients with stable angina pectoris in groups with presence and absence of type 2 diabetes. Klin Lab Diagn 2021; 66:325-332. [PMID: 34105907 DOI: 10.51620/0869-2084-2021-66-6-325-332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study of the parameters of the lipid profile and markers of the inflammatory reaction of the vascular wall in patients with stable angina pectoris in the presence or absence of type 2 diabetes mellitus (T2DM) is of great importance for revealing the gender characteristics of the pathophysiological mechanisms of the development and course of diseases, developing secondary prevention of complications and determining the prognosis. 194 patients with stable angina pectoris (SA), single-vessel coronary artery disease, mean age 60.3 ± 7.8 years were examined. Patients were divided into two groups: group 1 - patients with SA without diabetes 2 (n = 152), group 2 - with SA and diabetes 2 (n = 42). In each group, subgroups of men and women are distinguished. The study of biomarkers was carried out upon admission to the hospital on the background of therapy, taken on an outpatient basis. The study included a complex of parameters of the lipid spectrum, markers of the inflammatory response, endothelial dysfunction, and carbohydrate metabolism parameters. A comparative analysis of biomarkers revealed an excess of reference values of atherogenic lipid fractions in both groups of patients, regardless of patient gender. Moreover, in the first group of patients, in the subgroup of women, a significant excess of the level of TC, PL (a), and ApoA-1 was registered compared with the subgroup of men. In the second group, there were no significant differences in parameters between the male and female subgroups. Evaluation of the parameters of the inflammatory reaction revealed in the subgroup of women with T2DM a steady tendency to exceed the level of hs-CRP, TNF-α, homocysteine compared with both men and women in the SA group without T2DM. The logistic regression revealed the main biochemical markers that affect the aggravation of the course of IHD in women with T2DM: this is a uric acid level of more than 380 mmol / l - OS 11.5 (95% CI 1.71-77.69), TNF-α more 8 pg / ml - OR 7.5 (95% CI 1.07-52.46) and an increase in TG - OR 3.33 (95% CI 1.073-10.335). Thus, women of the 2nd group with the presence of T2DM are characterized by the highest level of atherogenic fractions of lipids, markers of vascular inflammation, glucose and HbA1c, which may indicate the greatest potential for the development of atherothrombotic complications in this subgroup of patients.
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Affiliation(s)
| | - N A Musikhina
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center RAS
| | - K S Avdeeva
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center RAS
| | - Yu A Sharoyan
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center RAS
| | - L I Gapon
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center RAS
| | - E A Gorbatenko
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center RAS
| | - E V Zueva
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center RAS
| | - L L Valeeva
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center RAS
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24
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Rintamäki R, Rautio N, Peltonen M, Jokelainen J, Keinänen-Kiukaanniemi S, Oksa H, Saaristo T, Puolijoki H, Saltevo J, Tuomilehto J, Uusitupa M, Moilanen L. Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care. Prim Care Diabetes 2021; 15:444-450. [PMID: 33771515 DOI: 10.1016/j.pcd.2021.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/23/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Abstract
AIMS The Finnish National Diabetes Prevention Program (FIN-D2D) was the first large-scale diabetes prevention program in a primary health care setting in the world. The risk reduction of type 2 diabetes was 69% after one-year intervention in high-risk individuals who were able to lose 5% of their weight. We investigated long-term effects of one-year weight change on the incidence of type 2 diabetes, cardiovascular events, and all-cause mortality. METHODS A total of 10,149 high-risk individuals for type 2 diabetes were identified in primary health care centers and they were offered lifestyle intervention to prevent diabetes. Of these individuals who participated in the baseline screening, 8353 had an oral glucose tolerance test (OGTT). Complete follow-up data during one-year intervention were available for 2730 individuals and those were included in the follow-up analysis. The long-term outcome events were collected from national health registers after the median follow-up of 7.4 years. RESULTS Among individuals who lost weight 2.5-4.9% and 5% or more during the first year, the hazard ratio for the incidence of drug-treated diabetes was 0.63 (95% CI 0.49-0.81, p = 0.0001), and 0.71 (95% CI 0.56-0.90, p = 0.004), respectively, compared with those with stable weight. There were no significant differences in cardiovascular events or all-cause mortality among study participants according to one-year weight changes. CONCLUSIONS High-risk individuals for type 2 diabetes who achieved a moderate weight loss by one-year lifestyle counseling in primary health care had a long-term reduction in the incidence of drug-treated type 2 diabetes. The observed moderate weight loss was not associated with a reduction in cardiovascular events.
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Affiliation(s)
- Reeta Rintamäki
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland.
| | - Nina Rautio
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Markku Peltonen
- Public Health Prevention Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Jokelainen
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland; Infrastructure for Populations Studies, University of Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland; Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
| | - Heikki Oksa
- Tampere University Hospital, Tampere, Finland
| | | | | | - Juha Saltevo
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Jaakko Tuomilehto
- Public Health Prevention Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leena Moilanen
- Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
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25
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Comorbid Diabetes in Inflammatory Bowel Disease Predicts Adverse Disease-Related Outcomes and Infectious Complications. Dig Dis Sci 2021; 66:2005-2013. [PMID: 32617771 DOI: 10.1007/s10620-020-06439-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) and inflammatory bowel diseases (IBD) are chronic systemic illnesses associated with chronic inflammation, dysbiosis, impaired immune function, and infection risk. The impact of DM in modifying disease activity in patients with IBD remains largely unknown. AIM To investigate the impact of DM on IBD-related disease outcomes, mortality, and infections in patients with IBD. METHODS We performed a longitudinal cohort analysis. Using a large institutional database, patients with concurrent IBD and DM (IBD-DM), and IBD without DM (IBD cohort), were identified and followed longitudinally to evaluate for primary (IBD-related) and secondary (mortality and infections) outcomes. Cox proportional hazards models were used to determine the independent effect of DM on each outcome, adjusting for confounding effects of covariates. RESULTS A total of 901 and 1584 patients were included in the IBD-DM and DM cohorts. Compared with IBD, IBD-DM had significantly higher risk of IBD-related hospitalization [adjusted hazard ratio (HR) 1.97, 95% confidence interval (1.71-2.28)], disease flare [HR 2.05 (1.75-2.39)], and complication [HR 1.54 (1.29-1.85)]. No significant difference was observed in the incidence of IBD-related surgery. All-cause mortality, sepsis, Clostridioides difficile infection (CDI), pneumonia, urinary tract infection, and skin infection were also more frequent in the IBD-DM than the IBD cohort (all p ≤ 0.05). Subgroup analysis of Crohn's disease (CD) and ulcerative colitis patients showed similar associations, except with an additional risk of surgery and no association with CDI in the CD-DM cohort. CONCLUSION Comorbid diabetes in patients with IBD is a predictor of poor disease-related and infectious outcomes.
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26
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Mozaffari H, Hosseini Z, Lafrenière J, Conklin AI. The role of dietary diversity in preventing metabolic-related outcomes: Findings from a systematic review. Obes Rev 2021; 22:e13174. [PMID: 33615679 DOI: 10.1111/obr.13174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
Dietary diversity has been linked to insulin resistance; however, studies are inconsistent on whether dietary diversity protects against metabolic-related outcomes. We aimed to comprehensively assess metabolic-related outcomes of greater diversity across the diet and within major food groups. A systematic search of peer-reviewed literature was done in bibliographic databases (Medline, Scopus, and Web of Science) for longitudinal studies that reported on original research. Data extraction and quality appraisal used predefined criteria; reported findings were synthesized through a narrative approach. Fourteen studies were identified as eligible. Greater dietary diversity across major food groups, and diversity within fruits and/or vegetables, was associated with reduced risk of type 2 diabetes (T2D). Effects varied based on exposure definition and adjustment for known confounders. While diversity of less healthy foods was associated with greater adiposity, diversity of all foods and healthy foods was associated with reduced incidence of depression and cognitive decline. Evidence supports the protective effect of dietary diversity against cognitive decline and T2D. The association between dietary diversity and adiposity may be dependent on the healthiness of foods. Public health efforts to prevent metabolic-related diseases should include an emphasis on a varied diet as a healthy eating strategy.
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Affiliation(s)
- Hadis Mozaffari
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zeinab Hosseini
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacynthe Lafrenière
- School of Nutrition, Institute of Nutrition and Functional Foods, Laval University, Quebec, Quebec, Canada
| | - Annalijn I Conklin
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St. Paul's Hospital, Vancouver, British Columbia, Canada
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27
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Incident psychopharmacological treatment and psychiatric hospital contact in individuals with newly developed type 2 diabetes - a register-based cohort study. Acta Neuropsychiatr 2021; 33:72-84. [PMID: 33109286 DOI: 10.1017/neu.2020.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
To investigate the association between newly developed type 2 diabetes (T2D) and incident psychopharmacological treatment and psychiatric hospital contact. Via Danish registers, we identified all 56 640 individuals from the Central and Northern Denmark Regions with newly developed T2D (defined by the first HbA1c measurement ≥6.5%) in 2000-2016 as well as 315 694 age- and sex-matched controls (without T2D). Those having received psychopharmacological treatment or having had a psychiatric hospital contact in the 5 years prior to the onset of T2D were not included. For this cohort, we first assessed the 2-year incidence of psychopharmacological treatment and psychiatric hospital contact. Secondly, via Cox regression, we compared the incidence of psychopharmacological treatment/psychiatric hospital contact among individuals with T2D to propensity score-matched controls - taking a wide range of potential confounders into account. Finally, via Cox proportional hazards regression, we assessed which baseline (T2D onset) characteristics were associated with subsequent psychopharmacological treatment and psychiatric hospital contact. A total of 8.3% of the individuals with T2D initiated psychopharmacological treatment compared to 4.6% of the age- and sex-matched controls. Individuals with T2D were at increased risk of initiating psychopharmacological treatment compared to the propensity score-matched controls (HR = 1.51, 95% CI = 1.43-1.59), whereas their risk of psychiatric hospital contact was not increased to the same extent (HR = 1.14, 95% CI = 0.98-1.32). Older age, somatic comorbidity, and being divorced/widowed were associated with both psychopharmacological treatment and psychiatric hospital contact following T2D. Individuals with T2D are at elevated risk of requiring psychopharmacological treatment.
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28
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The Combined Effect of Neuromuscular Electrical Stimulation and Insulin Therapy on Glycated Hemoglobin Concentrations, Lipid Profiles and Hemodynamic Parameters in Patients with Type-2-Diabetes and Hemiplegia Related to Ischemic Stroke: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073433. [PMID: 33810235 PMCID: PMC8036261 DOI: 10.3390/ijerph18073433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
Type-2-diabetes mellitus (T2DM) is a global problem of medical, social and economic consequences. Physical activity is a vital therapy in patients with T2DM, but some of them cannot exercise for various reasons. The purpose of our pilot study was to determine whether a combination of neuromuscular electrostimulation (NMES) and insulin therapy could improve the management of T2DM patients with hemiplegia caused by an ischemic stroke. Fifteen immobile patients with T2DM on insulin therapy were enrolled in the study. NMES was applied to their lower limbs for 60 min, 5 days a week, over a period of 12 weeks. The intervention caused statistically significant reductions in the blood concentrations of glycated hemoglobin, total cholesterol and low-density cholesterol in the participants. Furthermore, systolic and diastolic blood pressure levels were significantly lower. More randomized clinical trials are needed to accurately measure the effect of NMES on T2DM treatment and to determine whether it can be an alternative for physical activity for immobile patients with T2DM.
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29
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Luhar S, Kondal D, Jones R, Anjana RM, Patel SA, Kinra S, Clarke L, Ali MK, Prabhakaran D, Kadir MM, Tandon N, Mohan V, Narayan KMV. Lifetime risk of diabetes in metropolitan cities in India. Diabetologia 2021; 64:521-529. [PMID: 33225415 PMCID: PMC7864818 DOI: 10.1007/s00125-020-05330-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS We aimed to estimate the lifetime risk of diabetes and diabetes-free life expectancy in metropolitan cities in India among the population aged 20 years or more, and their variation by sex, age and BMI. METHODS A Markov simulation model was adopted to estimate age-, sex- and BMI-specific lifetime risk of developing diabetes and diabetes-free life expectancy. The main data inputs used were as follows: age-, sex- and BMI-specific incidence rates of diabetes in urban India taken from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018); age-, sex- and urban-specific rates of mortality from period lifetables reported by the Government of India (2014); and prevalence of diabetes from the Indian Council for Medical Research INdia DIABetes study (2008-2015). RESULTS Lifetime risk (95% CI) of diabetes in 20-year-old men and women was 55.5 (51.6, 59.7)% and 64.6 (60.0, 69.5)%, respectively. Women generally had a higher lifetime risk across the lifespan. Remaining lifetime risk (95% CI) declined with age to 37.7 (30.1, 46.7)% at age 60 years among women and 27.5 (23.1, 32.4)% in men. Lifetime risk (95% CI) was highest among obese Indians: 86.0 (76.6, 91.5)% among 20-year-old women and 86.9 (75.4, 93.8)% among men. We identified considerably higher diabetes-free life expectancy at lower levels of BMI. CONCLUSIONS/INTERPRETATION Lifetime risk of diabetes in metropolitan cities in India is alarming across the spectrum of weight and rises dramatically with higher BMI. Prevention of diabetes among metropolitan Indians of all ages is an urgent national priority, particularly given the rapid increase in urban obesogenic environments across the country. Graphical abstract.
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Affiliation(s)
- Shammi Luhar
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Dimple Kondal
- Centre for Chronic Disease Control (CCDC), New Delhi, India
| | - Rebecca Jones
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | | | - Shivani A Patel
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lynda Clarke
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control (CCDC), New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - M Masood Kadir
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Ozturk MA, Gunturk A, Kucukardali Y. Characteristics of Diabetic Ageing Patients in Nursing Homes: One Center Experience in Turkey. Nutr Metab Insights 2021; 14:1178638821990345. [PMID: 33597812 PMCID: PMC7863158 DOI: 10.1177/1178638821990345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/02/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Due to its widespread distribution and effects, type 2 diabetes is a frequently researched topic. However, the amount of information about type 2 diabetes in nursing homes residents is inadequate. The aim of this study is to elucidate on the frequency, treatments, comorbidities, and deaths of nursing home residents diagnosed with type 2 diabetes. Materials and methods Type 2 diabetes was evaluated in 612 people accepted to nursing homes as residents between January 2005 and January 2013. Medical records, prescriptions, laboratory results, and comorbidities were evaluated statistically. Results Approximately 26% (159) patients of the cohort had either preexisting type 2 diabetes during registration to nursing home or was diagnosed with it during the 8-year follow-up. The prevalence of DM was 25% in males and 26% in females. Average age was 75.7 ± 10.6 in diabetics and 76.7 ± 11.6 in non-diabetics. Hemoglobin, creatinine, triglycerides, HDL-cholesterol, and CRP values were not found to be different between the groups. Hypertension was diagnosed in 75% of diabetics versus 59% of non-diabetics, hyperlipidemia in 21% versus 7% (P < .01); however, atrial fibrillation was more common in non-diabetics (P = .022). There was no difference for survival rate between diabetic and non-diabetic groups (P = .743). Conclusion Approximately 1 out of 4 nursing home residents were found to have diabetes, with females being more affected then males. The survival rates both at the diabetic and non-diabetic patients were detected similar. Glucose, total cholesterol, LDL-cholesterol, and blood pressure values which can all impact survival should be closely watched from early on in the disease progress and their values should be optimized.
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Affiliation(s)
- Mehmet Akif Ozturk
- Department of Internal Medicine, Fatih Sultan Mehmet Hospital, Istanbul, Turkey
| | - Arzu Gunturk
- Department of Internal Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Yasar Kucukardali
- Department of Internal Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
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Risdon S, Battault S, Romo-Romo A, Roustit M, Briand L, Meyer G, Almeda-Valdes P, Walther G. Sucralose and Cardiometabolic Health: Current Understanding from Receptors to Clinical Investigations. Adv Nutr 2021; 12:1500-1513. [PMID: 33578411 PMCID: PMC8321845 DOI: 10.1093/advances/nmaa185] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/26/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
The excess consumption of added sugar is consistently found to be associated with weight gain, and a higher risk of type 2 diabetes mellitus, coronary heart disease, and stroke. In an effort to reduce the risk of cardiometabolic disease, sugar is frequently replaced by low- and null-calorie sweeteners (LCSs). Alarmingly, though, emerging evidence indicates that the consumption of LCSs is associated with an increase in cardiovascular mortality risk that is amplified in those who are overweight or obese. Sucralose, a null-caloric high-intensity sweetener, is the most commonly used LCS worldwide, which is regularly consumed by healthy individuals and patients with metabolic disease. To explore a potential causal role for sucralose in increased cardiovascular risk, this present review summarizes the preclinical and clinical data from current research detailing the effects of sucralose on systems controlling food intake, glucose homeostasis, and gut microbiota.
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Affiliation(s)
| | | | - Alonso Romo-Romo
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Matthieu Roustit
- Université Grenoble Alpes, Inserm U1042, Grenoble, France,Grenoble Alpes University Hospital, Clinical Pharmacology, Inserm CIC1406, Grenoble, France
| | - Loic Briand
- AgroSup Dijon, INRAE, Université de Bourgogne Franche-Comté, CNRS, Centre des Sciences du Goût et de l'Alimentation, Dijon, France
| | | | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
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Sütő G, Molnár GA, Rokszin G, Fábián I, Kiss Z, Szekanecz Z, Poór G, Jermendy G, Kempler P, Wittmann I. Risk of morbidity and mortality in patients with type 2 diabetes treated with sodium-glucose cotransporter-2 inhibitor and/or dipeptidyl peptidase-4 inhibitor: a nationwide study. BMJ Open Diabetes Res Care 2021; 9:9/1/e001765. [PMID: 33472796 PMCID: PMC7818813 DOI: 10.1136/bmjdrc-2020-001765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Mortality and disability in diabetes mellitus are determined mostly by cardiovascular complications and cancer. The impact of dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) monotherapy or combination on long-term complications of type 2 diabetes mellitus was studied. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes treated with DPP-4i or SGLT2i during a 3-year period were identified in the database of the National Institute of Health Insurance Fund in Hungary. All-cause mortality, acute myocardial infarction, stroke, hospitalization for heart failure (HHF), lower limb amputation (LLA) and cancer were assessed. Outcomes of add-on SGLT2i to DPP-4i treatment in comparison with switching DPP-4i therapy to SGLT2i were also evaluated. After propensity score matching, survival analysis was performed with a Cox proportional hazards model. RESULTS After propensity score matching, both SGLT2i and DPP-4i groups included 18 583 patients. All-cause mortality (HR, 0.80; 95% CI 0.68 to 0.94; p=0.0057), HHF (HR, 0.81; 95% CI 0.71 to 0.92; p=0.0018), and risk of cancer (HR, 0.75; 95% CI 0.66 to 0.86; p<0.0001) were lower in the SGLT2i population compared with DPP-4i. Risk of LLA was higher in the SGLT2i group (HR, 1.35; 95% CI 1.03 to 1.77; p=0.0315). SGLT2i in combination with DPP-4i results in lower all-cause mortality (HR, 0.46; 95% CI 0.31 to 0.67; p=0.0001), with a lower trend in stroke, LLA, HHF and cancer, but without any statistical difference. CONCLUSIONS SGLT2i treatment leads to a lower risk of overall mortality, HHF and cancer when compared with DPP-4i treatment. Adding SGLT2i to DPP-4i instead of switching from DPP-4i to SGLT2i further lowers the risk of all-cause mortality.
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Affiliation(s)
- Gábor Sütő
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | - Gergő A Molnár
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | | | | | - Zoltan Kiss
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Poór
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | - Peter Kempler
- First Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - István Wittmann
- Second Department of Medicine and Nephrology-Diabetes Centre, University of Pécs Medical School, Pécs, Hungary
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The Identification of Diabetes Mellitus Subtypes Applying Cluster Analysis Techniques: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249523. [PMID: 33353219 PMCID: PMC7766625 DOI: 10.3390/ijerph17249523] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022]
Abstract
Diabetes Mellitus is a chronic and lifelong disease that incurs a huge burden to healthcare systems. Its prevalence is on the rise worldwide. Diabetes is more complex than the classification of Type 1 and 2 may suggest. The purpose of this systematic review was to identify the research studies that tried to find new sub-groups of diabetes patients by using unsupervised learning methods. The search was conducted on Pubmed and Medline databases by two independent researchers. All time publications on cluster analysis of diabetes patients were selected and analysed. Among fourteen studies that were included in the final review, five studies found five identical clusters: Severe Autoimmune Diabetes; Severe Insulin-Deficient Diabetes; Severe Insulin-Resistant Diabetes; Mild Obesity-Related Diabetes; and Mild Age-Related Diabetes. In addition, two studies found the same clusters, except Severe Autoimmune Diabetes cluster. Results of other studies differed from one to another and were less consistent. Cluster analysis enabled finding non-classic heterogeneity in diabetes, but there is still a necessity to explore and validate the capabilities of cluster analysis in more diverse and wider populations.
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Brandtner EM, Muendlein A, Leiherer A, Armbruster FP, Dschietzig TB, Geiger K, Fraunberger P, Saely CH, Drexel H. Serum Parathyroid Hormone Predicts Mortality in Coronary Angiography Patients with Type 2 Diabetes. J Clin Endocrinol Metab 2020; 105:5891791. [PMID: 32785694 DOI: 10.1210/clinem/dgaa512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elevated serum levels of parathyroid hormone (PTH), one of the main regulators of calcium homeostasis and vitamin D metabolism, have been proposed as predictors of mortality. The impact of type 2 diabetes mellitus (T2DM) on the putative association between PTH and mortality has not been investigated thus far. AIM The aim of our study was to investigate the impact of T2DM on the power of PTH to predict mortality risk. METHODS Serum PTH levels were determined in 904 consecutive Caucasian patients referred to coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD), including 235 patients with T2DM. Prospectively, deaths were recorded over a mean follow-up period of 6.3 years. RESULTS PTH at baseline did not differ significantly between patients with and without T2DM (P = .307). Cox regression analysis revealed that the serum PTH level strongly predicted all-cause mortality in patients with T2DM (hazard ratio [HR] = 2.35 [1.37-4.03]; P = .002), whereas PTH did not predict all-cause mortality in patients without T2DM (HR = 1.04 [0.81-1.32]; P = .766). The interaction term PTH × T2DM was significant (P = .006), indicating a significantly stronger impact of PTH on mortality risk in patients with T2DM than in individuals without diabetes. The impact of PTH on mortality risk in patients with T2DM remained significant after adjustment for glycated hemoglobin A1c, diabetes duration, classical cardiovascular risk factors, serum levels of vitamin D, and kidney function (HR = 2.10 [1.10-4.10]; P = .030). CONCLUSION We conclude that PTH is a significantly stronger predictor of all-cause mortality in patients with T2DM than in those without T2DM.
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Affiliation(s)
- Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | | | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Drexel University College of Medicine, Philadelphia, Pennsylvania
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Rahman MA, Vijayaraghavan G, Ankudinov AS, Kalyagin AN. [State of the coronary arteries and assessment of the role of hormone replacement therapy in patients with coronary heart disease against the background of primary manifest hypothyroidism]. KARDIOLOGIIA 2020; 60:76-83. [PMID: 33131478 DOI: 10.18087/cardio.2020.9.n1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
Aim To study features of coronary damage and incidence of different types of acute coronary syndrome (ACS) in history associated with primary symptomatic hypothyroidism in patients with ischemic heart disease (IHD) and possible associations of replacement hormonal therapy with lipidogram indexes.Material and methods This retrospective study included 344 patients with IHD and functional class I-III stable angina (ССS, 1976). Of them 100 patients had primary symptomatic hypothyroidism and 244 had no hypothyroidism. Coronary angiography was performed for all patients included into this study. Routine laboratory, instrumental and clinical indexes were analyzed. Hypothyroidism was confirmed by levels of thyrotropic hormone, free triiodothyronine, and thyroxine. Comparative analysis was performed for the incidence of ACS types in history, types of coronary injury, and laboratory, instrumental and clinical indexes with assessment of potential interrelations. Statistically significant results were reported. Type of data distribution was evaluated with the Kolmogorov-Smirnov test. Quantitative data with normal (Gaussian) distribution were presented as mean (M) and standard deviation (SD). Data with attributes of non-normal distribution were presented as median (Me) with maximum and minimum values (min; max). Statistical significance of differences between means was assessed with the Mann-Whitney test. Logistic regression analysis was used in parallel for evaluating dependence of a quantitative variable on values of two or more quantitative or qualitative variables (factors). Significance level for testing of statistical hypotheses was р<0.05.Results Incidence of ST segment elevation ACS (STEACS) was significantly higher in IHD patients with hypothyroidism than in the group without hypothyroidism (61.6 and 35.6 %, р=0.03) and also with three-vessel coronary artery disease (60.6 and 30.6 %, р=0.001). In the IHD group with hypothyroidism, levels of total cholesterol, triglycerides, and low- and very low-density lipoproteins were significantly increased compared to the respective values in patients without hypothyroidism (р<0.0001). An inverse correlation was found between lipidogram indexes and L-thyroxine (р<0.0001).Conclusion The incidence of STEACS associated with primary symptomatic hypothyroidism in history was significantly higher in the patient group with IHD on the background of primary symptomatic hypothyroidism compared to the comparison group. Also, the incidence of three-vessel coronary disease was significantly greater than in the IHD patient group without hypothyroidism. A significant association was found between the replacement hormonal therapy and the best lipidogram indexes. The authors suggested that the key factor for prevention of adverse cardiovascular events in IHD with hypothyroidism is achieving control of clinical manifestations of hypothyroidism with replacement hormonal therapy.
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Affiliation(s)
| | | | | | - A N Kalyagin
- Irkutsk Medical State University, Irkutsk, Russia
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Ang GY. Age of onset of diabetes and all-cause mortality. World J Diabetes 2020; 11:95-99. [PMID: 32313608 PMCID: PMC7156298 DOI: 10.4239/wjd.v11.i4.95] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus continues to present a large social, financial and health system burden across the world. The relationship between age of onset of the different types of diabetes and all-cause mortality is uncertain. In this review paper, the relationship between age of onset of the different types of diabetes and all-cause mortality will be reviewed and an update of the current evidence will be presented. There is strong evidence of the relationship between age of onset of type 2 diabetes mellitus (T2DM) and all-cause mortality, good evidence of the relationship between age of onset of T1DM and all-cause mortality and no evidence of the relationship between age of onset of gestational diabetes or prediabetes and all-cause mortality. Further research is needed to look at whether aggressive management of earlier onset of T2DM can help to reduce premature mortality.
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Affiliation(s)
- Gary Yee Ang
- Health Services and Outcomes Research, National Healthcare Group, Singapore 138543, Singapore
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37
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Willems R, Pil L, Lambrinou CP, Kivelä J, Wikström K, Gonzalez-Gil EM, De Miguel-Etayo P, Nánási A, Semánová C, Van Stappen V, Cardon G, Tsochev K, Iotova V, Chakarova N, Makrilakis K, Dafoulas G, Timpel P, Schwarz P, Manios Y, Annemans L. Methodology of the health economic evaluation of the Feel4Diabetes-study. BMC Endocr Disord 2020; 20:14. [PMID: 32164685 PMCID: PMC7066818 DOI: 10.1186/s12902-019-0471-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus. METHODS The aim of this paper is to describe the detailed methodology of the intervention's cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention's value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only. CONCLUSIONS The optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources.
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Affiliation(s)
- Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
| | - Lore Pil
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
| | - Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Esther M. Gonzalez-Gil
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragon (IA2), Zaragoza, Spain
- Instituto de Investigacion Sanitaria Aragón (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red de Fisiopatologia de la Obesidad y Nutricion (CIBERObn), University of Zaragoza, Zaragoza, Spain
| | - Anna Nánási
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, 400 Hungary
| | - Csilla Semánová
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, 400 Hungary
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Campus Dunant, Watersportlaan 2, 9000 Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Campus Dunant, Watersportlaan 2, 9000 Ghent, Belgium
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, 1 Hr. Smirnenski Blvd, 9010 Varna, Bulgaria
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, 1 Hr. Smirnenski Blvd, 9010 Varna, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | | | - George Dafoulas
- National and Kapodistrian University of Athens, 17 Ag. Thoma St, 11527 Athens, Greece
| | - Patrick Timpel
- Department for Precention and Care of Diabetes, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Peter Schwarz
- Department for Precention and Care of Diabetes, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
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Härkänen T, Kuulasmaa K, Sares-Jäske L, Jousilahti P, Peltonen M, Borodulin K, Knekt P, Koskinen S. Estimating expected life-years and risk factor associations with mortality in Finland: cohort study. BMJ Open 2020; 10:e033741. [PMID: 32152164 PMCID: PMC7064132 DOI: 10.1136/bmjopen-2019-033741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To develop a tool to inform individuals and general practitioners about benefits of lifestyle changes by providing estimates of the expected age of death (EAD) for different risk factor values, and for those who plan and decide on preventive activities and health services at population level, to calculate potential need for these. DESIGN Prospective cohort study to estimate EAD using a model with 27 established risk factors, categorised into four groups: (1) sociodemographic background and medical history, (2) lifestyles, (3) life satisfaction, and (4) biological risk factors. We apply a Poisson regression model on the survival data split into 1-year intervals. PARTICIPANTS Total of 38 549 participants aged 25-74 years at baseline of the National FINRISK Study between 1987 and 2007. PRIMARY OUTCOME MEASURES Register-based comprehensive mortality data from 1987 to 2014 with an average follow-up time of 16 years and 4310 deaths. RESULTS Almost all risk factors included in the model were statistically significantly associated with death. The largest influence on the EAD appeared to be a current heavy smoker versus a never smoker as the EAD for a 30-year-old man decreased from 86.8 years, which corresponds to the reference values of the risk factors, to 80.2 years. Diabetes decreased EAD by >6.6 years. Whole or full milk consumers had 3.4 years lower EAD compared with those consuming skimmed milk. Physically inactive men had 2.4 years lower EAD than those with high activity. Men who found their life almost unbearable due to stress had 2.8 years lower EAD. CONCLUSIONS The biological risk factors and lifestyles, and the factors connected with life satisfaction were clearly associated with EAD. Our model for estimating a person's EAD can be used to motivate lifestyle changes.
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Affiliation(s)
- Tommi Härkänen
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kari Kuulasmaa
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Sares-Jäske
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Jousilahti
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Peltonen
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Katja Borodulin
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
- Age Institute, Helsinki, Finland
| | - Paul Knekt
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Koskinen
- Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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Kung FP, Tsai CF, Lu CL, Huang LC, Lu CH. Diabetes pay-for-performance program can reduce all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Medicine (Baltimore) 2020; 99:e19139. [PMID: 32049836 PMCID: PMC7035087 DOI: 10.1097/md.0000000000019139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This study aimed to examine the effect of a diabetes pay-for-performance (P4P) program on all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Using a Taiwanese representative nationwide cohort, we recruited 5478 patients with newly diagnosed type 2 diabetes enrolled in the P4P program within 5 years after a diagnosis of diabetes between January 1, 2002 and December 31, 2010 and individuals not enrolled in the P4P program were recruited as the control group matched 1:1 with the study group. We used multivariate Cox proportional hazard models analysis to investigate the effect of the P4P program and adherence on all-cause mortality. A total of 250 patients died in the P4P group compared to 395 in the control group (mortality rate 104 vs 169 per 10,000 person-years, respectively, P < .0001). The control group also had more comorbidities. Patients enrolled in the P4P program demonstrated significant long-term survival benefits, of which the adjusted hazard ratio (aHR) for all-cause mortality was 0.58 [95% CI (0.48-0.69)]. In the study group, better adherence to the P4P program resulted in a greater reduction in mortality, with aHRs [95% CI] of 0.48 [0.38-0.62] and 0.36 [0.26-0.49] in subjects with a minimum 1-year and 2-year good P4P adherence, respectively. Participating in the P4P program within 5 years after the diagnosis of diabetes resulted in a significant reduction in all-cause mortality, and this effect was particularly pronounced in the patients with better adherence to the P4P program.
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Affiliation(s)
- Fang-Ping Kung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chin-Li Lu
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung-Hsing University, Taichung
| | - Li-Chung Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Division of Psychiatry, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chieh-Hsiang Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Kaohsiung Christian Hospital, Kaohsiung City, Taiwan
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Forbes A. Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research. Front Endocrinol (Lausanne) 2020; 11:133. [PMID: 32256448 PMCID: PMC7089919 DOI: 10.3389/fendo.2020.00133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 02/27/2020] [Indexed: 01/09/2023] Open
Abstract
This review considers the burden of mortality observed in the older population of people with diabetes and identifies the risk factors associated with mortality hazard in this population. The mortality gap between older people with and without diabetes is enduring, with excess mortality being 10% greater than in the general population. While early mortality in men with diabetes is significantly greater than females with diabetes, the relative mortality risk in females is much higher compared to women without diabetes. Older people who have developed diabetes in middle age have significantly higher mortality hazard compared to those who develop it in old age, emphasizing the continued importance of optimizing diabetes care in all ages. To minimize mortality hazard in older age it is important to address some of the factors that convey risk, these include: comorbidity; polypharmacy; physical and mental frailty; safe glycemic targets for older people; hypoglycemia; glycemic targets; and the hypoglycemic agents. While the data to determine optimal management approaches are limited, the overall need is for a more diligent approach in assessing the needs of older people with diabetes to inform individualized care strategies and therapy goals that minimize potential hazards.
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Tebé C, Martínez-Laguna D, Carbonell-Abella C, Reyes C, Moreno V, Diez-Perez A, Collins GS, Prieto-Alhambra D. The association between type 2 diabetes mellitus, hip fracture, and post-hip fracture mortality: a multi-state cohort analysis. Osteoporos Int 2019; 30:2407-2415. [PMID: 31444526 DOI: 10.1007/s00198-019-05122-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022]
Abstract
UNLABELLED Type 2 diabetes mellitus (T2DM) is associated with an excess risk of fractures and overall mortality. This study compared hip fracture and post-hip fracture mortality in T2DM and non-diabetic subjects. The salient findings are that subjects in T2DM are at higher risk of dying after suffering a hip fracture. INTRODUCTION Previous research suggests that individuals with T2DM are at an excess risk of both fractures and overall mortality, but their combined effect is unknown. Using multi-state cohort analyses, we estimate the association between T2DM and the transition to hip fracture, post-hip fracture mortality, and hip fracture-free all-cause death. METHODS Population-based cohort from Catalonia, Spain, including all individuals aged 65 to 80 years with a recorded diagnosis of T2DM on 1 January 2006; and non-T2DM matched (up to 2:1) by year of birth, gender, and primary care practice. RESULTS A total of 44,802 T2DM and 81,233 matched controls (53% women, mean age 72 years old) were followed for a median of 8 years: 23,818 died without fracturing and 3317 broke a hip, of whom 838 subsequently died. Adjusted HRs for hip fracture-free mortality were 1.32 (95% CI 1.28 to 1.37) for men and 1.72 (95% CI 1.65 to 1.79) for women. HRs for hip fracture were 1.24 (95% CI 1.08 to 1.43) and 1.48 (95% CI 1.36 to 1.60), whilst HRs for post-hip fracture mortality were 1.28 (95% CI 1.02 to 1.60) and 1.57 (95% CI 1.31 to 1.88) in men and women, respectively. CONCLUSION T2DM individuals are at increased risk of hip fracture, post-hip fracture mortality, and hip fracture-free death. After adjustment, T2DM men were at a 28% higher risk of dying after suffering a hip fracture and women had 57% excess risk of post-hip fracture mortality.
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Affiliation(s)
- C Tebé
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Spain
- Universitat de Barcelona, Barcelona, Spain
- Universitat Rovira i Virgili, Reus, Spain
| | - D Martínez-Laguna
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - C Carbonell-Abella
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - C Reyes
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - V Moreno
- Biostatistics Unit at Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Spain
- Universitat de Barcelona, Barcelona, Spain
- Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, 08908, L'Hospitalet de Llobregat, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - A Diez-Perez
- Musculoskeletal Research Unit, IMIM-Hospital del Mar and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, 08003, Barcelona, Spain
| | - G S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK
| | - D Prieto-Alhambra
- Grupo de Investigación GREMPAL, IDIAP Jordi Gol and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Oxford, UK.
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Schernthaner G, Drexel H, Moshkovich E, Zilaitiene B, Martinka E, Czupryniak L, Várkonyi T, Janež A, Ducena K, Lalić K, Tankova T, Prázný M, Smirčić Duvnjak L, Sukhareva O, Sourij H. SGLT2 inhibitors in T2D and associated comorbidities - differentiating within the class. BMC Endocr Disord 2019; 19:64. [PMID: 31208401 PMCID: PMC6580491 DOI: 10.1186/s12902-019-0387-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/27/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND For patients with type 2 diabetes (T2D), cardiovascular disease (CVD) is the single most common cause of mortality. In 2008 and 2012, the Federal Drug Administration (FDA) and the European Medicines Agency (EMA) respectively mandated cardiovascular outcomes trials (CVOTs) on all new anti-diabetic agents, as prospective trials statistically powered to rule out excess cardiovascular risk in patients with T2D. Unexpectedly, some of these CVOTs have demonstrated not only cardiovascular safety, but also cardioprotective effects, as was first shown for the SGLT2 inhibitor empagliflozin in EMPA-REG OUTCOME. EXPERT OPINION To debate newly available CVOT data and to put them into context, we convened as a group of medical experts from the Central and Eastern European Region. Here we describe our discussions, focusing on the conclusions we can draw from EMPA-REG OUTCOME and other SGLT2 inhibitor CVOTs, including when considered alongside real-world evidence. CONCLUSION CVOTs investigating SGLT2 inhibitors have suggested benefits beyond glucose lowering that have been confirmed in real-world evidence studies.
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Affiliation(s)
| | - Heinz Drexel
- VIVIT-Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.
- Division of Angiology, Swiss Cardiovascular Center, University Hospital of Berne, Bern, Switzerland.
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.
- Drexel University College of Medicine, Philadelphia, PA, USA.
| | - Evgeny Moshkovich
- Unit of Endocrinology and Metabolism, Sapir Medical Center, Kfar-Saba, Israel
| | - Birute Zilaitiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Emil Martinka
- National Institute of Endocrinology and Diabetology, Lubochna, Slovakia
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Tamás Várkonyi
- 1st Dept of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
| | - Kristine Ducena
- Division of Endocrinology, Faculty of Internal Medicine, University of Latvia, Riga, Latvia
| | - Katarina Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Tsvetalina Tankova
- Clinical Centre of Endocrinology, Medical University - Sofia, Sofia, Bulgaria
| | - Martin Prázný
- Diabetes Centre, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Lea Smirčić Duvnjak
- School of Medicine, University of Zagreb, Vuk Vrhovac University Clinic-UH Merkur, Zagreb, Croatia
| | - Olga Sukhareva
- Endocrinology Research Centre, Moscow, Russian Federation
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Eslami A, Naghibi Irvani SS, Ramezankhani A, Fekri N, Asadi K, Azizi F, Hadaegh F. Incidence and associated risk factors for premature death in the Tehran Lipid and Glucose Study cohort, Iran. BMC Public Health 2019; 19:719. [PMID: 31182076 PMCID: PMC6558847 DOI: 10.1186/s12889-019-7056-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background The incidence and associated risk factors for premature death were investigated in a population-based cohort study in Iran. Methods A total of 7245 participants (3216 men), aged 30–70 years, were included. We conducted Cox proportional hazards models to identify the risk factors for premature death. For each risk factor, hazard ratio (HR), 95% confidence intervals (95% CI) and population attributable fraction (PAF) were calculated. Results After a median follow-up of 13.8 years, 262 premature deaths (153 in men) occurred. Underlying causes of premature deaths were cardiovascular disease (CVD) (n = 126), cancer (n = 51), road injuries (n = 15), sepsis and pneumonia (n = 9) and miscellaneous reasons (n = 61). The age-standardized incident rate of premature death was 2.35 per 1000 person years based on WHO standard population. Hypertension [HR 1.40, 95% CI (1.07–1.83)], diabetes (2.53, 1.94–3.29) and current smoking (1.58, 1.16–2.17) were significant risk factors for premature mortality; corresponding PAFs were 12.3, 22.4 and 9.2%, respectively. Overweight (body mass index (BMI): 25–29.9 kg/m2) (0.65, 0.49–0.87) and obesity (BMI ≥30 kg/m2) (0.67, 0.48–0.94) were associated with decreased premature mortality. After replacing general adiposity with central adiposity, we found no significant risk for the latter (0.92, 0.71–1.18). Moreover, when we excluded current smokers, those with prevalent cancer/cardiovascular disease and those with survival of less than 3 years, the inverse association between overweight (0.59, 0.39–0.88) and obesity (0.67, 0.43–1.04), generally remained unchanged; although, diabetes still showed a significant risk (2.62, 1.84–3.72). Conclusions Controlling three modifiable risk factors including diabetes, hypertension and smoking might potentially reduce mortality events by over 40%, and among these, prevention of diabetes should be prioritized to decrease burden of events. We didn’t confirm a negative impact of overweight and obesity status on premature mortality events.
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Affiliation(s)
- Ali Eslami
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, ShahidChamran Highway, P.O. Box: 19395-4763, Tehran, Iran
| | - Seyed Sina Naghibi Irvani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, ShahidChamran Highway, P.O. Box: 19395-4763, Tehran, Iran
| | - Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, ShahidChamran Highway, P.O. Box: 19395-4763, Tehran, Iran
| | - Nazanin Fekri
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, ShahidChamran Highway, P.O. Box: 19395-4763, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Keyvan Asadi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, ShahidChamran Highway, P.O. Box: 19395-4763, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Floor 3th, Number 24, Yemen Street, ShahidChamran Highway, P.O. Box: 19395-4763, Tehran, Iran.
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Moradi A, Alavi SM, Salimi M, Nouhjah S, Shahvali EA. The effect of short message service (SMS) on knowledge and preventive behaviors of diabetic foot ulcer in patients with diabetes type 2. Diabetes Metab Syndr 2019; 13:1255-1260. [PMID: 31336474 DOI: 10.1016/j.dsx.2019.01.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 01/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The present study aimed at evaluating the effectiveness of an educational intervention via mobile cells on foot care knowledge and foot care practices in patients with type 2 diabetes. MATERIAL AND METHODS This is an interventional quasi-experimental study carried out in 4 community health centers in Andimeshk City in Iran in 2017. Of 160 patients 80 cases were randomly assigned as intervention group and 80 patients as the control one. A three-section questionnaire completed by a face-to-face interviewing used for data collection before and after the intervention and three months after the education. Fasting Blood Sugar (FBS) and Hemoglobin A1C (HbA1c) tests were done for both groups in a single laboratory before and three months after training. RESULTS The mean age of patients in intervention group was 48.11 ± 9.7 and control group was 47.3 ± 7.9 years. The awareness of the patients related to diabetes foot care, in the intervention group after the training significantly improved (P < 0.001). The mean scores of preventive behaviors of diabetic foot significantly increased in the intervention group (P < 0.001). CONCLUSION The findings indicate that educational intervention based on short message service (SMS), resulting in improve foot care knowledge, foot care practices and metabolic control in patients with diabetes type 2.
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Affiliation(s)
- Ahmad Moradi
- Department of Health Education, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran.
| | - Seyed Mohammad Alavi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mahin Salimi
- Department of Social Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Sedigheh Nouhjah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Ostroumova OD, Goloborodova IV, Fomina VМ. Cardiovascular risk in type 2 diabetes patients. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-4-81-94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cardiovascular diseases remain leading cause of high mortality in diabetes patients. The article is focused on the influence of diabetes on cardiovascular risks. The prevalence presented, as the significance of the main and additional risk factors of cardiovascular diseases in the development of macrovascular complications in diabetes. In the context of influence on cardiovascular risks, modern glucose lowering drugs are considered, the safety and efficacy properties. Advantages of dapagliflozin underscored, the novel oral drug of new generation, with safe and prominent antidiabetic effect and ability to correct the main factors of cardiovascular risk (obesity, hypertension).
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Affiliation(s)
- O. D. Ostroumova
- A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD); I.M. Sechenov First Moscow State Medical University of the Ministry of Health
| | - I. V. Goloborodova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD)
| | - V. М. Fomina
- A.I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD)
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Tebé C, Martinez-Laguna D, Moreno V, Cooper C, Diez-Perez A, Collins GS, Prieto-Alhambra D. Differential Mortality and the Excess Rates of Hip Fracture Associated With Type 2 Diabetes: Accounting for Competing Risks in Fracture Prediction Matters. J Bone Miner Res 2018; 33:1417-1421. [PMID: 29624726 PMCID: PMC6108421 DOI: 10.1002/jbmr.3435] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 01/01/2023]
Abstract
Type 2 diabetes (T2DM) is associated with a reduced life expectancy. The latest published evidence suggests an increased risk of fractures among T2DM patients. We conducted a population-based cohort study to determine the impact of mortality as a competing risk in the study of the association between T2DM and hip fracture rates. Participants were all diagnosed T2DM patients registered in the Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP) database aged 65 years and older; up to two non-T2DM were matched by age, sex, and primary care facility. We used Cox regression models to estimate cause-specific hazard ratio (HR) of death or hip fracture according to T2DM status. Fine and Gray models were then fitted to estimate the subhazard ratio (SHR) of hip fracture while accounting for competing risk with death and to estimate the probability of hip fracture within 5 years. A total of 55,891 T2DM and 103,093 matched non-T2DM patients were observed for a median of 8 years. Mortality was 48.8 per 1000 person years (py) in T2DM, and 33.8 per 1000 py in non-T2DM; hip fracture rates were 6.0 per 1000 py and 4.9 per 1000 py, respectively. Cox models confirmed a significant association for death and hip fracture: HR 1.51 (95% CI, 1.48 to 1.55), and HR 1.32 (95% CI, 1.24 to 1.40), respectively. Accounting for death as a competing event (Fine-Gray models), the association between T2DM and hip fracture risk remained statistically significant (SHR 1.15; 95% CI, 1.09 to 1.21) and the probability of a hip fracture within 5 years was 2.3% for TD2M and 1.9% for non-TD2M patients compared to 2.6% and 2.1% respectively using Kaplan-Meier (KM) estimates. T2DM patients have a 50% increased mortality and, after adjusting for differential survival at 5 years, a 21% increased incidence of hip fracture when compared to matched non-T2DM. Failing to account for differential mortality leads to an overestimation of fracture risk. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Cristian Tebé
- Biostatisitcs Unit at Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Basic Medical Sciences, Universitat de Barcelona, Barcelona, Spain.,Department of Basic Medical Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Daniel Martinez-Laguna
- Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and CIBERFes, University Institute for Primary Care Research (IDIAP) Jordi Gol, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.,Ambit Barcelona, Primary Care Department, Institut Catala de la Salut, Barcelona, Spain
| | - Victor Moreno
- Department of Basic Medical Sciences, Universitat de Barcelona, Barcelona, Spain.,Unit of Biomarkers and Susceptibility, Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, Madrid, Spain
| | - Cyrus Cooper
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, UK
| | - Adolfo Diez-Perez
- Musculoskeletal Research Unit, IMIM-Hospital del Mar and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - Gary S Collins
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, UK.,Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and CIBERFes, University Institute for Primary Care Research (IDIAP) Jordi Gol, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.,Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, UK.,Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Foryoung JB, Ditah C, Nde Fon P, Mboue-Djieka Y, Nebongo DN, Mbango ND, Balla V, Choukem SP. Long-term mortality in outpatients with type 2 diabetes in a reference hospital in Cameroon: a retrospective cohort study. BMJ Open 2018; 8:e019086. [PMID: 29472266 PMCID: PMC5855307 DOI: 10.1136/bmjopen-2017-019086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/08/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES There are limited data on mortality in patients with type 2 diabetes mellitus (T2DM) in Sub-Saharan Africa. We aimed at determining the mortality rate, and the causes and the predictors of death in patients with T2DM followed as outpatients in a reference hospital in Cameroon. DESIGN Retrospective cohort study. SETTING A reference hospital in Cameroon. PARTICIPANTS From December 2015 to March 2016, patients with T2DM aged 18 years and older and who consulted between January 2009 and December 2014, were contacted directly or through their next of kin, and included in this study. All participants with less than 75% of desired data in files, those who could not be reached on the phone and those who refused to provide consent were excluded from the study. Of the 940 eligible patients, 628 (352 men and 276 women) were included and completed the study, giving a response rate of 66.8%. OUTCOME MEASURES Death rate, causes of death and predictors of death. RESULTS Of the 628 patients (mean age: 56.5 years; median diabetes duration: 3.5 years) followed up for a total of 2161 person-years, 54 died, giving a mortality rate of 2.5 per 100 person-years and a cumulative mortality rate of 8.6%. Acute metabolic complications (22.2%), cardiovascular diseases (16.7%), cancers (14.8%), nephropathy (14.8%) and diabetic foot syndrome (13.0%) were the most common causes of death. Advanced age (adjusted HR (aHR) 1.06, 95% CI 1.02 to 1.10; P=0.002), raised glycated haemoglobin (HbA1c) (aHR 1.16, 95% CI 1.00 to 1.35; P=0.051), low blood haemoglobin (aHR 1.06, 95% CI 1.02 to 1.10; P=0.002) and proteinuria (aHR 2.97, 95% CI 1.40 to 6.28; P=0.004) were identified as independent predictors of death. CONCLUSIONS The mortality rate in patients with T2DM is high in our population, with acute metabolic complications as the leading cause. Patients with advanced age, raised HbA1c, anaemia or proteinuria are at higher risk of death and therefore represent the target of interest to prevent mortality in T2DM.
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Affiliation(s)
- Joyce B Foryoung
- Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Chobufo Ditah
- Sub-Divisional Hospital of Njinikom, Njinikom, Cameroon
| | - Peter Nde Fon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Daniel N Nebongo
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| | - Noel D Mbango
- Diabetes and Endocrinology Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Vanessa Balla
- Diabetes and Endocrinology Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Simeon-Pierre Choukem
- Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
- Diabetes and Endocrinology Unit, Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
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48
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Toumpanakis A, Turnbull T, Alba-Barba I. Effectiveness of plant-based diets in promoting well-being in the management of type 2 diabetes: a systematic review. BMJ Open Diabetes Res Care 2018; 6:e000534. [PMID: 30487971 PMCID: PMC6235058 DOI: 10.1136/bmjdrc-2018-000534] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/28/2018] [Accepted: 07/08/2018] [Indexed: 02/06/2023] Open
Abstract
Diet interventions have suggested an association between plant-based diets and improvements in psychological well-being, quality of life and glycated hemoglobin (HbA1c) control in populations with diabetes. The aims of this review are to systematically analyze the available literature on plant-based diet interventions targeting diabetes in adults and to clearly define the benefits on well-being of such interventions. This is a systematic review of controlled trials. A computerized systematic literature search was conducted in the following electronic databases: Allied and Complementary Medicine, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, E-Journals, Excerpta Medica Database, MEDLINE, Health Management Information Consortium, PsycARTICLES, PsycINFO, PubMed, SocINDEX and Web of Science. The search strategy retrieved 1240 articles, of which 11 met the inclusion criteria (n=433; mean sample age 54.8 years). Plant-based diets were associated with significant improvement in emotional well-being, physical well-being, depression, quality of life, general health, HbA1c levels, weight, total cholesterol and low-density lipoprotein cholesterol, compared with several diabetic associations' official guidelines and other comparator diets. Plant-based diets can significantly improve psychological health, quality of life, HbA1c levels and weight and therefore the management of diabetes.
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Affiliation(s)
| | - Triece Turnbull
- Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Isaura Alba-Barba
- Department of Cardiology, East Sussex NHS Healthcare Trust, Saint Leonards-on-Sea, UK
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49
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Walker J, Colhoun H, Livingstone S, McCrimmon R, Petrie J, Sattar N, Wild S. Type 2 diabetes, socioeconomic status and life expectancy in Scotland (2012-2014): a population-based observational study. Diabetologia 2018; 61:108-116. [PMID: 29075822 PMCID: PMC6448945 DOI: 10.1007/s00125-017-4478-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/18/2017] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess the role of socioeconomic status (SES) in the associations between type 2 diabetes and life expectancy in a complete national population. METHODS An observational population-based cohort study was performed using the Scottish Care Information - Diabetes database. Age-specific life expectancy (stratified by SES) was calculated for all individuals with type 2 diabetes in the age range 40-89 during the period 2012-2014, and for the remaining population of Scotland aged 40-89 without type 2 diabetes. Differences in life expectancy between the two groups were calculated. RESULTS Results were based on 272,597 individuals with type 2 diabetes and 2.75 million people without type 2 diabetes (total for 2013, the middle calendar year of the study period). With the exception of deprived men aged 80-89, life expectancy in people with type 2 diabetes was significantly reduced (relative to the type 2 diabetes-free population) at all ages and levels of SES. Differences in life expectancy ranged from -5.5 years (95% CI -6.2, -4.8) for women aged 40-44 in the second most-deprived quintile of SES, to 0.1 years (95% CI -0.2, 0.4) for men aged 85-89 in the most-deprived quintile of SES. Observed life-expectancy deficits in those with type 2 diabetes were generally greater in women than in men. CONCLUSIONS/INTERPRETATION Type 2 diabetes is associated with reduced life expectancy at almost all ages and levels of SES. Elimination of life-expectancy deficits in individuals with type 2 diabetes will require prevention and management strategies targeted at all social strata (not just deprived groups).
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Affiliation(s)
- Jeremy Walker
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Helen Colhoun
- Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | - Shona Livingstone
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Rory McCrimmon
- Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
| | - John Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Wild
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
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50
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Martinez-Laguna D, Nogues X, Abrahamsen B, Reyes C, Carbonell-Abella C, Diez-Perez A, Prieto-Alhambra D. Excess of all-cause mortality after a fracture in type 2 diabetic patients: a population-based cohort study. Osteoporos Int 2017; 28:2573-2581. [PMID: 28744600 DOI: 10.1007/s00198-017-4096-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/15/2017] [Indexed: 01/09/2023]
Abstract
UNLABELLED Post-fracture mortality in type 2 diabetes mellitus (T2DM) patients has been poorly studied. We report an absolute and relative excess all-cause mortality following a fracture in these patients compared to non-diabetic patients. INTRODUCTION T2DM and osteoporotic fractures are independently associated with a reduced lifespan, but it is unknown if T2DM confers an excess post-fracture mortality compared to non-diabetic fracture patients. We report post-fracture all-cause mortality according to T2DM status. METHODS This is a population-based cohort study using data from the SIDIAP database. All ≥50 years old T2DM patients registered in SIDIAP in 2006-2013 and two diabetes-free controls matched on age, gender, and primary care center were selected. Study outcome was all-cause mortality following incident fractures. Participants were followed from date of any fracture (AF), hip fracture (HF), and clinical vertebral fracture (VF) until the earliest of death or censoring. Cox regression was used to calculate mortality according to T2DM status after adjustment for age, gender, body mass index, smoking, alcohol intake, and previous ischemic heart and cerebrovascular disease. RESULTS We identified 166,106 T2DM patients and 332,212 non-diabetic, of which 11,066 and 21,564, respectively, sustained a fracture and were then included. Post-fracture mortality rates (1000 person-years) were (in T2DM vs non-diabetics) 62.7 vs 49.5 after AF, 130.7 vs 112.7 after HF, and 54.9 vs 46.2 after VF. Adjusted HR (95% CI) for post-AF, post-HF, and post-VF mortality was 1.30 (1.23-1.37), 1.28 (1.20-1.38), and 1.20 (1.06-1.35), respectively, for T2DM compared to non-diabetics. CONCLUSIONS T2DM patients have a 30% increased post-fracture mortality compared to non-diabetics and a remarkable excess in absolute mortality risk. More research is needed on the causes underlying such excess risk, and on the effectiveness of measures to reduce post-fracture morbi-mortality in T2DM subjects.
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Affiliation(s)
- D Martinez-Laguna
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, CIBERFES ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain
- Ambit Barcelona, Primary Care Department, Institut Catala de la Salut, Barcelona, Spain
| | - X Nogues
- Internal Medicine Department IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - B Abrahamsen
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
- OPEN Odense Patient Data Explorative Network, Institute of Clinical Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, CIBERFES ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - C Carbonell-Abella
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, CIBERFES ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain
- Ambit Barcelona, Primary Care Department, Institut Catala de la Salut, Barcelona, Spain
| | - A Diez-Perez
- Internal Medicine Department IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Autonomous University of Barcelona and CIBERFES, ISCIII, Barcelona, Catalonia, Spain
| | - D Prieto-Alhambra
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, CIBERFES ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain.
- Internal Medicine Department IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- Autonomous University of Barcelona and CIBERFES, ISCIII, Barcelona, Catalonia, Spain.
- MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Musculoskeletal Biomedical Research Centre, University of Oxford, Oxford, UK.
- Musculoskeletal Pharmaco and Device Epidemiology, Botnar Research Centre, Nuffield Orthopaedics Centre, Windmill Road, Oxford, OX3 7LD, UK.
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