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Wallen-Russell C, Pearlman N, Wallen-Russell S, Cretoiu D, Thompson DC, Voinea SC. A Catastrophic Biodiversity Loss in the Environment Is Being Replicated on the Skin Microbiome: Is This a Major Contributor to the Chronic Disease Epidemic? Microorganisms 2023; 11:2784. [PMID: 38004795 PMCID: PMC10672968 DOI: 10.3390/microorganisms11112784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
There has been a catastrophic loss of biodiversity in ecosystems across the world. A similar crisis has been observed in the human gut microbiome, which has been linked to "all human diseases affecting westernized countries". This is of great importance because chronic diseases are the leading cause of death worldwide and make up 90% of America's healthcare costs. Disease development is complex and multifactorial, but there is one part of the body's interlinked ecosystem that is often overlooked in discussions about whole-body health, and that is the skin microbiome. This is despite it being a crucial part of the immune, endocrine, and nervous systems and being continuously exposed to environmental stressors. Here we show that a parallel biodiversity loss of 30-84% has occurred on the skin of people in the developed world compared to our ancestors. Research has shown that dysbiosis of the skin microbiome has been linked to many common skin diseases and, more recently, that it could even play an active role in the development of a growing number of whole-body health problems, such as food allergies, asthma, cardiovascular diseases, and Parkinson's, traditionally thought unrelated to the skin. Damaged skin is now known to induce systemic inflammation, which is involved in many chronic diseases. We highlight that biodiversity loss is not only a common finding in dysbiotic ecosystems but also a type of dysbiosis. As a result, we make the case that biodiversity loss in the skin microbiome is a major contributor to the chronic disease epidemic. The link between biodiversity loss and dysbiosis forms the basis of this paper's focus on the subject. The key to understanding why biodiversity loss creates an unhealthy system could be highlighted by complex physics. We introduce entropy to help understand why biodiversity has been linked with ecosystem health and stability. Meanwhile, we also introduce ecosystems as being governed by "non-linear physics" principles-including chaos theory-which suggests that every individual part of any system is intrinsically linked and implies any disruption to a small part of the system (skin) could have a significant and unknown effect on overall system health (whole-body health). Recognizing the link between ecosystem health and human health allows us to understand how crucial it could be to maintain biodiversity across systems everywhere, from the macro-environment we inhabit right down to our body's microbiome. Further, in-depth research is needed so we can aid in the treatment of chronic diseases and potentially change how we think about our health. With millions of people currently suffering, research to help mitigate the crisis is of vital importance.
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Affiliation(s)
| | - Nancy Pearlman
- Ecology Center of Southern California, Los Angeles, CA 90035, USA;
| | | | - Dragos Cretoiu
- Department of Medical Genetics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 011062 Bucharest, Romania
| | - Dana Claudia Thompson
- Fetal Medicine Excellence Research Center, Alessandrescu-Rusescu National Institute for Mother and Child Health, 011062 Bucharest, Romania
| | - Silviu Cristian Voinea
- Department of Surgical Oncology, Prof. Dr. Al. Trestioreanu Oncology Institute, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania
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Delicano RA, Hammar U, Egenvall A, Westgarth C, Mubanga M, Byberg L, Fall T, Kennedy B. The shared risk of diabetes between dog and cat owners and their pets: register based cohort study. BMJ 2020; 371:m4337. [PMID: 33303475 PMCID: PMC7726310 DOI: 10.1136/bmj.m4337] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate whether dog and cat owners and their pets share a risk of developing diabetes. DESIGN Cohort study. SETTING Register based longitudinal study, Sweden. PARTICIPANTS 208 980 owner-dog pairs and 123 566 owner-cat pairs identified during a baseline assessment period (1 January 2004 to 31 December 2006). MAIN OUTCOME MEASURES Type 2 diabetes events in dog and cat owners and diabetes events in their pets, including date of diagnosis during the follow-up period (1 January 2007 to 31 December 2012). Owners with type 2 diabetes were identified by combining information from the National Patient Register, the Cause of Death Register, and the Swedish Prescribed Drug Register. Information on diabetes in the pets was extracted from veterinary care insurance data. Multi-state models were used to assess the hazard ratios with 95% confidence intervals and to adjust for possible shared risk factors, including personal and socioeconomic circumstances. RESULTS The incidence of type 2 diabetes during follow-up was 7.7 cases per 1000 person years at risk in dog owners and 7.9 cases per 1000 person years at risk in cat owners. The incidence of diabetes in the pets was 1.3 cases per 1000 dog years at risk and 2.2 cases per 1000 cat years at risk. The crude hazard ratio for type 2 diabetes in owners of a dog with diabetes compared with owners of a dog without diabetes was 1.38 (95% confidence interval 1.10 to 1.74), with a multivariable adjusted hazard ratio of 1.32 (1.04 to 1.68). Having an owner with type 2 diabetes was associated with an increased hazard of diabetes in the dog (crude hazard ratio 1.28, 1.01 to 1.63), which was attenuated after adjusting for owner's age, with the confidence interval crossing the null (1.11, 0.87 to 1.42). No association was found between type 2 diabetes in cat owners and diabetes in their cats (crude hazard ratio 0.99, 0.74 to 1.34, and 1.00, 0.78 to 1.28, respectively). CONCLUSIONS Data indicated that owners of a dog with diabetes were more likely to develop type 2 diabetes during follow-up than owners of a dog without diabetes. It is possible that dogs with diabetes could serve as a sentinel for shared diabetogenic health behaviours and environmental exposures.
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Affiliation(s)
- Rachel Ann Delicano
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Agneta Egenvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Carri Westgarth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Mwenya Mubanga
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Beatrice Kennedy
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Calleja JL, García-Monzón C, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Albillos A, Francés R, Fernández-Rodríguez C, Diago M, Soriano G, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Estévez P, Guerra MH, Augustín S, Banales JM, Aspichueta P, Benlloch S, Rosales JM, Salmerón J, Turnes J, Romero Gómez M. Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH. J Hepatol 2020; 73:17-25. [PMID: 32147361 DOI: 10.1016/j.jhep.2020.02.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) could play a catalytic role in the development of metabolic comorbidities, although the magnitude of this effect in metabolically healthy patients with NAFLD remains unclear. We assessed the role of biopsy-proven NAFLD on the risk of developing type 2 diabetes mellitus (T2DM) and other metabolic comorbidities (arterial hypertension [AHT], and dyslipidemia) in metabolically healthy patients. METHODS We included 178 metabolically healthy-defined by the absence of baseline T2DM, AHT, dyslipidemia-patients with biopsy-proven NAFLD from the HEPAmet Registry (N = 1,030). Hepamet fibrosis score (HFS), NAFLD fibrosis score, and Fibrosis-4 were calculated. Follow-up was computed from biopsy to the diagnosis of T2DM, AHT, or dyslipidemia. RESULTS During a follow-up of 5.6 ± 4.4 years, T2DM occurred in 9% (16/178), AHT in 8.4% (15/178), low HDL in 9.6% (17/178), and hypertriglyceridemia in 23.6% (42/178) of patients. In multivariate analysis, significant fibrosis predicted T2DM and AHT. Independent variables related to T2DM appearance were significant fibrosis (HR 2.95; 95% CI 1.19-7.31; p = 0.019), glucose levels (p = 0.008), age (p = 0.007) and BMI (p = 0.039). AHT was independently linked to significant fibrosis (HR 2.39; 95% CI 1.14-5.10; p = 0.028), age (p = 0.0001), BMI (p = 0.006), glucose (p = 0.021) and platelets (p = 0.050). The annual incidence rate of T2DM was higher in patients with significant fibrosis (4.4 vs. 1.2 cases per 100 person-years), and increased in the presence of obesity, similar to AHT (4.6 vs. 1.1 cases per 100 person-years). HFS >0.12 predicted the risk of T2DM (25% [4/16] vs. HFS <0.12 4.5% [4/88]; logRank 6.658, p = 0.010). CONCLUSION Metabolically healthy patients with NAFLD-related significant fibrosis were at greater risk of developing T2DM and AHT. HFS >0.12, but not NAFLD fibrosis score or Fibrosis-4, predicted the occurrence of T2DM. LAY SUMMARY Patients with biopsy-proven non-alcoholic fatty liver disease and significant fibrosis were at risk of developing type 2 diabetes mellitus and arterial hypertension. The risk of metabolic outcomes in patients with significant fibrosis was increased in the presence of obesity. In addition to liver biopsy, patients at intermediate-to-high risk of significant fibrosis by Hepamet fibrosis score were at risk of type 2 diabetes mellitus.
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Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
| | - Rocío Aller
- Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición, Universidad de Valladolid, Spain
| | | | - Javier Crespo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Carmelo García-Monzón
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa Madrid, Spain
| | | | - Joan Caballería
- CIBERehd, Spain; Liver Unit. Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBPAS), Barcelona, Spain
| | | | - Luis Ibañez
- CIBERehd, Spain; Hospital Gregorio Marañón, Madrid, Spain
| | | | - Agustín Albillos
- CIBERehd, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- CIBERehd, Spain; Hospital General Universitario de Alicante, Universidad Miguel Hernández, Spain
| | | | - Moisés Diago
- Hospital General Universitario de Valencia, Spain
| | | | - Raúl J Andrade
- CIBERehd, Spain; Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBERehd, León, España
| | | | | | | | | | | | - Jesús M Banales
- CIBERehd, Spain; Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Patricia Aspichueta
- Biocruces Research Institute, Barakaldo, Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Leioa, Spain
| | | | | | | | | | - Manuel Romero Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
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Wubishet BL, Harris ML, Forder PM, Byles JE. Age and cohort rise in diabetes prevalence among older Australian women: Case ascertainment using survey and healthcare administrative data. PLoS One 2020; 15:e0234812. [PMID: 32555738 PMCID: PMC7302694 DOI: 10.1371/journal.pone.0234812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Due to the absence and or costliness of biological measures such as glycated haemoglobin, diabetes case ascertainment and prevalence studies are usually conducted using surveys or routine health service use databases. However, the use of each of these sources is associated with its limitations potentially impacting the quality of the case ascertainment and prevalence estimation. This study aimed at ascertaining diabetes cases and estimating prevalence among mid- and older-age women through simultaneous use of a longitudinal survey and multiple healthcare administrative data sources. METHODS Data were available for 12,432 and 13,714 women born in 1921-26 and 1946-51 from the Australian Longitudinal Study on Women's Health (ALSWH). Diabetes was ascertained using the ALSWH survey, health service use, and cause of death data. Parsimonious multiple logistic regression analyses tested associations between sociodemographic and health variables and the presence of diabetes. RESULTS In both cohorts, two or more of the sources captured more than 80% of the women with diabetes. The point prevalence of diabetes increased from 8.4% when the mean age of the women were aged 73, to 22.0% of surviving women at age 90 in the 1921-26 cohort; and from 2.6% at age 48 to 15.8% at age 68 in the 1946-51 cohort. In the 1921-26 cohort, women who were obese (OR: 3.56; 95 CI: 3.04-4.17) and women who were sedentary (OR: 1.18; 95 CI: 1.09-1.40) were more likely to have diabetes compared to those who had a normal weight and engaged in a moderate level of physical activity. In the 1946-51 cohort, the odds of diabetes increased three times (OR: 2.99; 95 CI: 2.54-3.52) for overweight women and nine times (OR: 8.78; 95 CI: 7.46-10.33) for obese women compared to those who had normal weight. CONCLUSIONS The simultaneous use of multiple data sources improved the validity of diabetes case ascertainment. Application of this methodology in future studies may have important benefits including estimation of disease burden, health service needs, and resource allocation with improved precision. Diabetes prevalence increased with age, was much higher in the 1946-51 cohort than in 1921-26 at similar ages, and was significantly associated with physical inactivity and obesity. Interventions to promote physical activity and a healthy weight are needed to prevent the rising prevalence of diabetes across successive generations.
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Affiliation(s)
- Befikadu L. Wubishet
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
- School of Pharmacy, Mekelle University, Mekelle, Tigray, Ethiopia
- * E-mail:
| | - Melissa L. Harris
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peta M. Forder
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Julie E. Byles
- Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
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5
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Gémes K, Talbäck M, Modig K, Ahlbom A, Berglund A, Feychting M, Matthews AA. Burden and prevalence of prognostic factors for severe COVID-19 in Sweden. Eur J Epidemiol 2020; 35:401-409. [PMID: 32424571 PMCID: PMC7233678 DOI: 10.1007/s10654-020-00646-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
The World Health Organization and European Centre for Disease Prevention and Control suggest that individuals over the age of 70 years or with underlying cardiovascular disease, cancer, chronic obstructive pulmonary disease, asthma, or diabetes are at increased risk of severe COVID-19. However, the prevalence of these prognostic factors is unknown in many countries. We aimed to describe the burden and prevalence of prognostic factors of severe COVID-19 at national and county level in Sweden. We calculated the burden and prevalence of prognostic factors for severe COVID-19 based on records from the Swedish national health care and population registers for 3 years before 1st January 2016. 9,624,428 individuals were included in the study population. 22.1% had at least one prognostic factor for severe COVID-19 (2,131,319 individuals), and 1.6% had at least three factors (154,746 individuals). The prevalence of underlying medical conditions ranged from 0.8% with chronic obstructive pulmonary disease (78,516 individuals) to 7.4% with cardiovascular disease (708,090 individuals), and the county specific prevalence of at least one prognostic factor ranged from 19.2% in Stockholm (416,988 individuals) to 25.9% in Kalmar (60,005 individuals). We show that one in five individuals in Sweden is at increased risk of severe COVID-19. When compared with the critical care capacity at a local and national level, these results can aid authorities in optimally planning healthcare resources during the current pandemic. Findings can also be applied to underlying assumptions of disease burden in modelling efforts to support COVID-19 planning.
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Affiliation(s)
- Katalin Gémes
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ahlbom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anita Berglund
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anthony A Matthews
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Ahmed A, Lager A, Fredlund P, Elinder LS. Consumption of fruit and vegetables and the risk of type 2 diabetes: a 4-year longitudinal study among Swedish adults. J Nutr Sci 2020; 9:e14. [PMID: 32284862 PMCID: PMC7132554 DOI: 10.1017/jns.2020.7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
A low intake of fruit and vegetables is a significant contributor to the global burden of disease. The aim of this study was to estimate the size of the risk of type 2 diabetes (T2D) of a low intake and to investigate possible sex differences. In this regard, this study used a longitudinal data from the Stockholm Public Health Cohort located in Sweden, collected in 2010 and 2014. The analysis included 14 718 men and 20 589 women aged 25 to 84 years. Fruit and vegetable intake, separately <2 servings/d or combined <4 servings/d (one serving corresponding to 100 g) was set as a cut-point for low intake. The sex difference at baseline was examined. Sex-stratified logistic regression was performed with onset of T2D as the outcome and fruit and vegetable intake at baseline as the exposure with adjustment for other known risk factors. Results indicate that men consumed significantly (P < 0⋅001) less fruit and vegetables compared with women. A 62 % higher risk to develop T2D over the 4-year period was observed in men who had low vegetable intake compared with high intake after adjusting for age, education, BMI, smoking, alcohol and physical activity (OR 1⋅62; 95 % CI 1⋅00, 2⋅63). In women, a significantly higher risk of T2D was also observed with a low intake of vegetables, but not after adjustment. The present study suggests that higher consumption of vegetables seems to be protective for the onset of T2D in men. Thus, increasing the intake of vegetables in men should be a public health priority.
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Affiliation(s)
- Arif Ahmed
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Demography, Stockholm University, Stockholm, Sweden
| | - Anton Lager
- Centre for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Peeter Fredlund
- Centre for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Liselotte Schäfer Elinder
- Centre for Epidemiology and Community Medicine, Stockholm Region, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Wang M, Gong WW, Pan J, Fei FR, Wang H, Yu M, Zhou XY, Hu RY. Incidence and Time Trends of Type 2 Diabetes Mellitus among Adults in Zhejiang Province, China, 2007-2017. J Diabetes Res 2020; 2020:2597953. [PMID: 32051832 PMCID: PMC6995322 DOI: 10.1155/2020/2597953] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/16/2019] [Accepted: 01/03/2020] [Indexed: 01/19/2023] Open
Abstract
AIMS Population-based incidence data are paramount to assess the effects of prevention strategies for diabetes, yet the relevant studies in mainland China are scarce. This study is aimed at estimating the type 2 diabetes mellitus (T2DM) incidence and time trends in Chinese adults. Material and Methods. Based on the Diabetes Surveillance System of Zhejiang Province, 879,769 newly diagnosed T2DM cases were identified from January 1, 2007, to December 31, 2017. Annual incidence, incidence rate ratios (IRRs), and average annual percentage change with their 95% confidence intervals (CIs) were reported. RESULTS The age-standardized overall incidence rate of T2DM was reported to be 281.73 (95% CI: 281.26-282.20) per 100,000 person-years, 293.19 (95% CI: 292.51-293.87) in males and 270.42 (95% CI: 269.76-271.09) in females. Compared with the ≥80 years age group, younger adults were at lower risk for T2DM (IRRs ranged from 0.035 to 0.986 and the 95% CIs did not include the null), except for the 70-79 years age group (IRR: 1.087, 95% CI: 1.077-1.097). Compared with females and rural areas, the risk for T2DM was higher in males (IRR: 1.083, 95% CI: 1.079-1.088) and urban areas (IRR: 1.005, 95% CI: 1.001-1.009), respectively. The standardized annual incidence rate increased from 164.85 in 2007 to 268.65 per 100,000 person-years in 2017, with an average annual increase of 4.01% and grew more rapidly in male, younger, and rural area populations. CONCLUSIONS Our study suggested a significant increase in the incidence rate of T2DM among Chinese over the past decade, especially in adults characterized by male sex, younger age, and rural areas.
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Affiliation(s)
- Meng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Wei-Wei Gong
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Jin Pan
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Fang-Rong Fei
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Hao Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Min Yu
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xiao-Yan Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Ru-Ying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
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Björck L, Lundberg C, Schaufelberger M, Lissner L, Adiels M, Rosengren A. Body mass index in women aged 18 to 45 and subsequent risk of heart failure. Eur J Prev Cardiol 2019; 27:1165-1174. [PMID: 31684761 DOI: 10.1177/2047487319882510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The incidence of heart failure (HF) is decreasing in older ages, but increasing rates have been observed among younger persons in Sweden. Therefore, we investigated the relationship between risk of hospitalization for HF and body mass index (BMI). METHODS This was a prospective registry-based cohort study. We included 1,374,031 women aged 18-45 years (mean age 27.9 years) who gave birth during 1982-2014, and were registered in the Medical Birth Register. Information on hospitalization because of HF was collected through linkage to the National Inpatient Register. RESULTS Compared to women with a BMI of 20-<22.5 kg/m2, women with a BMI of 22.5-<25.0 had a hazard ratio (HR) of 1.24 (95% confidence interval (CI), 1.10-1.39) for HF after adjustment for age, year, parity, baseline disorders, smoking, and education. The HR (95% CI) increased to 1.56 (1.36-1.78), 2.39 (2.05-2.78), 2.82 (2.43-3.28), and 4.51 (3.63-5.61) in women with a BMI of 25-<27.5, 27.5-<30, 30-<35, and ≥35 kg/m2, respectively. The multiple-adjusted HRs (95% CI) associated with risk of HF per one-unit increase in BMI in women with a BMI ≥ 22.5 kg/m2 ranged from 1.01 (0.97-1.06) for HF related to valvular disease to 1.14 (1.12-1.15) for coronary heart disease, diabetes, or hypertension. CONCLUSION Increasing body weight was strongly associated with the risk of early HF in women. Compared with lean women, the risk for HF started to increase at high-normal BMI levels, and was nearly five-fold in women with a BMI ≥ 35 kg/m2.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Christina Lundberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
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Patti G, Sticchi A, Pasceri V, Ricci F, Renda G, Hamrefors V, Melander O, Sutton R, Engström G, De Caterina R, Fedorowski A. The co-predictive value of a cardiovascular score for CV outcomes in diabetic patients with no atrial fibrillation. Diabetes Metab Res Rev 2019; 35:e3145. [PMID: 30790434 DOI: 10.1002/dmrr.3145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/30/2019] [Accepted: 02/18/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Risk factors included in the cardiovascular (CHA2 DS2 -VASc) score, currently used for atrial fibrillation (AF), may predispose to cardiovascular events whether or not AF is present. The aim was to explore the predictive role of CHA2 DS2 -VASc score on cardiovascular outcomes in diabetic patients without AF. METHODS We accessed individual data from 610 diabetic patients without AF at baseline included in the prospective cohort of the Malmö Diet and Cancer study. Main outcome measure was the occurrence of cardiovascular events (stroke, coronary events) and death. Mean follow-up was 14.5 ± 5 years (8845 person/years). RESULTS The CHA2 DS2 -VASc score significantly predicted the risk of all outcome measures. There was a significant increase in stroke, coronary events, and death risk by each point of CHA2 DS2 -VASc score elevation [stroke: adjusted hazard ratio (aHR) 1.43, 95% CI 1.14-1.79, P = 0.001; coronary events: aHR 1.55, 95% CI 1.34-1.80, P < 0.0001; death: aHR 1.94, 95% CI 1.71-2.21, P < 0.0001]. A CHA2 DS2 -VASc score ≥4 was associated with higher incidence of ischemic stroke (aHR 1.47, 95% CI 1.18-1.82; P = 0.001), coronary events (aHR 1.32; 95% CI 1.11-1.58; P = 0.002), and death (aHR 1.36; 95% CI 1.20-1.54; P < 0.001). CONCLUSIONS In this population-based study on diabetic patients without AF, the CHA2 DS2 -VASc score was an independent predictor of ischemic stroke, coronary events, and overall mortality. Regardless of the AF status, the CHA2 DS2 -VASc score might represent a rapid and user-friendly tool for clinical assessment of diabetic patients at higher cardiovascular risk.
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Affiliation(s)
- Giuseppe Patti
- Cardiology, University of L'Aquila, L'Aquila, Italy
- Campus Bio-Medico Hospital, Rome, Italy
| | | | - Vincenzo Pasceri
- Interventional Cardiology, San Filippo Neri Hospital of Rome, Rome, Italy
| | - Fabrizio Ricci
- Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Giulia Renda
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, and Center of Excellence on Aging, CeSI-Met, G. d'Annunzio University, Chieti, Italy
| | - Viktor Hamrefors
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Richard Sutton
- National Heart and Lung Institute, Imperial College, London, UK
| | - Gunnar Engström
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
| | | | - Artur Fedorowski
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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10
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Elinder LS, Hakimi S, Lager A, Patterson E. Global region of birth is an independent risk factor for type 2 diabetes in Stockholm, Sweden. Eur J Public Health 2018; 27:447-453. [PMID: 27864357 DOI: 10.1093/eurpub/ckw207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background In Stockholm, type 2 diabetes (T2D) is a public health concern and much more prevalent in areas with a high proportion of foreign-born individuals. One in five individuals in Stockholm County are born outside of Sweden, and we therefore investigated if global region of birth was associated with diabetes risk, adjusting for established risk factors. Cross-sectional data from the population-based Stockholm Public Health Survey 2010 ( N = 69 115) was combined with registry-based information on country of birth grouped into eight global geographical regions. Cases of T2D were identified through self-reported physician-diagnosed diabetes and age at diagnosis. Region of birth was the independent risk factor and multivariable logistic regression analysis was performed adjusting for the risk factors age, sex, weight status, educational level, multiple dietary factors, tobacco, alcohol and physical activity. T2D prevalence was 5.1% in the sample. Relative to Swedish-born participants, higher odds ratio (OR) were found in those born in Asia [OR 3.2, 95% confidence interval (CI) 2.2-4.7], Sub-Saharan Africa (OR 2.5, 95% CI 1.5-4.1) and North Africa/the Middle East (OR 2.1, 95% CI 1.6-2.8), after adjustment for established risk factors. Participants from Eastern Europe and Latin America had an elevated risk but this did not remain after adjustment for other risk factors. Region of birth was found to be an independent risk factor for T2D for participants born in Asia, Africa and the Middle East. This increased risk should be taken into consideration when allocating resources for prevention, detection and care.
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Affiliation(s)
- Liselotte Schäfer Elinder
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Shawn Hakimi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Emma Patterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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11
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Brostedt EM, Msghina M, Persson M, Wettermark B. Health care use, drug treatment and comorbidity in patients with schizophrenia or non-affective psychosis in Sweden: a cross-sectional study. BMC Psychiatry 2017; 17:416. [PMID: 29284436 PMCID: PMC5747108 DOI: 10.1186/s12888-017-1582-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study investigated the prevalence of schizophrenia (ICD-10 F 20) and of other non-affective psychosis (NAP, ICD-10 F 21 - F 29) in Sweden. It further assessed health care use, comorbidity and medication for these patient groups. Most studies either have a study population of patients with strictly defined schizophrenia or a psychosis population of which strict schizophrenia cases form a smaller set. The present study permits comparison of the two mutually exclusive patient groups using data at the individual level in the diagnosis of non-affective psychosis, use of health care, medical treatment and comorbidity by diagnosis or medical treatment. METHODS In 2012, data were extracted from a regional registry containing patient-level data on consultations, hospitalisations, diagnoses and dispensed drugs for the total population in the region of Stockholm (2.1 million inhabitants). The size of the total psychosis population was 18,769, of which 7284 had a diagnosis of schizophrenia. Crude prevalence rates and risk rates with 95% confidence intervals were calculated. RESULTS In 2012, the prevalence of schizophrenia and NAP was 3.5/1000 and 5.5/1000, respectively. Schizophrenia was most common among patients aged 50-59 years and NAP most common among patients aged 40-49 years. Schizophrenia patients used psychiatric health care more often than the NAP patients but less overall inpatient care (78.6 vs. 60.0%). The most prevalent comorbidities were substance abuse/dependence (7.9% in the schizophrenia group vs. 11.7% in the NAP group), hypertension (7.9 vs. 9.7%) and diabetes (6.9 vs. 4.8%). The parenteral form of long-acting injectable antipsychotics was more often dispensed to patients with schizophrenia (10 vs. 2%). CONCLUSIONS This study, analysing all diagnoses recorded in a large health region, confirmed prevalence rates found in previous studies. Schizophrenia patients use more psychiatric and less overall inpatient health care than NAP patients. Differences between the two patient groups in comorbidity and drug treatment were found. The registered rates of a substance abuse/dependence diagnosis were the most common comorbidity observed among the patients investigated. The observed differences between the schizophrenia and the NAP patients in health care consumption, comorbidity and drug treatment are relevant and warrant further studies.
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Affiliation(s)
- Erica M. Brostedt
- 0000 0001 2326 2191grid.425979.4Department of Healthcare Development, Public Health Care Services, Stockholm County Council, Box 6909, 102 39 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Medicine, Clinical Epidemiology Unit T2, Centre for Pharmacoepidemiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, 17176 Sweden
| | - Mussie Msghina
- 0000 0004 1937 0626grid.4714.6Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Universitetssjukhuset, Huddinge, Karolinska Institutet, Stockholm, 141 86 Sweden
| | - Marie Persson
- 0000 0001 2326 2191grid.425979.4Pharmaceutical Unit, Public Health Care Services, Stockholm County Council, Box 17533, Stockholm, 11891 Sweden
| | - Björn Wettermark
- 0000 0001 2326 2191grid.425979.4Department of Healthcare Development, Public Health Care Services, Stockholm County Council, Box 6909, 102 39 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Medicine, Clinical Epidemiology Unit T2, Centre for Pharmacoepidemiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, 17176 Sweden
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12
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Björkström K, Stål P, Hultcrantz R, Hagström H. Histologic Scores for Fat and Fibrosis Associate With Development of Type 2 Diabetes in Patients With Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol 2017; 15:1461-1468. [PMID: 28479500 DOI: 10.1016/j.cgh.2017.04.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/21/2017] [Accepted: 04/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) is a strong risk factor for development of type 2 diabetes, but little is known about how long-term NAFLD or its histologic features affect risk. We aimed to investigate the cumulative incidence of type 2 diabetes in patients with NAFLD and to identify histologic factors that affect risk of diabetes. METHODS We performed a retrospective study of 396 patients in Sweden diagnosed with NAFLD by biopsy analysis from 1971 through 2009 who did not have type 2 diabetes at baseline. Data on development of type 2 diabetes were collected from patient charts and national registers. Patients were categorized into groups with fibrosis stages 0-2 (n = 357) or stages 3-4 (n = 39). Hazard ratios of histologic parameters for type 2 diabetes development were calculated separately in a multivariate Cox regression model adjusted for sex, age, body mass index, and serum levels of triglycerides greater than 150 mg/dL. RESULTS During a mean follow-up period of 18.4 years (range, 0-41 years), 132 individuals (33%) developed type 2 diabetes. A significantly higher proportion of patients with fibrosis stages 3-4 (51.2%) developed type 2 diabetes than patients with fibrosis stages 0-2 (31.3%) (P = .02). For patients with fibrosis stages 0-2, fat score associated independently with development of type 2 diabetes (adjusted hazard ratio, 1.34; 95% confidence interval, 1.03-1.74; P = .03). No histologic factors associated with development of diabetes in patients with fibrosis stages 3-4. Presence of nonalcoholic steatohepatitis was not associated with development of type 2 diabetes. CONCLUSIONS In a retrospective study we found a higher proportion of patients with fibrosis stages 3-4 to develop type 2 diabetes than patients with fibrosis stages 0-2. In patients with fibrosis stages 0-2, fat score associates with risk of type 2 diabetes.
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Affiliation(s)
- Karl Björkström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | - Per Stål
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Centre for Digestive Diseases, Unit of Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Centre for Digestive Diseases, Unit of Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Centre for Digestive Diseases, Unit of Hepatology, Karolinska University Hospital, Stockholm, Sweden
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13
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Modig K, Berglund A, Talbäck M, Ljung R, Ahlbom A. Estimating incidence and prevalence from population registers: example from myocardial infarction. Scand J Public Health 2017; 45:5-13. [PMID: 28683658 DOI: 10.1177/1403494817702327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To illustrate how the fundamental epidemiological measures, incidence rate and prevalence proportion, can be estimated based on Swedish population registers using acute myocardial infarction (MI) as an example, together with a discussion about the analytical decisions. METHODS All individuals in Sweden aged 60-89 (born 1904-1954) during the study period 1994-2014 were identified through the Total Population Register. Cases of MI were defined and identified from information on hospital admissions and causes of death. Incidence rates of all, first, and recurrent MI were calculated together with prevalence proportions. RESULTS The incidence rate of all, first, and recurrent MI declined over the study period. While the incidence rates of first MI are lower for women than men, the incidence rates of recurrent MI are considerably higher but similar for men and women. The prevalence calculated with duration of disease set at 28 days also declined. This was despite improved survival from MI and increased life expectancy over the same period meaning that the decline in incidence was large enough to compensate for increased survival. CONCLUSIONS Calculating incidence and prevalence of diseases using population registers requires detailed and well-reasoned definitions. The definitions will affect both the study population and the number of disease events and it is essential that the cases and the study population are defined in a coherent way. Different measures of disease occurrence contribute with different aspects of the disease panorama and a joint interpretation contributes to a thorough understanding of the disease development in a population.
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Affiliation(s)
- Karin Modig
- 1 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anita Berglund
- 1 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- 1 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- 1 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ahlbom
- 1 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,2 Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden
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14
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Qin L, Chen S, Flood E, Shaunik A, Romero B, de la Cruz M, Alvarez C, Grandy S. Glucagon-Like Peptide-1 Receptor Agonist Treatment Attributes Important to Injection-Experienced Patients with Type 2 Diabetes Mellitus: A Preference Study in Germany and the United Kingdom. Diabetes Ther 2017; 8:335-353. [PMID: 28236271 PMCID: PMC5380499 DOI: 10.1007/s13300-017-0237-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION This study assessed the relative importance of treatment-related attributes in influencing patient preferences for glucagon-like peptide-1 receptor agonists (GLP-1RAs) among injection-experienced type 2 diabetes mellitus (T2DM) patients in Germany and the United Kingdom. METHODS T2DM patients experienced with injecting once-weekly (QW) exenatide or once-daily (QD) liraglutide completed an online discrete-choice experiment (DCE) survey. Patients chose between hypothetical blinded treatment profiles reflecting attributes of GLP-1RAs. The DCE survey included eight attributes: efficacy, side effects, device size, needle size, titration, injection preparation, long-term efficacy/safety, and dosing frequency. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a conditional logit model indicating the likelihood of choosing a treatment with a given attribute level versus a reference attribute level. RESULTS 510 GLP-1RA injection-experienced patients completed the survey; 45.3% respondents were being treated with exenatide QW and 54.7% respondents were being treated with liraglutide QD. In terms of GLP-1RA attributes, patients indicated a preference for a treatment with greater efficacy (i.e., a 1.5-point improvement in HbA1c) (OR 2.58; 95% CI 2.37, 2.80; p < 0.001), fewer side effects (OR 2.67; 95% CI 2.52, 2.82; p < 0.001), once-weekly rather than once-daily administration (OR 2.26; 95% CI 2.13, 2.39; p < 0.001), and the preparation required for a multi-use pen (OR 1.71; 95% CI 1.55, 1.88; p < 0.001). Needle size, device size, and titration were not significant drivers of patient preference. CONCLUSIONS Among GLP-1RA injection-experienced patients, key drivers of treatment preference for a hypothetical GLP-RA profile were side effects, efficacy, dosing frequency, and required preparation. Understanding patient preferences is important for optimizing treatment decision-making and improving treatment adherence. FUNDING AstraZeneca.
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Affiliation(s)
- Lei Qin
- AstraZeneca, Gaithersburg, MD, USA.
| | | | - Emuella Flood
- ICON plc, Clinical Outcomes Assessment, Gaithersburg, MD, USA
| | | | - Beverly Romero
- ICON plc, Clinical Outcomes Assessment, Gaithersburg, MD, USA
| | | | - Cynthia Alvarez
- ICON plc, Medical Affairs Statistical Analysis, San Diego, CA, USA
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15
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Pither J, Botta A, Maity C, Ghosh S. Analysis using national databases reveals a positive association between dietary polyunsaturated fatty acids with TV watching and diabetes in European females. PLoS One 2017; 12:e0173084. [PMID: 28355278 PMCID: PMC5371297 DOI: 10.1371/journal.pone.0173084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 11/15/2016] [Indexed: 11/18/2022] Open
Abstract
In recent years, dietary polyunsaturated fatty acids (PUFA) have increased in parallel to sedentary behavior and diabetes across the world. To test any putative association between dietary PUFA and sedentary behavior or diabetes in females, we obtained country-specific, cross-sectional data on sedentary activity and diabetes prevalence from European Cardiovascular Statistics 2012. Age and gender-specific, nutritional data from each country were obtained from nutritional surveys as well. Socioeconomic (GDP), physical environment (urbanization index) and climatic confounders were accounted for each country. Upon analysis, we found a strong, positive association between sedentary lifestyle in 11-yr old girls (> = 2 hours of TV/ weekday) and dietary PUFA across 21 European countries. Further, a weak association of dietary PUFA and a strong relationship of per-capita GDP was established with elevated fasting blood glucose [(> = 7.0 mmol/L; or on medication] among 25+ year old adult females across 23 countries in Europe. In summary, we present novel ecological evidence that dietary PUFA is strongly associated with sedentary behavior among pre-teen girls and weakly associated with diabetes among adult women across Europe. In the latter group, per-capita GDP was a significant predictor for diabetes as well. Therefore, we recommend that prospective randomized controlled trials (RCTs) be implemented to evaluate if ubiquitous presence of dietary PUFA and low socioeconomic status are possible confounders when intervening to treat/prevent sedentary lifestyle or diabetes in female subjects in Western nations.
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Affiliation(s)
- Jason Pither
- Department of Biology, IK Barber School of Arts and Sciences, University of British Columbia-Okanagan, Kelowna, Canada
| | - Amy Botta
- Department of Biology, IK Barber School of Arts and Sciences, University of British Columbia-Okanagan, Kelowna, Canada
| | - Chittaranjan Maity
- Department of Biochemistry, KPC Medical College, Kolkata, West Bengal, India
| | - Sanjoy Ghosh
- Department of Biology, IK Barber School of Arts and Sciences, University of British Columbia-Okanagan, Kelowna, Canada
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16
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Overbeek JA, Heintjes EM, Prieto-Alhambra D, Blin P, Lassalle R, Hall GC, Lapi F, Bianchini E, Hammar N, Bezemer ID, Herings RMC. Type 2 Diabetes Mellitus Treatment Patterns Across Europe: A Population-based Multi-database Study. Clin Ther 2017; 39:759-770. [PMID: 28342563 DOI: 10.1016/j.clinthera.2017.02.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/03/2017] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to determine the similarities and differences of type 2 diabetes mellitus (T2DM) treatment patterns in daily practice in 5 European countries and whether these reflect differences in guidelines. METHODS Prescriptions for drugs used in diabetes treatment during a 5-year study period were obtained from electronic databases. Patients initiating T2DM treatment during the study period were included. An SAS analysis tool was developed to create episodes of use of drug classes, which resulted in treatment patterns. FINDINGS A total of 253,530 patients initiating T2DM treatment during the study period were included; 52% to 55% were male, and the mean age ranged from 62 to 67 years. Metformin was the most common initial treatment in all countries. After initial therapy, most patients in the Netherlands, Spain, and the United Kingdom switched to a combination of metformin + a sulfonylurea derivative (SU). In Italy, metformin in combination with an SU was outnumbered by "other treatment," mainly because of repaglinide use. In France, treatments including dipeptidyl peptidase-4 inhibitors were most frequent as second- and fourth-line treatment. Metformin monotherapy was again most commonly observed as the third line of treatment in all countries. Fourth treatment was a combination of metformin + an SU in the Netherlands and Spain; in the United Kingdom and France, dipeptidyl peptidase-4 inhibitors were the most frequently used fourth line of treatment. IMPLICATIONS This study provides a comprehensive overview of T2DM treatment patterns among patients initiating T2DM treatment in 5 European countries. There were differences, especially regarding the uptake of newer incretin-based treatments, which are usually prescribed as a second and/or third treatment in agreement with local guidelines. These variations reflect the differences between the national guidelines of these countries.
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Affiliation(s)
- Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands; EMGO Institute for Health and Care research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands.
| | - Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Daniel Prieto-Alhambra
- GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Patrick Blin
- Bordeaux PharmacoEpi, CIC Bordeaux CIC 1401, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, CIC Bordeaux CIC 1401, Bordeaux, France
| | | | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Elisa Bianchini
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Irene D Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands; EMGO Institute for Health and Care research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands
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17
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Vangen-Lønne AM, Wilsgaard T, Johnsen SH, Løchen ML, Njølstad I, Mathiesen EB. Declining Incidence of Ischemic Stroke. Stroke 2017; 48:544-550. [DOI: 10.1161/strokeaha.116.014377] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/03/2016] [Accepted: 12/16/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
It is proposed that 20% to 40% of the decline in first-ever stroke incidence is attributed to the improvement of risk factor control. We estimated the impact of modifiable cardiovascular risk factors on the changing incidence of ischemic stroke (IS) between 1995 and 2012, using individual person data from repeated surveys in a general population.
Methods—
The proportion of the IS incidence decline explained by change in each risk factor over time was estimated from 1995 to 2012 by Poisson regression among 26 329 participants who attended the fourth Tromsø survey in 1994 to 1995. Hazard ratios for IS were estimated with Cox proportional hazards regression among 27 936 participants who attended at least 1 of the Tromsø surveys in 1994 to 1995, 2001, or 2007 to 2008. Age- and sex-adjusted means or prevalences of risk factors over time were estimated by generalized estimating equations.
Results—
There were 1226 first-ever IS during 367 636 person-years of follow-up. Changes in cardiovascular risk factors accounted for 57% of the decrease in IS incidence from 1995 to 2012. The most important contributors were decreasing mean systolic blood pressure and smoking prevalence, accounting for 26% and 17% of the observed decline, respectively. Conversely, increasing diabetes mellitus prevalence contributed negatively to the declining IS incidence.
Conclusions—
Changes in cardiovascular risk factors explained 57% of the decrease in IS incidence from 1995 to 2012. Reduction in systolic blood pressure and prevalence of smoking were the most important contributors.
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Affiliation(s)
- Anne M. Vangen-Lønne
- From the Departments of Clinical Medicine (A.M.V.-L., S.H.J., E.B.M.) and Community Medicine (T.W., M.-L.L., I.N.), The Arctic University of Norway, Tromsø; Department of Neurology, Innlandet Hospital Trust, Norway (A.M.V.-L.); and Department of Neurology, University Hospital of North Norway, Tromsø (S.H.J., E.B.M.)
| | - Tom Wilsgaard
- From the Departments of Clinical Medicine (A.M.V.-L., S.H.J., E.B.M.) and Community Medicine (T.W., M.-L.L., I.N.), The Arctic University of Norway, Tromsø; Department of Neurology, Innlandet Hospital Trust, Norway (A.M.V.-L.); and Department of Neurology, University Hospital of North Norway, Tromsø (S.H.J., E.B.M.)
| | - Stein Harald Johnsen
- From the Departments of Clinical Medicine (A.M.V.-L., S.H.J., E.B.M.) and Community Medicine (T.W., M.-L.L., I.N.), The Arctic University of Norway, Tromsø; Department of Neurology, Innlandet Hospital Trust, Norway (A.M.V.-L.); and Department of Neurology, University Hospital of North Norway, Tromsø (S.H.J., E.B.M.)
| | - Maja-Lisa Løchen
- From the Departments of Clinical Medicine (A.M.V.-L., S.H.J., E.B.M.) and Community Medicine (T.W., M.-L.L., I.N.), The Arctic University of Norway, Tromsø; Department of Neurology, Innlandet Hospital Trust, Norway (A.M.V.-L.); and Department of Neurology, University Hospital of North Norway, Tromsø (S.H.J., E.B.M.)
| | - Inger Njølstad
- From the Departments of Clinical Medicine (A.M.V.-L., S.H.J., E.B.M.) and Community Medicine (T.W., M.-L.L., I.N.), The Arctic University of Norway, Tromsø; Department of Neurology, Innlandet Hospital Trust, Norway (A.M.V.-L.); and Department of Neurology, University Hospital of North Norway, Tromsø (S.H.J., E.B.M.)
| | - Ellisiv B. Mathiesen
- From the Departments of Clinical Medicine (A.M.V.-L., S.H.J., E.B.M.) and Community Medicine (T.W., M.-L.L., I.N.), The Arctic University of Norway, Tromsø; Department of Neurology, Innlandet Hospital Trust, Norway (A.M.V.-L.); and Department of Neurology, University Hospital of North Norway, Tromsø (S.H.J., E.B.M.)
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Carlsson S, Andersson T, Ahlbom A. Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden. Diabet Med 2016; 33:1149-50. [PMID: 27429054 DOI: 10.1111/dme.12984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/04/2015] [Accepted: 09/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- S Carlsson
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Andersson
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Sweden
| | - A Ahlbom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Sweden
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Rasmussen SS, Johansen NB, Witte DR, Borch-Johnsen K, Sandbaek A, Lauritzen T, Jørgensen ME. Incidence of register-based diabetes 10 years after a stepwise diabetes screening programme: the ADDITION-Denmark study. Diabetologia 2016; 59:989-97. [PMID: 26857739 DOI: 10.1007/s00125-016-3887-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS Screening programmes for type 2 diabetes inevitably find more people at high risk of developing diabetes than people with undiagnosed prevalent diabetes. We describe the incidence of diabetes for risk groups according to advancement in a screening process. METHODS In 2001-2006, a diabetes screening programme based on the Danish diabetes risk score and measures of HbA1c and glucose was carried out in Danish general practices. The present study includes 13,249 individuals with low diabetes risk scores and 22,726 with high diabetes risk scores but no diabetes according to WHO 1999 criteria. Seven incremental levels of diabetes risk were defined and followed for incident diabetes recorded in the Danish National Diabetes Register until December 2012. For each group, cumulative diabetes incidence was calculated. Incidence rates and rate ratios were estimated by Poisson regression analyses. RESULTS After 10 years of follow-up 1,164 new diabetes cases were registered. Incidence rates were 1.0, 4.2, 14.5, 28.8 and 52.6 per 1,000 person-years in individuals at low risk and in those with normal glucose tolerance, impaired fasting glucose, impaired glucose tolerance and one diabetic glucose value, respectively. For each step in the screening algorithm, the risk of developing diabetes was higher than in the previous step. CONCLUSIONS/INTERPRETATION The risk of developing clinical diabetes in people who screen negative for diabetes depends on the level of risk stratification at screening, even at lower risk levels. This risk increases markedly in the presence of impaired glucose regulation. These results can inform policy recommendations concerning prevention strategies following screening.
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Affiliation(s)
- Signe S Rasmussen
- Department of Cardiology, Nephrology and Endocrinology H, Nordsjællands University Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark.
| | - Nanna B Johansen
- Steno Diabetes Center, Gentofte, Denmark
- The Danish Diabetes Academy, Odense, Denmark
| | - Daniel R Witte
- The Danish Diabetes Academy, Odense, Denmark
- Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Annelli Sandbaek
- Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Center, Gentofte, Denmark
- Center for Health Research in Greenland, Southern Denmark University, Odense, Denmark
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20
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Mosca A, Leclerc M, Hugot JP. Gut Microbiota Diversity and Human Diseases: Should We Reintroduce Key Predators in Our Ecosystem? Front Microbiol 2016; 7:455. [PMID: 27065999 PMCID: PMC4815357 DOI: 10.3389/fmicb.2016.00455] [Citation(s) in RCA: 346] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/21/2016] [Indexed: 12/12/2022] Open
Abstract
Most of the Human diseases affecting westernized countries are associated with dysbiosis and loss of microbial diversity in the gut microbiota. The Western way of life, with a wide use of antibiotics and other environmental triggers, may reduce the number of bacterial predators leading to a decrease in microbial diversity of the Human gut. We argue that this phenomenon is similar to the process of ecosystem impoverishment in macro ecology where human activity decreases ecological niches, the size of predator populations, and finally the biodiversity. Such pauperization is fundamental since it reverses the evolution processes, drives life backward into diminished complexity, stability, and adaptability. A simple therapeutic approach could thus be to reintroduce bacterial predators and restore a bacterial diversity of the host microbiota.
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Affiliation(s)
- Alexis Mosca
- Hôpital Robert Debré, Assistance Publique-Hopitaux de ParisParis, France; Institut National de la Santé et de la Recherche Médicale et Université Paris Diderot, Sorbonne Paris-Cité, United Medical Resources 1149 Labex InflamexParis, France
| | - Marion Leclerc
- INRA, AgroParisTech, United Medical Resources 1319 MICALIS Paris, France
| | - Jean P Hugot
- Hôpital Robert Debré, Assistance Publique-Hopitaux de ParisParis, France; Institut National de la Santé et de la Recherche Médicale et Université Paris Diderot, Sorbonne Paris-Cité, United Medical Resources 1149 Labex InflamexParis, France
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21
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Jacob S, Klimke-Hübner A, Dippel FW, Hopfenmüller W. 'Knowing what matters in diabetes: healthier below 7': results of the campaign's first 10 years (part 1): participants with known type 2 diabetes. Cardiovasc Endocrinol 2016; 5:14-20. [PMID: 28392972 PMCID: PMC5367495 DOI: 10.1097/xce.0000000000000072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION During the 'Knowing what matters in diabetes: healthier below 7' diabetes campaign, more than 30 000 randomly participating individuals underwent an occasional, voluntary diabetes risk check between 2005 and 2014. METHODS This campaign aimed to inform individuals in Germany about diabetes mellitus and its complications, the established risk factors for development of type 2 diabetes (T2D), their prevalence and management in the real-life population, the quality of risk factor control and actual disease management in participants with a history of established diabetes mellitus [people with diabetes (PWD)]. Besides demographic characteristics (e.g. sex, age) and anamnestic information (antihypertensive treatment, history of elevated plasma glucose levels, genetic disposition), risk factor assessment included BMI, waist circumference, and lifestyle (physical activity, nutritional habits). The requested information was complemented by direct measurements of blood pressure (BP) (routine), plasma glucose, and HbA1c (voluntary). Between 2005 and 2014, more than 31 000 individuals participated in 45 single campaigns in numerous German cities. Here, we report on the results of the subgroup of participants with known diabetes mellitus. RESULTS Among the 26 522 individuals with a completed questionnaire participating in the years 2006-2014, 21 055 participants (79.4%) did not have a history of diabetes and 5098 individuals (19.2%) reported being diagnosed with T2D, 369 (1.4%) with type 1 diabetes. The proportion of participants with T2D increased markedly over the years from 13.3 (2006) to 21.7% (2014). The age group older than 64 years was the largest within this subgroup (67.3%), 48.4% men and 51.6% women. The prevalence of overweight or obesity was found in 78% and 69.2% of the PWD. More than 40% of individuals with T2D had no regular physical exercise and more than 15% had unfavorable nutritional habits. In all, 69.9% of participants with T2D had elevated BP as assessed during the campaign or reported treatment with antihypertensive drugs at any time. On average, almost half of PWD (46.3%) had an HbA1c above 7.0%; a significant trend toward higher values over the 10-year period was observed. CONCLUSION The analysis of PWD participating in the 'Knowing what matters in diabetes: healthier below 7' campaign showed that despite huge efforts in the past, important aspects for progression and complications of T2D mellitus are still not well controlled. This includes lifestyle habits as well as pharmaceutical treatment. Although the participants in this study cannot be considered a representative sample of the German population and occasional measurements without standardization further limit firm conclusions, the BP, plasma glucose, and HbA1c results indicate that a major proportion of PWD have insufficient metabolic and BP control. The marked increase in the proportion of T2D among all participants over time is consistent with the increasing prevalence of T2D mellitus found in many other countries worldwide in the recent decades. Our findings underline the importance of an optimized therapy for further improvement of disease management in those already diagnosed with this common chronic, progressive disease.
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Affiliation(s)
| | | | | | - Werner Hopfenmüller
- Institute for Biostatistics and Epidemiology, Charite Berlin, Berlin, Germany
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Torre C, Guerreiro J, de Oliveira Martins S, Raposo JF, Martins AP, Leufkens H. Patterns of glucose lowering drugs utilization in Portugal and in the Netherlands. Trends over time. Prim Care Diabetes 2015; 9:482-489. [PMID: 25911273 DOI: 10.1016/j.pcd.2015.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/05/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
AIMS To compare the temporal trends in the consumption patterns of glucose lowering drugs (GLD) between Portugal and the Netherlands from 2004 to 2013 and to examine possible reasons behind the cross-national variation found. METHODS All GLD (ATC pharmacological subgroup A10B) were selected for analysis. Consumption data were obtained for the 10-year period. Portuguese and Dutch drug estimates were obtained from nationwide databases. RESULTS The consumption of GLD increased in Portugal from 52.9 defined daily dose per 1000 inhabitants per day (DHD) in 2004 to 70.0 DHD in 2013 and in the Netherlands from 44.9 DHD in 2004 to 50.7 DHD in 2013. In Portugal, the use of fixed-dose combinations, especially with dipeptidyl peptidase-4 inhibitors (DPP-4) increased remarkably and in 2013 represented almost a quarter of total GLD consumption. In the Netherlands, the use of combinations was residual. CONCLUSIONS The consumption of GLD rose over the 10-year period in both countries. However, Portuguese overall consumption and costs of GLD were higher. The differentially rapid uptake of DPP-4 inhibitors in Portugal was the main driver of the cost difference.
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Affiliation(s)
- Carla Torre
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal.
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal
| | - Sofia de Oliveira Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal; Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - João Filipe Raposo
- Faculty of Medical Sciences, New University of Lisbon, Lisboa, Portugal; Portuguese Diabetes Association (APDP), Lisboa, Portugal
| | - Ana Paula Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal; Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Hubert Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Andersson T, Ahlbom A, Carlsson S. Diabetes Prevalence in Sweden at Present and Projections for Year 2050. PLoS One 2015; 10:e0143084. [PMID: 26619340 PMCID: PMC4664416 DOI: 10.1371/journal.pone.0143084] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/02/2015] [Indexed: 02/07/2023] Open
Abstract
Background Data on the future diabetes burden in Scandinavia is limited. Our aim was to project the future burden of diabetes in Sweden by modelling data on incidence, prevalence, mortality, and demographic factors. Method To project the future burden of diabetes we used information on the prevalence of diabetes from the national drug prescription registry (adults ≥20 years), previously published data on relative mortality in people with diabetes, and population demographics and projections from Statistics Sweden. Alternative scenarios were created based on different assumptions regarding the future incidence of diabetes. Results Between 2007 and 2013 the prevalence of diabetes rose from 5.8 to 6.8% in Sweden but incidence remained constant at 4.4 per 1000 (2013). With constant incidence and continued improvement in relative survival, prevalence will increase to 10.4% by year 2050 and the number of afflicted individuals will increase to 940 000. Of this rise, 30% is accounted for by changes in the age structure of the population and 14% by improved relative survival in people with diabetes. A hypothesized 1% annual rise in incidence will result in a prevalence of 12.6% and 1 136 000 cases. Even with decreasing incidence at 1% per year, prevalence of diabetes will continue to increase. Conclusion We can expect diabetes prevalence to rise substantially in Sweden over the next 35 years as a result of demographic changes and improved survival among people with diabetes. A dramatic reduction in incidence is required to prevent this development.
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Affiliation(s)
- Tomas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anders Ahlbom
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sofia Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Luksiene D, Tamosiunas A, Virviciute D, Bernotiene G, Peasey A. Anthropometric trends and the risk of cardiovascular disease mortality in a Lithuanian urban population aged 45-64 years. Scand J Public Health 2015; 43:882-9. [PMID: 26261188 PMCID: PMC4639754 DOI: 10.1177/1403494815597582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 11/23/2022]
Abstract
Aims: To estimate trends in anthropometric indexes from 1992 to 2008 and to evaluate the risk of cardiovascular disease mortality in relation to anthropometric indexes (body mass index, waist circumference, waist:hip ratio, waist:height ratio). Methods: Data from the three surveys (1992–2008) are presented. A random sample of 5147 subjects aged 45–64 years was selected for statistical analysis. During follow-up there were 141 deaths from cardiovascular disease (excluding those with cardiovascular disease at entry). Cox’s regression was used to estimate the associations between anthropometric indexes and cardiovascular disease mortality. Results: During a 17-year period among men, the prevalence of obesity (body mass index ⩾30 kg/m2) increased from 18.4% to 32.1% (p<0.001) and a high level of waist:hip ratio (>0.9) from 59.3% to 72.9% (p<0.001). The risk profile of obesity did not change in women, but prevalence of a high level of waist:hip ratio (>0.85) increased from 25.9% to 41.5% (p<0.001). Multivariable-adjusted Cox’s regression models showed that body mass index, waist circumference, waist:hip ratio, waist:height ratio were associated with cardiovascular disease mortality risk only in men (hazard ratios 1.40, 1.45, 1.49, 1.46 respectively (p<0.01)). Conclusions: Our data indicate that anthropometric measures such as body mass index, waist circumference, waist:hip ratio and waist:height ratio are good indicators of cardiovascular disease mortality risk only in men aged 45–64 years.
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Affiliation(s)
- Dalia Luksiene
- Lithuanian University of Health Sciences, Academy of Medicine, Institute of Cardiology, Department of Population Studies, Lithuania Lithuanian University of Health Sciences, Academy of Medicine, Public Health Faculty, Department of Environmental and Occupational Medicine, Lithuania
| | - Abdonas Tamosiunas
- Lithuanian University of Health Sciences, Academy of Medicine, Institute of Cardiology, Department of Population Studies, Lithuania Lithuanian University of Health Sciences, Academy of Medicine, Public Health Faculty, Department of Preventive Medicine, Lithuania
| | - Dalia Virviciute
- Lithuanian University of Health Sciences, Academy of Medicine, Institute of Cardiology, Department of Population Studies, Lithuania
| | - Gailute Bernotiene
- Lithuanian University of Health Sciences, Academy of Medicine, Institute of Cardiology, Department of Population Studies, Lithuania
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, UK
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Al-Lawati JA, Panduranga P, Al-Shaikh HA, Morsi M, Mohsin N, Khandekar RB, Al-Lawati HJ, Bayoumi RA. Epidemiology of Diabetes Mellitus in Oman: Results from two decades of research. Sultan Qaboos Univ Med J 2015; 15:e226-e233. [PMID: 26052456 PMCID: PMC4450786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/25/2014] [Accepted: 12/24/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES This study aimed to describe the epidemiology of diabetes mellitus over the past two decades in Oman, particularly in terms of its prevalence and incidence. In addition, the study sought to estimate the future incidence of diabetes in Oman. METHODS Three national and three regional surveys conducted between 1991 and 2010 were analysed to obtain the age-adjusted prevalence and undiagnosed proportion of type 2 diabetes mellitus (T2DM) among Omani subjects aged ≥20 years. Diabetes mellitus registers and published studies were used to determine incidence rates of both type 1 diabetes mellitus (T1DM) and T2DM in Oman. Linear regression was used to determine trends and projections for diabetes in 2050. RESULTS The age-adjusted prevalence of T2DM in Oman varied from 10.4% to 21.1%, while the highest prevalence of impaired fasting glucose was found in males (35.1%). In comparison to men, higher incidence rates of T2DM were found in women (2.7 cases compared to 2.3 cases per 1,000 person-years, respectively). No significant trends were observed for the prevalence or incidence of T2DM in both genders. Undiagnosed T2DM was more common in men (range: 33-68%) than women (range: 27-53%). The results of this study show that by 2050, there will be an estimated 350,000 people with T2DM living in Oman (a 174% increase compared to estimates for 2015). CONCLUSION Health authorities need to prioritise diabetes prevention and control in order to prevent or delay long-term complications and avert a potential epidemic of diabetes in Oman.
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Affiliation(s)
- Jawad A. Al-Lawati
- Departments of Non-Communicable Disease Control, Ministry of Health, Muscat, Oman
| | | | - Hala A. Al-Shaikh
- Department of Paediatric Endocrinology, Muscat Private Hospital, Muscat, Oman
| | | | - Nabil Mohsin
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Rajiv B. Khandekar
- Department of Research, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Riad A. Bayoumi
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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