Incidence of diabetes and its mortality according to body mass index in South Koreans aged 40-79 years

Health and Productivity Benefits with Early Intensified Treatment in Patients with Type 2 Diabetes: Results from Korea

The available evidence suggests positive health outcomes associated with early treatment intensification in Type 2 diabetes mellitus (T2DM). Our study estimated the productivity effects arising from improved health correlated with early intensified treatment in T2DM in Korea. Using a recently published methodology and model, we investigated the association between early intensified treatment and the probability of experiencing fewer diabetes-related complication events. Treatment strategies leading to better health outcomes are expected to be associated with social value through increased participation in paid and unpaid work activities. Therefore, we translated the lower incidence of complications into monetary terms related to productivity for the Korean population. We quantified productivity by considering (a) absenteeism, (b) presenteeism, (c) permanent loss of labor force, and (d) activity restriction. Deterministic and probabilistic sensitivity analyses in the base case parameter were performed. Approximately, 1.7 thousand (standard deviation [SD] ±580 events) micro- and macrovascular complication events could potentially be avoided by early treatment intensification. This led to a societal gain attributed to increased productivity of 23 million USD (SD ± $8.2 million). This article demonstrates the likelihood of achieving better health and productivity through early intensified treatment in diabetes.

Incidence and temporal trends in type 2 diabetes by weight status: A systematic review and meta-analysis of prospective cohort studies

Background

Diabetes is more prevalent among overweight/obese individuals, but has become a significant public health challenge among normal weight populations. In this meta-analysis, we aimed to estimate diabetes/prediabetes incidence and its temporal trends by weight status.

Methods

PubMed, Embase, Web of Science, and Cochrane Library were searched until 8 December 2021. Prospective cohort studies reporting diabetes incidence by baseline body mass index (BMI) categories in adults were included. The median year of data collection was used to assess the temporal trends. Subgroup analyses and meta-regression were also performed.

Results

We included 94 studies involving 3.4 million adults from 22 countries. The pooled diabetes incidence in underweight, normal-weight, and overweight/obese adults was 4.5 (95% confidence interval (CI) = 2.8-7.3), 2.7 (95% CI = 2.2-3.3), and 10.5 (95% CI = 9.3-11.8) per 1000 person-years, respectively. The diabetes incidence in low- and middle-income countries (LMICs) was higher than in high-income countries among normal-weight (5.8 vs 2.0 per 1000 person-years) or overweight/obese (15.9 vs 8.9 per 1000 person-years) adults. European and American regions had a higher diabetes incidence than the non-Western areas, regardless of weight status. Underweight diabetes incidence decreased significantly from 1995-2000 to 2005-2010. Diabetes incidence in normal-weight populations has increased continuously since 1985 by an estimated 36% every five years. In overweight/obese adults, diabetes incidence increased between 1985-1990 and 1995-2000, stabilised between 2000 and 2010, and spiked suddenly after 2010.

Conclusions

Diabetes incidence and its temporal trends differed by weight status. The continuous upward trend of diabetes incidence among overweight/obese individuals requires urgent attention, particularly in LMICs. Furthermore, diabetes among normal-weight individuals is becoming a significant public health problem.

Registration

PROSPERO (CRD42020215957).

Association of weight status and the risks of diabetes in adults: a systematic review and meta-analysis of prospective cohort studies

Obesity is a known risk factor for type 2 diabetes mellitus (T2DM); however, the associations between underweight and T2DM and between weight status and prediabetes have not been systematically reviewed. We aimed to estimate the relative risks (RRs) of prediabetes/T2DM in underweight/overweight/obesity relative to normal weight. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to December 8, 2021. Prospective cohort studies with a minimum 12-month follow-up period reporting the association between baseline body mass index (BMI) categories and risk of prediabetes/T2DM in adults were included. Study quality was assessed using the Newcastle-Ottawa Scale. The main analyses of T2DM risk were performed using the ethnic-specific (Asian/non-Asian) BMI classification and additional analyses of prediabetes/T2DM risk by including all eligible studies. Random-effects models with inverse variance weighting were used. Subgroup analyses and meta-regression were conducted to explore the potential effects of pre-specified modifiers. The study protocol was registered with PROSPERO (CRD42020215957). Eighty-four articles involving over 2.69 million participants from 20 countries were included. The pooled RR of prediabetes risk was 1.24 (95% CI: 1.19-1.28, I² = 9.7%, n = 5 studies) for overweight/obesity vs. normal weight. The pooled RRs of T2DM based on the ethnic-specific BMI categories were 0.93 (95% CI: 0.75-1.15, I² = 55.5%, n = 12) for underweight, 2.24 (95% CI: 1.95-2.56, I² = 92.0%, n = 47) for overweight, 4.56 (95% CI: 3.69-5.64, I² = 96%, n = 43) for obesity, and 22.97 (95% CI: 13.58-38.86, I² = 92.1%, n = 6) for severe obesity vs. normal weight. Subgroup analyses indicated that underweight is a protective factor against T2DM in non-Asians (RR = 0.68, 95% CI: 0.40-0.99, I² = 56.1%, n = 6). The magnitude of the RR of T2DM in overweight/obesity decreased with age and varied by region and the assessment methods for weight and T2DM. Overweight/obesity was associated with an increased prediabetes/T2DM risk. Further studies are required to confirm the association between underweight and prediabetes/T2DM, particularly in Asian populations.

Fatty liver index and risk of diabetes incidence: A systematic review and dose-response meta-analysis of cohort studies

AIMS

Fatty Liver Index (FLI) is a surrogate index for diagnosis of Fatty Liver Disease (FLD). We performed a dose-response meta-analysis to investigate the relationship between FLI and diabetes incidence in prospective cohort studies.

METHODS

We conducted a systematic search of articles up to November 2019 in PubMed, SCOPUS, Cochrane library, and Embase. Hazard Ratios (HRs) with corresponding 95% confidence intervals (CIs) of studies were pooled using meta-analysis with DerSimonian and Laird random-effects models to find combined HRs. Dose-response effect of this relationship was also assessed.

RESULTS

Twenty-seven studies providing 70,918 participants were included in the meta-analysis. Pooled results showed that the highest category of FLI was associated with an increased incidence of diabetes [HR: 2.88, 95% CI: 2.18-3.81; P for heterogeneity: 0.001]. Subgroup analysis based on sex, continent, and the quality of study could not explain the source of heterogeneity. The pooled HR from the random-effects dose-response model indicated a significant association between FLI level and risk of diabetes incidence (Coef=0.0239, p=0.001).

CONCLUSION

Our dose-response meta-analysis revealed a direct relationship between FLI and HR of diabetes incidence.

Increased Mortality Burden in Young Asian Subjects with Dysglycemia and Comorbidities

BACKGROUND

High blood glucose level has a linear relationship with all-cause mortality. However, the influence of glycemic abnormality on mortality differs by age group. We aimed to analyze all-cause mortality according to glycemic status, age groups, and comorbidities using a national health database.

METHODS

The 6,330,369 participants who underwent Korean National Health Screening in 2009 were followed up until 2016, with a median follow-up of 7.3 years. All-cause mortality rates were analyzed according to glycemic status (normoglycemia, impaired fasting glucose [IFG], newly diagnosed diabetes, diabetes duration <5 years, diabetes duration ≥5 years), age groups (20-39, 40-65, and ≥65 years), and comorbidities using the Korean National Health Insurance System database.

RESULTS

At baseline, 712,901 (11.3%) subjects had diabetes. Compared with subjects without diabetes, those with diabetes at baseline showed increased mortality risk after adjustment for multiple risk factors (hazard ratio [HR] 1.613; 95% confidence interval [CI] 1.598,1.629), and those with IFG showed a significantly increased mortality risk compared with normoglycemic subjects (HR 1.053; 95% CI 1.042,1.064). Mortality risk associated with glycemic status decreased gradually from younger to older age groups and was consistently higher in those with diabetes with coronary heart disease, ischemic stroke or decreased renal function than those without comorbidities.

CONCLUSION

Compared with normoglycemic subjects, subjects with diabetes and IFG had an increased mortality risk and the mortality risk was higher in the younger age group than in the older age group. The presence of diabetes and comorbid diseases synergistically increased mortality risk.

Optimal fasting glucose levels with regard to cardiovascular and mortality outcomes in people treated with or without antidiabetic medication

AIMS

To investigate the optimal fasting blood glucose (FBG) levels among individuals actively treated or untreated with antidiabetic drugs.

METHODS

In two population-based cohorts of Korean adults extracted from the National Health Information Database, multivariable-adjusted hazard ratios of outcomes over 10 and 8 years of follow-up were estimated according to achieved FBG levels and antidiabetic drug use. The primary outcomes were major cardiovascular disease (CVD) events and all-cause mortality.

RESULTS

In total, 66 533 of 450 537 and 100 556 of 767 382 participants in the respective cohorts received antidiabetic treatment. For untreated FBG, the CVD risk and mortality increased linearly from an FBG threshold of 5.6 mmol/L; however, for FBG treated with antidiabetic drugs there were J-shaped associations with the outcome risks. For treated FBG levels of 4.4 to 5.5 mmol/L, 7.8 to 8.8 mmol/L, 8.9 to 9.9 mmol/L and ≥ 10.0 mmol/L, vs 6.1 to 6.9 mmol/L, the hazard ratios for major CVD events were 1.17 (95% confidence interval [CI] 1.04-1.32), 1.06 (95% CI 0.96-1.18), 1.37 (95% CI 1.22-1.53) and 1.61 (95% CI 1.46-1.78), respectively, and those for all-cause mortality were 1.20 (95% CI 1.11-1.29), 1.05 (95% CI 0.99-1.12), 1.29 (95% CI 1.10-1.50) and 1.69 (95% CI 1.59-1.81), respectively.

CONCLUSIONS

These findings indicate that pharmacological therapy achieving FBG levels of <7.8 to 8.9 mmol/L and a non-pharmacological approach to maintaining normal glucose levels help reduce the risk of adverse outcomes, while lowering FBG to normal levels through antidiabetic drugs is not beneficial or may even be harmful.

Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda - a descriptive retrospective study

Background

Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda.

Methods

We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients’ registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients’ LTFU rates in hazard ratios (HRs).

Results

Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2–36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy.

Conclusion

We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients.

A comparison of trunk circumference and width indices for hypertension and type 2 diabetes in a large-scale screening: a retrospective cross-sectional study

Anthropometric indices determine important risk factors for many chronic diseases. However, to date, no study has simultaneously analyzed the capabilities of trunk circumference and width indices to identify hypertension and type 2 diabetes in a large-scale screening study. The objectives of this study were to examine the associations of hypertension and - diabetes with circumference and width indices measured at the five identical positions (axillary, chest, rib, waist, and pelvic) and to compare the capabilities of circumference and width indices to identify the two diseases. Data were obtained from the Korean Health and Genome Epidemiology Study database. The associations and abilities of the circumference indices to identify diabetes were greater than those for hypertension. Overall, trunk circumference indices displayed stronger associations with and greater abilities to identify hypertension and diabetes than did trunk width indices at the five positions. In the comparative analysis between index pairs of circumference and width in patients with diabetes, significant differences were shown at all five positions and in the adjusted analysis of axillary, chest, rib, and pelvic positions. Therefore, width indices should not be used as an alternative indicator of type 2 diabetes in either men or women, except when measured at the waist.

Blood Pressure-Related Risk Among Users Versus Nonusers of Antihypertensives: A Population-Based Cohort in Korea

There have been few studies comparing blood pressure (BP)-related outcomes between users and nonusers of antihypertensive drugs. We constructed a population-based cohort of 492 540 Koreans aged 40 to 79 years, who had no preexisting cardiorenal diseases, from the National Health Insurance Service-Health Screening database. The primary composite outcome was death (or critical care unit admission) from cardiorenal causes, revascularization for myocardial infarction or stroke, and new-onset end-stage renal disease. Using time-dependent Cox models, we estimated hazard ratios according to BP and antihypertensive use, which were determined in each year of follow-up. Over 10 years of follow-up, the primary outcome occurred in 26 122 subjects, and 33 550 deaths were noted. Among nonusers of antihypertensives, the risk for the primary outcome increased linearly from a BP of 105/65 mm Hg, and the risk for all-cause mortality increased from a BP of 115/75 mm Hg. Among irregular users, the risk for the primary outcome increased as the BP increased >115/75 mm Hg. Among active users, the risk for the primary outcome increased in systolic BP <115 mm Hg and >135 mm Hg, and in diastolic BP <65 mm Hg and >85 mm Hg, and the risk for all-cause mortality increased in systolic BP <125 mm Hg and >135 or 145 mm Hg. In conclusion, this population-based study demonstrated that the associations between BP and adverse outcomes were J-shaped among active antihypertensive users, but linear or flat and then increasing among nonusers or irregular users.