Mortality experience of a low-income population with young-onset diabetes

Potential Medicinal Value of Rhein for Diabetic Kidney Disease

Diabetic kidney disease (DKD) is the primary cause of mortality among diabetic patients. With the increasing prevalence of diabetes, it has become a major concern around the world. The therapeutic effect of clinical use of drugs is far from expected, and therapy choices to slow the progression of DKD remain restricted. Therefore, research on new drugs and treatments for DKD has been a hot topic in the medical field. It has been found that rhein has the potential to target the pathogenesis of DKD and has a wide range of pharmacological effects on DKD, such as anti-nephritis, decreasing blood glucose, controlling blood lipids and renal protection. In recent years, the medical value of rhein in the treatment of diabetes, DKD and renal disease has gradually attracted worldwide attention, especially its potential in the treatment of DKD. Currently, DKD can only be treated with medications from a single symptom and are accompanied by adverse effects, while rhein improves DKD with a multi-pathway and multi-target approach. Therefore, this paper reviews the therapeutic effects of rhein on DKD, and proposes solutions to the limitations of rhein itself, in order to provide valuable references for the clinical application of rhein in DKD and the development of new drugs.

Diabetes duration or age at onset and mortality in insulin-dependent diabetics: a systematic review and meta-analysis

BACKGROUND

This meta-analysis was conducted given the contradictory findings from studies on the influence of diabetes duration or age at onset on mortality in patients with insulin-dependent diabetes mellitus (IDDM).

METHODS

Electronic databases (PubMed, Embase, Cochrane, Web of Knowledge, Scopus, and CINHAL) were comprehensively searched to identify relevant studies until October 31, 2022. All of the selected articles contained statistics on hazard ratios, relative risks (RRs), or odds ratios, or data for estimating the association between diabetes duration or age at onset and total mortality in IDDM patients. Regardless the heterogeneity assessed by the I² statistic, pooled RRs and 95% confidence intervals (CI) for total mortality were acquired via random effect meta-analysis with inverse variance weighting.

RESULTS

This meta-analysis finally included 19 studies involving 122, 842 individuals. Both age at onset and diabetes duration were positively associated with an increased mortality rate in IDDM patients. Specifically, the pooled RRs for age at onset and diabetes duration were 1.89 (95%CI 1.43-2.50) and 1.89 (95%CI 1.16-3.09) respectively. Subgroup analyses revealed that only prepubertal onset was associated with a greater survival advantage than pubertal or postpubertal onset.

CONCLUSIONS

The findings of this meta-analysis and systematic review suggest that a later age at onset or longer diabetes duration is associated with increased risk of total mortality in IDDM patients. However, this conclusion shall be interpreted with caution due to the possibility of residual confounding and be confirmed in the future by well-designed studies.

Diabetes and Mortality From Respiratory Diseases: The Japan Collaborative Cohort Study

BACKGROUND

Little evidence is available about the association between diabetes and respiratory disease mortality among Japanese populations. We aimed to explore the association between diabetes and the risk of respiratory diseases mortality through a nationwide prospective study in Japan.

METHODS

We followed 95,056 participants (39,925 men and 55,131 women) for a median 17.1 years. The information about diabetes status, sociodemographic characteristics, and lifestyles was collected at baseline. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of mortality from respiratory diseases associated with baseline diabetes status.

RESULTS

We identified 2,838 deaths from total respiratory diseases (1,759 respiratory infection, 432 chronic obstructive pulmonary disease, and 647 other respiratory diseases). The association between diabetes and total respiratory disease mortality was statistically significant among women (HR 1.81; 95% CI, 1.39-2.37) but of borderline statistical significance in men (P for interaction <0.01). Besides, there were significant associations between diabetes and mortality from respiratory infection among both men and women (HR 1.39; 95% CI, 1.10-1.76 and HR 2.30; 95% CI, 1.71-3.11, respectively; P for interaction <0.001). However, we failed to detect any statistically significant association between diabetes and COPD mortality. Moreover, the subgroup analysis revealed that the association between diabetes and total respiratory disease mortality was stronger in never smokers when compared with ever smokers (P for interaction = 0.02).

CONCLUSIONS

Significant association was observed between diabetes and the risk of total respiratory disease mortality, in particular from respiratory infection. Prevention and control of respiratory diseases, especially respiratory infection, should be paid more attention among people with diabetes in clinical and public health practice.

Increased risk of respiratory diseases in adults with Type 1 and Type 2 diabetes

AIMS

Diabetes is linked with decreases in lung elasticity and in capacity to transfer carbon monoxide. Systemic inflammation, a common concern with diabetes, may contribute to airflow obstruction. We examined the association of self-reported diabetes with self-reported respiratory diseases (RDs) among 53,146 adults from the C8 Health Project.

METHODS

Participants were categorized into three groups: Type 1 (T1D, n = 781), Type 2 (T2D, n = 4277), or no diabetes (n = 48,088). ORs (95% CIs) for the association of diabetes with four RDs were computed: emphysema, chronic obstructive pulmonary disease (COPD), chronic bronchitis (CB), and asthma. Covariates controlled for were age, sex, estimated glomerular filtration rate, C-reactive protein, smoking history, BMI, and perfluorooctonaoic acid (C8).

RESULTS

RDs were present in 26%, 21% and 13% of persons with T1D, T2D, and no diabetes, respectively. In multivariable analyses, persons with T1D were 62% more likely to have any RD (OR: 1.62, CI: (1.36-1.93)), while those with T2D were 1.3 times as likely (OR: 1.26, CI: 1.15-1.37)). Compared to those without diabetes, in those with T1D and T2D diabetes respectively, ORs (CIs) for COPD were 1.89 (1.38-2.57), 1.45 (1.23-1.71), asthma: 1.51 (1.21-1.87), 1.38 (1.24-1.53), CB: 1.96 (1.57-2.45), 1.35 (1.20-1.52) and emphysema: 1.25 (0.85-1.82), 1.31 (1.10-1.56). Population attributable risks for any RDs associated with a history of smoking were 19%, 30%, and 26% for those with Type 1, Type 2, and no diabetes respectively.

CONCLUSIONS

Diabetes, more so in T1D, appears to increase RD risk. Smoking is an important risk factor, but not as informative in Type 1 diabetes.

Morbidity and mortality in young-onset type 2 diabetes in comparison to type 1 diabetes: where are we now?

Increasingly, we recognise that type 2 diabetes in youth is a disease with an aggressive time course and a significant complication risk. On the other hand, outcomes for youth with type 1 diabetes appear generally to be improving. With increasing numbers of both types of diabetes in youth, it is timely that a comparative perspective is offered to help clinicians prognosticate more appropriately. Contemporary comparative studies add a new perspective to a consistent story, that for youth-onset type 2 diabetes, the development and progression of cardio-renal complications are increased and the survival prognosis is significantly worse than for type 1 diabetes. Here, we review this mounting evidence, highlight the importance of metabolic syndrome factors in the excess risk and underscore that there remains a significant mortality gap for youth with either type of diabetes, to be addressed as a matter of urgency.

A comparison of all-cause mortality with pioglitazone and insulin in type 2 diabetes: an expanded analysis from a retrospective cohort study

OBJECTIVES

The objectives of this study were to assess and compare all-cause mortality rates between pioglitazone (PIO) and insulin (INS).

RESEARCH DESIGN

The study population included 56,536 patients with type 2 diabetes aged ≥45 years who were first-time users of PIO or INS. Data from 1 May 2000 until 30 June 2010 from the i3 InVision Data Mart database were linked to death records of the US Social Security Administration obtained in March 2012, with approval from the Institutional Review Board and in full compliance with the Health Insurance Portability and Accountability Act of 1996.

MAIN OUTCOME MEASURES

Kaplan-Meier curves were generated and hazard ratios (HRs) were estimated for the occurrence of deaths in the PIO and INS cohorts using Cox proportional hazards models adjusted with inverse probability weights derived from propensity scores.

RESULTS

After adjustment for >40 covariates through inverse probability weights derived from propensity scores, the PIO group showed a significantly lower risk of all-cause mortality (HR 0.33; 95% confidence interval, 0.31, 0.36). The risk of all-cause mortality was also significantly lower in the PIO cohort than the INS cohort among subgroups based on baseline variables such as sex, age (<55 years, ≥55 years), antidiabetic medication use (sulfonylureas or metformin), lipid-altering medication use, and congestive heart failure status. The study has some limitations. Use of a claims database means a potential bias toward a younger cohort. Disease-specific mortality was not identified because of no recorded cause of death. Reliable information regarding the differences in disease deterioration rate and some clinical and lab results were not available, which limits the statistical adjustment of baseline variables.

CONCLUSION

PIO was associated with a lower risk of all-cause mortality than INS.

Premature mortality and comorbidities in young-onset diabetes: a 7-year prospective analysis

BACKGROUND

There is an increasing prevalence of young-onset diabetes, especially in developing areas. We compared the clinical outcomes and predictors for cardiovascular-renal events between Chinese patients with type 2 diabetes with young- or late-onset of disease diagnosed before or after the age of 40 years, respectively.

METHODS

The Hong Kong Diabetes Registry was established in 1995 as an ongoing quality improvement initiative with consecutive enrollment of diabetic patients from ambulatory settings for documentation of risk factors, microvascular and macrovascular complications, and clinical outcomes using a structured protocol.

RESULTS

In 9509 Chinese patients with type 2 diabetes with a median (interquartile range) follow-up period of 7.5 (3.9-10.8) years, 21.3% (n = 2066) had young-onset diabetes. Despite 20 years difference in age, patients with young-onset diabetes (mean age, 41.3 years) had a similar or worse risk profile than those with late-onset disease (mean age, 61.9 years). Compared with the patients with late-onset diabetes, those with young-onset diabetes had lower rates of cardiovascular disease and chronic kidney disease for the same disease duration but a higher cumulative incidence of clinical events at any given age. With the use of stepwise Cox proportional hazard analysis, patients with young-onset diabetes had higher risks for cardiovascular and renal events when adjusted by age, but no difference in risks than in the patients with late-onset diabetes when further adjusted by disease duration.

CONCLUSIONS

Patients with young-onset diabetes had a similar or worse metabolic risk profile compared with those with late-onset disease. This group had higher risks for cardiovascular-renal complications at any given age, driven by longer disease duration.

Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes

OBJECTIVE

To evaluate long-term clinical outcomes and survival in young-onset type 2 diabetes (T2DM) compared with type 1 diabetes (T1DM) with a similar age of onset.

RESEARCH DESIGN AND METHODS

Records from the Royal Prince Alfred Hospital Diabetes Clinical Database, established in 1986, were matched with the Australian National Death Index to establish mortality outcomes for all subjects until June 2011. Clinical and mortality outcomes in 354 patients with T2DM, age of onset between 15 and 30 years (T2DM15-30), were compared with T1DM in several ways but primarily with 470 patients with T1DM with a similar age of onset (T1DM15-30) to minimize the confounding effect of age on outcome.

RESULTS

For a median observation period of 21.4 (interquartile range 14-30.7) and 23.4 (15.7-32.4) years for the T2DM and T1DM cohorts, respectively, 71 of 824 patients (8.6%) died. A significant mortality excess was noted in T2DM15-30 (11 vs. 6.8%, P = 0.03), with an increased hazard for death (hazard ratio 2.0 [95% CI 1.2-3.2], P = 0.003). Death for T2DM15-30 occurred after a significantly shorter disease duration (26.9 [18.1-36.0] vs. 36.5 [24.4-45.4] years, P = 0.01) and at a relatively young age. There were more cardiovascular deaths in T2DM15-30 (50 vs. 30%, P < 0.05). Despite equivalent glycemic control and shorter disease duration, the prevalence of albuminuria and less favorable cardiovascular risk factors were greater in the T2DM15-30 cohort, even soon after diabetes onset. Neuropathy scores and macrovascular complications were also increased in T2DM15-30 (P < 0.0001).

CONCLUSIONS

Young-onset T2DM is the more lethal phenotype of diabetes and is associated with a greater mortality, more diabetes complications, and unfavorable cardiovascular disease risk factors when compared with T1DM.

Linear association between household income and metabolic control in children with insulin-dependent diabetes mellitus despite free access to health care

BACKGROUND

In health care systems with a user fee, the impact of socioeconomic factors on pediatric insulin-dependent diabetes mellitus (IDDM) control could be due to the cost of accessing care.

HYPOTHESIS

There is a linear association between household income and the average glycosylated hemoglobin (HbA1c) of children and adolescents with IDDM despite free access to health care.

METHODS

We used a linear regression model to examine the association between normalized average HbA1c of 1766 diabetic children (diagnosed at our institution from 1980 to 2011 before 17 years of age) and the median household income of their neighborhoods (obtained from Statistics Canada, 2006 Census data).

RESULTS

We found a negative linear association (P < .001; r = -0.2) between the level of income and metabolic control assessed by HbA1c after controlling for sex, age at diagnosis, duration of diabetes, ethnicity, geographical factors, frequency of visits, current age (as a proxy for change in practice over time), and change of measurement methods of HbA1c across time. For every increase of $15,000 in annual income, HbA1c decreased by 0.1%.

CONCLUSION

We report a linear association of household income with metabolic control of IDDM in childhood. Given that Canada has a system of free universal access to health care, confounding by access to care is unlikely. Considering the impact of poorly controlled IDDM in childhood on the development of long-term complications, our findings suggest that the higher complication rate found in adults of low socioeconomic status might originate from the poor control that they experienced in childhood. Support for the care of IDDM children from low-income neighborhoods should be increased.