1
|
Gupta P, Doherty L, Temprosa M, Pop-Busui R, Gadde KM, Singh P, Owora AH, Wessells H, Sarma AV. Prevalence and predictors of female sexual dysfunction among sexually active women in the diabetes prevention program outcomes study. Neurourol Urodyn 2024; 43:977-990. [PMID: 38501372 DOI: 10.1002/nau.25436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To determine the burden and identify correlates of female sexual dysfunction (FSD) among women with prediabetes (PreD) and type 2 diabetes (T2D) enrolled in the Diabetes Prevention Program (DPP) Outcomes Study (DPPOS). METHODS The DPPOS visit included the Female Sexual Function Index (FSFI) to determine sexual function. Of 1464 participants, 1320 (90%) completed the (FSFI) and 426 were sexually active. A backward selection multivariable logistic regression model estimated the odds of FSD for sociodemographic, clinical, and diabetes-related covariates. RESULTS One hundred and eighty-five (43%) had a score of ≤26.55 and met the criteria for FSD. After adjustment for DPP treatment and age, urinary incontinence (UI) (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.15-3.17) and hysterectomy (OR = 1.89, 95% CI = 1.01-3.53) were associated with increased odds of FSD. Increased body mass index was protective for FSD (OR = 0.93 per kg/m2, 95% CI = 0.89-0.96). Michigan Neuropathy Screening Instrument-based peripheral neuropathy (mean±SD scores 1.1±1.3 vs. 0.9±1.1, p < 0.0001) and Electrocardiogram (ECG)-based autonomic dysfunction measures (mean ± SD heart rate levels 64.3 ± 6.8 vs. 65.6 ± 10.2, p = 0.008) were associated with FSD. There were no differences in diabetes rates between women who did (66.5%) and did not (66%) have (p = 0.7). CONCLUSIONS FSD is prevalent in women with PreD and T2D. Our findings suggest that FSD is associated with neuropathic complications commonly observed in PreD and T2D.
Collapse
Affiliation(s)
- Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsay Doherty
- Department of Biostatistics and Bioinformatics, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Marinella Temprosa
- Department of Biostatistics and Bioinformatics, Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine, Orange, California, USA
| | - Prachi Singh
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Arthur H Owora
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Hunter Wessells
- Department of Urology and Diabetes, Research Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Aruna V Sarma
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
2
|
Graffy P, Zimmerman L, Luo Y, Yu J, Choi Y, Zmora R, Lloyd-Jones D, Allen NB. Longitudinal clustering of Life's Essential 8 health metrics: application of a novel unsupervised learning method in the CARDIA study. J Am Med Inform Assoc 2024; 31:406-415. [PMID: 38070172 PMCID: PMC10797259 DOI: 10.1093/jamia/ocad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE Changes in cardiovascular health (CVH) during the life course are associated with future cardiovascular disease (CVD). Longitudinal clustering analysis using subgraph augmented non-negative matrix factorization (SANMF) could create phenotypic risk profiles of clustered CVH metrics. MATERIALS AND METHODS Life's Essential 8 (LE8) variables, demographics, and CVD events were queried over 15 ears in 5060 CARDIA participants with 18 years of subsequent follow-up. LE8 subgraphs were mined and a SANMF algorithm was applied to cluster frequently occurring subgraphs. K-fold cross-validation and diagnostics were performed to determine cluster assignment. Cox proportional hazard models were fit for future CV event risk and logistic regression was performed for cluster phenotyping. RESULTS The cohort (54.6% female, 48.7% White) produced 3 clusters of CVH metrics: Healthy & Late Obesity (HLO) (29.0%), Healthy & Intermediate Sleep (HIS) (43.2%), and Unhealthy (27.8%). HLO had 5 ideal LE8 metrics between ages 18 and 39 years, until BMI increased at 40. HIS had 7 ideal LE8 metrics, except sleep. Unhealthy had poor levels of sleep, smoking, and diet but ideal glucose. Race and employment were significantly different by cluster (P < .001) but not sex (P = .734). For 301 incident CV events, multivariable hazard ratios (HRs) for HIS and Unhealthy were 0.73 (0.53-1.00, P = .052) and 2.00 (1.50-2.68, P < .001), respectively versus HLO. A 15-year event survival was 97.0% (HIS), 96.3% (HLO), and 90.4% (Unhealthy, P < .001). DISCUSSION AND CONCLUSION SANMF of LE8 metrics identified 3 unique clusters of CVH behavior patterns. Clustering of longitudinal LE8 variables via SANMF is a robust tool for phenotypic risk assessment for future adverse cardiovascular events.
Collapse
Affiliation(s)
- Peter Graffy
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Lindsay Zimmerman
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Yuan Luo
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Jingzhi Yu
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Yuni Choi
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, United States
| | - Rachel Zmora
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Norrina Bai Allen
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, United States
| |
Collapse
|
3
|
Wang C, Xin Q, Zheng M, Liu S, Yao S, Li Y, Tian L, Feng Z, Wang M, Zhao M, Chen S, Wu S, Xue H. Association of Resting Heart Rate Trajectories With Cardiovascular Disease and Mortality in Patients With Diabetes Mellitus. J Clin Endocrinol Metab 2023; 108:2981-2989. [PMID: 37084400 DOI: 10.1210/clinem/dgad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
CONTEXT Longitudinal patterns of resting heart rate (RHR) in patients with diabetes mellitus and their association with health outcomes are not well-characterized. OBJECTIVE We sought to explore the RHR trajectories in patients with diabetes mellitus and their association with cardiovascular disease (CVD) and all-cause mortality. DESIGN The Kailuan Study is a prospective cohort study. Participants underwent health examinations biennially starting in 2006 and were followed until December 31, 2020. SETTING General community. PARTICIPANTS A total of 8218 diabetic participants who attended at least 3 of the examinations conducted in 2006, 2008, 2010, and 2012 were included. MAIN OUTCOME MEASURES CVD and all-cause mortality. RESULTS We identified 4 RHR trajectories in participants with diabetes mellitus between 2006 and 2012: low-stable (range, 66.83-64.91 beats/min; n = 1705), moderate-stable (range, 76.30-76.95 beats/min; n = 5437), high-decreasing (mean decreased from 92.14 to 85.60 beats/min; n = 862), and high-increasing (mean increased from 84.03 to 111.62 beats/min; n = 214). During an average follow-up of 7.25 years, 977 cases of CVD and 1162 deaths were identified. Compared with the low-stable trajectory, adjusted hazard ratios (HRs) for CVD were 1.48 (95% CI, 1.02-2.14; P = .04) for the high-increasing trajectory, adjusted HRs for all-cause mortality were 1.34 (95% CI, 1.14-1.58; P < .01) for the moderate-stable trajectory, 1.68 (95% CI, 1.35-2.10; P < .01) for the high-decreasing trajectory, and 2.47 (95% CI, 1.85-3.31; P < .01) for the high-increasing trajectory. CONCLUSIONS RHR trajectories were associated with the subsequent risks of CVD and all-cause mortality in patients with diabetes mellitus.
Collapse
Affiliation(s)
- Chi Wang
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Qian Xin
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Mengyi Zheng
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Shihe Liu
- Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China
| | - Siyu Yao
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Yanjie Li
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Lu Tian
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Zekun Feng
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Miao Wang
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Maoxiang Zhao
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China
| | - Hao Xue
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| |
Collapse
|
4
|
Rasmussen VF, Thrysøe M, Nyengaard JR, Tankisi H, Karlsson P, Hansen J, Krogh K, Brock C, Kamperis K, Madsen M, Singer W, Vestergaard ET, Kristensen K, Terkelsen AJ. Neuropathy in adolescents with type 1 diabetes: Confirmatory diagnostic tests, bedside tests, and risk factors. Diabetes Res Clin Pract 2023; 201:110736. [PMID: 37276985 DOI: 10.1016/j.diabres.2023.110736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
AIMS To estimate the prevalence of large fiber (LFN), small fiber (SFN), and autonomic neuropathy in adolescents with type 1 diabetes using confirmatory tests known from adults and to identify risk factors and bedside methods for neuropathy. METHODS Sixty adolescents with type 1 diabetes (diabetes duration > five years) and 23 control subjects underwent neurological examination and confirmatory diagnostic tests for neuropathy, including nerve conduction studies, skin biopsies determining intraepidermal nerve fiber density, quantitative sudomotor axon reflex test (QSART), cardiovascular reflex tests (CARTs), and tilt table test. Possible risk factors were analyzed. Bedside tests (biothesiometry, DPNCheck®, Sudoscan, and Vagus®device) were compared with the confirmatory tests using ROC analysis. RESULTS The prevalence of neuropathies in the adolescents with diabetes (mean HbA1c 7.6% (60 mmol/mol)) was as follows: 14% confirmed/26% subclinical LFN, 2% confirmed/25% subclinical SFN, 20% abnormal QSART, 8% abnormal CARTs, and 14% orthostatic hypotension. Higher age, higher insulin dose, previous smoking, and higher triglycerides level were found to increase the relative risk for neuropathy. The bedside tests showed poor to acceptable concordance with the confirmatory tests (all, AUC ≤ 0.75). CONCLUSIONS The diagnostic tests confirmed the presence of neuropathy in adolescents with diabetes and underscore the importance of prevention and screening.
Collapse
Affiliation(s)
- Vinni Faber Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark.
| | - Mathilde Thrysøe
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Randel Nyengaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Neurophysiology, Department of Clinical Medicine, Aarhus University, Denmark
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - John Hansen
- Institute of Health Science and Technology, Aalborg University, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Christina Brock
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Konstantinos Kamperis
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Mette Madsen
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Denmark; Steno Diabetes Center North Denmark, Aalborg, Denmark
| | | | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
5
|
Kuo YW, Lee JD, Lee CP, Huang YC, Lee M. Association between initial in-hospital heart rate and glycemic control in patients with acute ischemic stroke and diabetes mellitus. BMC Endocr Disord 2023; 23:69. [PMID: 36991469 PMCID: PMC10054020 DOI: 10.1186/s12902-023-01325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND A high resting heart rate (HR) has been associated with an increased risk of diabetes mellitus. This study explored the association between initial in-hospital HR and glycemic control in patients with acute ischemic stroke (AIS) and diabetes mellitus. METHODS We analyzed data from 4,715 patients with AIS and type 2 diabetes mellitus enrolled in the Chang Gung Research Database between January 2010 and September 2018. The study outcome was unfavorable glycemic control, defined as glycated hemoglobin (HbA1c) ≥ 7%. In statistical analyses, the mean initial in-hospital HR was used as both a continuous and categorical variable. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression analysis. The associations between the HR subgroups and HbA1c levels were analyzed using a generalized linear model. RESULTS Compared with the reference group (HR < 60 bpm), the adjusted ORs for unfavorable glycemic control were 1.093 (95% CI 0.786-1.519) for an HR of 60-69 bpm, 1.370 (95% CI 0.991-1.892) for an HR of 70-79 bpm, and 1.608 (95% CI 1.145-2.257) for an HR of ≥ 80 bpm. Even after adjusting for possible confounders, the HbA1c levels after admission and discharge among diabetic stroke patients increased significantly in the subgroups with higher HRs (p < 0.001). CONCLUSIONS High initial in-hospital HR is associated with unfavorable glycemic control in patients with AIS and diabetes mellitus, particularly in those with an HR of ≥ 80 bpm, compared with those with an HR of < 60 bpm.
Collapse
Affiliation(s)
- Ya-Wen Kuo
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
- Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 613, Chiayi, Taoyuan, Taiwan (R.O.C.).
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 613, Chiayi, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd., Puzi City, Chiayi County 613, Chiayi, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
6
|
Bloomgarden Z. Developments in type 1 and type 2 diabetes. J Diabetes 2021; 13:530-531. [PMID: 33855791 DOI: 10.1111/1753-0407.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Zachary Bloomgarden
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|