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Fan YP, Lai TH, Lai JN, Yang CC. Impacts of medication adherence and home healthcare on the associations between polypharmacy and the risk of severe hypoglycemia among elderly diabetic patients in Taiwan from 2002 to 2012: A nationwide case-crossover study. Geriatr Nurs 2024; 58:8-14. [PMID: 38729064 DOI: 10.1016/j.gerinurse.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024]
Abstract
AIM To assess how medication adherence and home healthcare support influence the role of polypharmacy in induced hypoglycemia events among elderly diabetic patients. METHODS This case-crossover study retrieved records on diabetic patients >=65 years with severe hypoglycemia from 2002 to 2012 in Taiwan. Case period defined as 1-3 days before severe hypoglycemia was compared with a preceding control period of the same length, with an all-washout period of 30 days. Moreover, the modifiable effects of medication adherence and home healthcare service use were evaluated by stratified analysis. RESULTS Totally 2,237 patients were identified. Polypharmacy use was associated with the risk of severe hypoglycemia. Patients receiving polypharmacy without home healthcare services (aOR: 1.34; 95 % CI: 1.16-1.54) and those with poor adherence to anti-diabetic medications (aOR: 1.48; 95 % CI: 1.24-1.77) were significantly associated with an elevated risk of severe hypoglycemia. In patients with good adherence, non-home healthcare users being prescribed with polypharmacy had a higher risk of severe hypoglycemia. In the group that received home healthcare services, patients with poor adherence using polypharmacy had a higher risk of severe hypoglycemia. CONCLUSIONS Good adherence and receiving home healthcare services were associated with a decreased odds of severe hypoglycemic events in elderly diabetic patients, regardless of the fact whether they were prescribed with polypharmacy.
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Affiliation(s)
- Yu-Pei Fan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, Department of Medical Education; MacKay Memorial Hospital, Taipei, Taiwan
| | - Tzu-Hsuan Lai
- Traditional Chinese Medicine-Acupuncture Program, College of Traditional Chinese Medicine Practitioners and Acupuncturists, Kwantlen Polytechnic University, Richmond, Canada
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, Departments of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Chen-Chang Yang
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, Department of Medical Education; Institute of Environmental and Occupational Health Sciences, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
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2
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Sun M, Yan G, Sun S, Li X, Sun W, Wang Y. Malondialdehyde and Zinc May Relate to Severity of Microvascular Complications in Diabetes: A Preliminary Study on Older Adults with Type 2 Diabetes Mellitus in Northeast China. Clin Interv Aging 2024; 19:1141-1151. [PMID: 38948168 PMCID: PMC11214795 DOI: 10.2147/cia.s464615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
Background Serum trace elements and oxidative stress factors are related to diabetic microvascular complications. The study was to investigate the complex relationship between trace elements, oxidative stress factors, and the severity of microvascular complications of diabetes in older adults. Methods The present study included patients with or without type 2 diabetes, and blood glucose, blood lipids, trace elements (iron, magnesium, zinc), oxidative stress factors (malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), and total antioxidant capacity (T-AOC)) were evaluated. Risk factors for the severity of diabetic microvascular complications in older adults with diabetes were also estimated. Results There were statistically significant differences in fasting blood glucose (FBG), triglycerides (TG), low density lipoprotein (LDL), glycated hemoglobin (HbAlc), MDA, NO, SOD, T-AOC, magnesium, and zinc between the two groups (P<0.05). Iron (rZinc = 0.147, rSOD = 0.180, rT-AOC = 0.193, P < 0.05) was positively correlated with zinc, SOD and T-AOC. Iron was negatively correlated with MDA (rMDA = -0.146, P < 0.05). Magnesium was positively correlated with SOD (rMagnesium = 0.147, P < 0.05). Zinc (rSOD = 0.616, rT-AOC = 0.575, P < 0.01) was positively correlated with SOD and T-AOC. Zinc (rMDA =-0.636, rNO=-0.616, P<0.01) was positively correlated with MDA and negatively correlated with NO. The course of disease (18.653, [5.726; 60.764], P <0.01), FBG (1.265, [1.059; 1.511], P <0.05), HbAlc (1.545, [1.431; 1.680], P <0.01), MDA (2.989, [1.900; 4.702], P <0.01) were risk factor for the severity of diabetic microvascular complications. Zinc (0.680, [0.503; 0.919], P < 0.05) and SOD (0.820, [0.698; 0.964], P < 0.05) were protective factors for the severity of diabetic microvascular complications. Conclusion Serum trace elements are related to oxidative stress levels in older adults with type 2 diabetes. The more stable trace element in older adults with diabetes, the lower the oxidative stress and the fewer microvascular complications of diabetes.
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Affiliation(s)
- Min Sun
- Department of Geriatrics, The First Hospital of Jilin University, Changchun, People’s Republic of China
| | - Guanchi Yan
- Department of Endocrinology and Metabolism, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, People’s Republic of China
| | - Siming Sun
- Department of Clinical Research, The First Hospital of Jilin University, Changchun, People’s Republic of China
| | - Xiaonan Li
- Department of Geriatrics, The First Hospital of Jilin University, Changchun, People’s Republic of China
| | - Wei Sun
- Education Department, The First Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yuehui Wang
- Department of Geriatrics, The First Hospital of Jilin University, Changchun, People’s Republic of China
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Jaykumar AB, Binns D, Taylor CA, Anselmo A, Birnbaum SG, Huber KM, Cobb MH. WNKs regulate mouse behavior and alter central nervous system glucose uptake and insulin signaling. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.09.598125. [PMID: 38915673 PMCID: PMC11195145 DOI: 10.1101/2024.06.09.598125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Certain areas of the brain involved in episodic memory and behavior, such as the hippocampus, express high levels of insulin receptors and glucose transporter-4 (GLUT4) and are responsive to insulin. Insulin and neuronal glucose metabolism improve cognitive functions and regulate mood in humans. Insulin-dependent GLUT4 trafficking has been extensively studied in muscle and adipose tissue, but little work has demonstrated either how it is controlled in insulin-responsive brain regions or its mechanistic connection to cognitive functions. In this study, we demonstrate that inhibition of WNK (With-No-lysine (K)) kinases improves learning and memory in mice. Neuronal inhibition of WNK enhances in vivo hippocampal glucose uptake. Inhibition of WNK enhances insulin signaling output and insulin-dependent GLUT4 trafficking to the plasma membrane in mice primary neuronal cultures and hippocampal slices. Therefore, we propose that the extent of neuronal WNK kinase activity has an important influence on learning, memory and anxiety-related behaviors, in part, by modulation of neuronal insulin signaling.
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Affiliation(s)
- Ankita B. Jaykumar
- Departments of Pharmacology, UT Southwestern Medical Center, Dallas, USA
| | - Derk Binns
- Departments of Pharmacology, UT Southwestern Medical Center, Dallas, USA
| | - Clinton A. Taylor
- Departments of Pharmacology, UT Southwestern Medical Center, Dallas, USA
| | - Anthony Anselmo
- Departments of Pharmacology, UT Southwestern Medical Center, Dallas, USA
| | - Shari G. Birnbaum
- Departments of Peter O’Donnell Jr. Brain Institute and Psychiatry, UT Southwestern Medical Center, Dallas, USA
| | | | - Melanie H. Cobb
- Departments of Pharmacology, UT Southwestern Medical Center, Dallas, USA
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Vezza T, Víctor VM. SIRT1 and miR-34a-5p: Valuable Biomarkers for the Early Detection of Cognitive Impairment in Type 2 Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:e1546-e1547. [PMID: 38104246 DOI: 10.1210/clinem/dgad740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Teresa Vezza
- Servicio de Digestivo, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - Víctor M Víctor
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain
- Department of Physiology, University of Valencia, INCLIVA, 46010 Valencia, Spain
- CIBERehd-Department of Pharmacology, University of Valencia, 46010 Valencia, Spain
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Albai O, Timar B, Braha A, Timar R. Predictive Factors of Anxiety and Depression in Patients with Type 2 Diabetes Mellitus. J Clin Med 2024; 13:3006. [PMID: 38792547 PMCID: PMC11122043 DOI: 10.3390/jcm13103006] [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: 04/11/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Diabetes mellitus (DM) is a chronic condition associated with multiple complications and comorbidities. Some of these comorbidities are anxiety and depression, with a negative impact on the quality of life, non-adherence to treatment, and poor prognosis. The main aim of this study was to evaluate depression and anxiety in a group of patients with DM and their impact on quality of life and identify factors that improve the prognosis and increase the life expectancy and quality of life of patients with DM. Methods: A total of 209 patients with type 2 DM (T2DM) were enrolled cross-sectionally. Patients were screened for psychiatric disorders, cognitive impairment, and metabolic parameters. Results: Included patients had a median age of 66.0 (58; 70) years, a median DM duration of 9 (6; 15) years, and a suboptimal glycemic control reflected by a median HbA1c of 7.8 (7; 9.2) mg/dL. Patients presented anxiety at different stages in 51.5% of cases, and similarly, depression in 37.5% of cases. Age, duration of DM, HbA1c, and postprandial hyperglycemia (PPG) were predictive factors for anxiety and depression in patients with T2DM. An age > 57 years (sensitivity 84.3, specificity 33.7, AUROC 0.621, p = 0.002) and an HbA1c > 8.5% (sensitivity 45.8, specificity 83.1, AUROC = 0.635, p < 0.0001) predict a higher rate of anxiety, respectively, of depression in these patients. Conclusions: Patients with T2DM have an increased rate of anxiety and depression due to persistent hyperglycemia and aging, which is expressed in a lower quality of life.
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Affiliation(s)
- Oana Albai
- Department of Second Internal Medicine Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (A.B.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease/MOL-NEPHRO-VASC, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Timar
- Department of Second Internal Medicine Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (A.B.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease/MOL-NEPHRO-VASC, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adina Braha
- Department of Second Internal Medicine Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (A.B.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
| | - Romulus Timar
- Department of Second Internal Medicine Diabetes, Nutrition, Metabolic Diseases, and Systemic Rheumatology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.A.); (A.B.); (R.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases Clinic, “Pius Brînzeu” Emergency Clinical County University Hospital, 300723 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease/MOL-NEPHRO-VASC, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Prasanna Kumar KM, Chowdhury S, Bantwal G, Unnikrishnan AG, Kalra S, Aggarwal S, Singh AK, Pandit K, Shukla R, Vishwanathan V, Khobragade K, Sarda PS. Insulin Access Enhancement in India: Expert Views on Integrating Interchangeable Biosimilar Insulin Glargine. Cureus 2024; 16:e60983. [PMID: 38910730 PMCID: PMC11193911 DOI: 10.7759/cureus.60983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Achieving and maintaining optimal glycemic targets is the fundamental goal of the management of diabetes. However, failure of oral antidiabetic drugs (OADs) to sustain the targeted glycemic levels in individuals with progressing disease often requires initiation of insulin therapy. This article consolidates the expert opinions of 377 doctors who participated in 34 advisory board meetings held digitally (n=23) and in person (n=11) across India. The present report underscores the need for readily available alternatives, such as biosimilar insulins, in the Indian healthcare market to make insulin accessible to every patient with diabetes. The introduction of biosimilar insulins in the Indian healthcare market is the key to making insulin accessible to every patient with diabetes. Biosimilars are biologic products that closely resemble reference/originator biologics and demonstrate no clinically meaningful differences in safety and effectiveness. The concept of interchangeability serves as a pivotal differentiator for biosimilars, underlining their reliability and safety, and plays a significant role in their broader acceptance and integration into healthcare systems. The 'interchangeability' designation by the United States Food and Drug Administration (USFDA) elevates the biosimilar concept, promoting faster and broader adoption of insulin biosimilars, especially benefiting patients prone to non-adherence to insulin therapy. Healthcare providers are encouraged to consider the option of initiating or transitioning to biosimilar insulin glargine to address the insulin accessibility challenges.
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Affiliation(s)
- K M Prasanna Kumar
- Department of Endocrinology, Center For Diabetes and Endocrine Care (CDEC), Bengaluru, IND
| | | | - Ganapathi Bantwal
- Endocrinology and Diabetes, St. John's Medical College Hospital, Bengaluru, IND
| | | | - Sanjay Kalra
- Endocrinology, Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, IND
| | - Sameer Aggarwal
- Endocrinology, Apex Plus Superspeciality Hospital, Rohtak, IND
| | | | - Kaushik Pandit
- Endocrinology, Diabetes and Metabolism, Fortis Medical Centre, Kolkata, IND
| | - Rishi Shukla
- Endocrinology, Center For Diabetes and Endocrine Disease, Kanpur, IND
| | - Vijay Vishwanathan
- Diabetology, M. Viswanathan (MV) Hospital for Diabetes, Chennai, IND
- Diabetology, Prof. M. Viswanathan Diabetes Research Centre, Chennai, IND
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7
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Miao W, Lu Y, Xv H, Zheng C, Yang W, Qian X, Chen J, Geng G. Study protocol for a prediction model for mild cognitive impairment in older adults with diabetes mellitus and construction of a nurse-led screening system: a prospective observational study. BMJ Open 2024; 14:e075466. [PMID: 38326248 PMCID: PMC10860066 DOI: 10.1136/bmjopen-2023-075466] [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: 05/09/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION With an increasing number of older adults in China, the number of people with cognitive impairment is also increasing. To decrease the risk of dementia, it is necessary to timely detect mild cognitive impairment (MCI), which is the preliminary stage of dementia. The prevalence of MCI is relatively high among older adults with diabetes mellitus (DM); however, no effective screening strategy has been designed for this population. This study will construct a nurse-led screening system to detect MCI in community-dwelling older adults with DM in a timely manner. METHODS AND ANALYSIS A total of 642 participants with DM will be recruited (n=449 for development, n=193 for validation). The participants will be divided into MCI and none-MCI groups. The candidate predictors will include demographic variables, lifestyle factors, history of diseases, physical examinations, laboratory tests and neuropsychological tests. Univariate analysis, least absolute shrinkage and selection operator regression screening, and multivariate logistic regression analysis will be conducted to identify the outcome indicators. Based on the multivariate logistic regression equation, we will develop a traditional model as a comparison criterion for the machine learning models. The Hosmer-Lemeshow goodness-of-fit test and calibration curve will be used to evaluate the calibration. Sensitivity, specificity, area under the curves and clinical decision curve analysis will be performed for all models. We will report the sensitivity, specificity, area under the curve and decision curve analysis of the validation dataset. A prediction model with better performance will be adopted to form the nurse-led screening system. ETHICS AND DISSEMINATION This prospective study has received institutional approval of the Medical Ethics Committee of Qidong Hospital of TCM (QDSZYY-LL-20220621). Study results will be disseminated through conference presentations, Chinese Clinical Trial Registry and publication. TRIAL REGISTRATION NUMBER ChiCTR2200062855.
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Affiliation(s)
- Weiwei Miao
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Yanling Lu
- Qidong Hospital of TCM, Nantong, Jiangsu, China
| | - Honglian Xv
- Nantong Shibei Nursing Home, Nantong, Jiangsu, China
| | - Chen Zheng
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Wenwen Yang
- Medical School, Nantong University, Nantong, Jiangsu, China
| | - Xiangyun Qian
- Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
| | - Jianqun Chen
- Nantong Shibei Nursing Home, Nantong, Jiangsu, China
| | - Guiling Geng
- Medical School, Nantong University, Nantong, Jiangsu, China
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8
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Kim M, Kim B, Park S. Social Support, eHealth Literacy, and mHealth Use in Older Adults With Diabetes: Moderated Mediating Effect of the Perceived Importance of App Design. Comput Inform Nurs 2024; 42:136-143. [PMID: 38129323 DOI: 10.1097/cin.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Mobile healthcare has emerged as a prominent technological solution for self-management of health. However, the development and utilization of tailored mobile healthcare applications for older adults with diabetes mellitus remain limited. This study examined the relationship between social support and mobile healthcare use and further explored how this relationship varies with eHealth literacy and application design among older adults with diabetes mellitus. A descriptive cross-sectional trial was conducted with a structured self-report questionnaire, surveying 252 South Korean older adults with diabetes mellitus via offline and online modes. The mediating effect and moderated mediating effect were analyzed with the PROCESS macro of SPSS. eHealth literacy mediated the relationship between social support and mobile healthcare use. High levels of eHealth literacy and social support may increase mobile healthcare use among older adults with diabetes. Application design aesthetics facilitated mobile healthcare use. Future researchers, healthcare providers, and developers can contribute to the development of tailored mobile healthcare applications for older adults with diabetes mellitus by considering application design aspects such as font size, color, and menu configuration.
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Affiliation(s)
- Minjin Kim
- Author Affiliations: Graduate School of Information (Ms Kim) and Graduate School of Information (Dr Kim), Yonsei University; and College of Nursing, Hanyang University (Dr Park), Seoul, South Korea
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Bernstein S, Gilson S, Zhu M, Nathan AG, Cui M, Press VG, Shah S, Zarei P, Laiteerapong N, Huang ES. Diabetes Life Expectancy Prediction Model Inputs and Results From Patient Surveys Compared With Electronic Health Record Abstraction: Survey Study. JMIR Aging 2023; 6:e44037. [PMID: 37962566 PMCID: PMC10662674 DOI: 10.2196/44037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/13/2023] [Accepted: 09/19/2023] [Indexed: 11/15/2023] Open
Abstract
Background Prediction models are being increasingly used in clinical practice, with some requiring patient-reported outcomes (PROs). The optimal approach to collecting the needed inputs is unknown. Objective Our objective was to compare mortality prediction model inputs and scores based on electronic health record (EHR) abstraction versus patient survey. Methods Older patients aged ≥65 years with type 2 diabetes at an urban primary care practice in Chicago were recruited to participate in a care management trial. All participants completed a survey via an electronic portal that included items on the presence of comorbid conditions and functional status, which are needed to complete a mortality prediction model. We compared the individual data inputs and the overall model performance based on the data gathered from the survey compared to the chart review. Results For individual data inputs, we found the largest differences in questions regarding functional status such as pushing/pulling, where 41.4% (31/75) of participants reported difficulties that were not captured in the chart with smaller differences for comorbid conditions. For the overall mortality score, we saw nonsignificant differences (P=.82) when comparing survey and chart-abstracted data. When allocating participants to life expectancy subgroups (<5 years, 5-10 years, >10 years), differences in survey and chart review data resulted in 20% having different subgroup assignments and, therefore, discordant glucose control recommendations. Conclusions In this small exploratory study, we found that, despite differences in data inputs regarding functional status, the overall performance of a mortality prediction model was similar when using survey and chart-abstracted data. Larger studies comparing patient survey and chart data are needed to assess whether these findings are reproduceable and clinically important.
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Affiliation(s)
- Sean Bernstein
- Rush University Medical Center, ChicagoIL, United States
| | - Sarah Gilson
- Section of General Internal Medicine, Department of Medicine, University of Chicago, ChicagoIL, United States
| | - Mengqi Zhu
- Section of General Internal Medicine, Department of Medicine, University of Chicago, ChicagoIL, United States
| | - Aviva G Nathan
- Section of General Internal Medicine, Department of Medicine, University of Chicago, ChicagoIL, United States
| | - Michael Cui
- Rush University Medical Center, ChicagoIL, United States
| | - Valerie G Press
- Section of General Internal Medicine, Department of Medicine, University of Chicago, ChicagoIL, United States
| | - Sachin Shah
- Section of General Internal Medicine, Department of Medicine, University of Chicago, ChicagoIL, United States
| | - Parmida Zarei
- College of Medicine, University of Illinois Chicago, ChicagoIL, United States
| | - Neda Laiteerapong
- Section of General Internal Medicine, Department of Medicine, University of Chicago, ChicagoIL, United States
| | - Elbert S Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, ChicagoIL, United States
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10
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Avnat E, Chodick G, Shalev V. Identifying Profiles of Patients With Uncontrolled Type 2 Diabetes Who Would Benefit From Referral to an Endocrinologist. Endocr Pract 2023; 29:855-861. [PMID: 37595841 DOI: 10.1016/j.eprac.2023.08.002] [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: 06/05/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To compare the outcomes of glycemic uncontrolled diabetes mellitus type 2 patients receiving treatment from endocrinologists with those treated by primary care physicians. Additionally, this research aims to identify patient profiles that would benefit from personalized referral-a novel medical approach that aims to match the most suitable specialist for effectively managing patient while considering the patient's profile. METHODS This retrospective cohort study uses the Maccabi Healthcare Services diabetes registry to match 508 pairs of glycemic uncontrolled diabetes mellitus type 2 patients treated by endocrinologists (EndoG) and primary care physicians (PcPG). Using a generalized additive model, we analyzed the hemoglobin A1c (HbA1c) trend over 1 year for each group. We employed the odds ratio (OR) from conditional logistic regression to determine the likelihood of favorable outcomes in the EndoG compared to the PcPG, using the entire cohort and subcohort profiles. RESULTS The generalized additive model comparison indicated an improvement in HbA1c levels in both groups, with the EndoG outperforming the PcPG. Furthermore, the EndoG group had an OR = 2.27 (95% confidence interval, 1.6 to 3.2) for reducing HbA1c by at least 1% within a year and an OR = 1.68 (95% confidence interval, 1.02 to 2.76) for achieving low-density lipoprotein levels< 100 mg/dl. We identified 96 profiles with positive outcomes, all favoring treatment by endocrinologists. CONCLUSIONS EndoG demonstrated superior HbA1c control over time and achieved better outcomes compared to PcPG. The identification of 96 profiles benefiting from endocrinologist referral emphasizes the potential of personalized referral.
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Affiliation(s)
- Eden Avnat
- School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Gabriel Chodick
- School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Maccabi Data Science Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Varda Shalev
- School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Maccabi Data Science Institute, Maccabi Healthcare Services, Tel Aviv, Israel
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11
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Fløde M, Hermann M, Haugstvedt A, Søfteland E, Igland J, Åsberg A, Jenssen TG, Graue M. High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway. BMC Endocr Disord 2023; 23:218. [PMID: 37817166 PMCID: PMC10566065 DOI: 10.1186/s12902-023-01472-6] [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: 04/22/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND A scoping review from 2021 identified a lack of studies on the incidence, prevention and management of hypoglycaemia in home-dwelling older people with diabetes. The aim of this study was to investigate the frequency and duration of hypoglycaemic episodes measured by continuous glucose monitoring (CGM) in older people with diabetes who received home care and who were treated with glucose-lowering medications, and to compare the frequency and duration of hypoglycaemic episodes between subgroups of the study population according to demographic and clinical variables. METHODS This was an observational study investigating the occurrence of hypoglycaemia in people with diabetes aged ≥ 65 years. Data were collected using blinded continuous glucose monitoring (CGM, iPro2) for 5 consecutive days. Frequency and duration of hypoglycaemic episodes were assessed using a sensor glucose cut-off value of 3.9 mmol/L. A blood sample for measurement of HbA1c and creatinine-based eGFR (CKD-EPI) was obtained during the monitoring period. Demographic and clinical data were collected from electronic patient records. RESULTS Fifty-six individuals were enrolled (median age 82 years and 52% were men). Of the 36 participants who were treated with insulin, 33% had at least one hypoglycaemic episode during the five-day period. Among 18 participants who neither used insulin nor sulfonylurea, but other glucose-lowering medications, 44% had at least one hypoglycaemicepisode. Of those with hypoglycaemic episodes, 86% lived alone. The median duration of the hypoglycaemia was 1 h and 25 min, ranging from 15 min to 8 h and 50 min. CONCLUSION This study identified an unacceptably high number of unknown hypoglycaemic episodes among older home-dwelling people with diabetes receiving home care, even among those not using insulin or sulfonylurea. The study provides essential knowledge that can serve as a foundation to improve the treatment and care for this vulnerable patient group. The routines for glucose monitoring and other prevention tasks need to be considered more comprehensively, also, among those treated with glucose-lowering medications other than insulin.
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Affiliation(s)
- Mari Fløde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Monica Hermann
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway
| | - Trond Geir Jenssen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
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12
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Yi TW, Smyth B, Di Tanna GL, Arnott C, Cardoza K, Kang A, Pollock C, Agarwal R, Bakris G, Charytan DM, de Zeeuw D, Heerspink HJL, Neal B, Wheeler DC, Cannon CP, Zhang H, Zinman B, Perkovic V, Levin A, Mahaffey KW, Jardine M. Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial. Am J Kidney Dis 2023; 82:84-96.e1. [PMID: 36889425 DOI: 10.1053/j.ajkd.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/21/2022] [Indexed: 03/08/2023]
Abstract
RATIONALE & OBJECTIVE It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kidney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study. STUDY DESIGN Secondary analysis of a randomized controlled trial. SETTING & PARTICIPANTS Participants in the CREDENCE trial. INTERVENTION Participants were randomly assigned to receive canagliflozin 100mg/d or placebo. OUTCOMES Primary composite outcome of kidney failure, doubling of serum creatinine concentration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Outcomes were evaluated by age at baseline (<60, 60-69, and≥70 years) and sex in the intention-to-treat population using Cox regression models. RESULTS The mean age of the cohort was 63.0±9.2 years, and 34% were female. Older age and female sex were independently associated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (a composite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.48-0.82], and 0.89 [0.61-1.29] for ages<60, 60-69, and≥70 years, respectively; P=0.3for interaction) or sexes (HRs, 0.71 [95% CI, 0.54-0.95] and 0.69 [0.56-0.84] in women and men, respectively; P=0.8for interaction). No differences in safety outcomes by age group or sex were observed. LIMITATIONS This was a post hoc analysis with multiple comparisons. CONCLUSIONS Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants. FUNDING This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical. TRIAL REGISTRATION The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791.
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Affiliation(s)
- Tae Won Yi
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Department of Medicine, Clinician Investigator Program, University of British Columbia, Vancouver, British Columbia
| | - Brendan Smyth
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, New South Wales, Australia; Department of Renal Medicine, St George Hospital, Kogarah, New South Wales, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia
| | - Clare Arnott
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, New South Wales, Australia
| | - Kathryn Cardoza
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Amy Kang
- Department of Renal Medicine, Prince of Wales Hospital, New South Wales, Australia
| | - Carol Pollock
- Kolling Institute of Medical Research, Sydney Medical School, New South Wales, Australia; Department of Renal Medicine, Royal North Shore Hospital, New South Wales, Australia
| | - Rajiv Agarwal
- Indiana University School of Medicine and VA Medical Center, Indianapolis, IN
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - David M Charytan
- Nephrology Division, New York University Langone Medical Center, New York University School Grossman of Medicine, New York, NY
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Charles Perkins Centre, University of Sydney, New South Wales, Australia; School of Public, Imperial College London, London, United Kingdom
| | - David C Wheeler
- Department of Renal Medicine, University College London Medical School, London, United Kingdom
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Department of Renal Medicine, Royal North Shore Hospital, New South Wales, Australia
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Meg Jardine
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia; Department of Nephrology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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13
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Yin Q, Gao Y, Wang X, Li S, Hou X, Bi W. China should emphasize understanding and standardized management in diabetic cognitive dysfunction. Front Endocrinol (Lausanne) 2023; 14:1195962. [PMID: 37415663 PMCID: PMC10321298 DOI: 10.3389/fendo.2023.1195962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Qingqing Yin
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yan Gao
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xinyu Wang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shangbin Li
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xunyao Hou
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wenkai Bi
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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14
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Kim JL, Lewallen KM, Hollingsworth EK, Shah AS, Simmons SF, Vasilevskis EE. Patient-Reported Barriers and Enablers to Deprescribing Recommendations During a Clinical Trial (Shed-MEDS). THE GERONTOLOGIST 2023; 63:523-533. [PMID: 35881109 PMCID: PMC10028229 DOI: 10.1093/geront/gnac100] [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: 02/28/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Effective deprescribing requires shared decision making between a patient and their clinician, and should be used when implementing evidence-based deprescribing conversations. As part of the Shed-MEDS clinical trial, this study assessed barriers and enablers that influence patient decision making in deprescribing to inform future implementation efforts and adaptations. RESEARCH DESIGN AND METHODS Shed-MEDS, a randomized controlled deprescribing trial, included hospitalized older adults discharging to post-acute care facilities. A trained clinician reviewed each participant's medical history and medication list to identify medications with potential for deprescribing. The study clinician then conducted a semistructured patient-centered deprescribing interview to determine patient (or surrogate) concerns about medications and willingness to deprescribe. Reeve et al.'s (2013) framework was used to categorize barriers and enablers to deprescribing from the patient's perspective, including "appropriateness of cessation," "fear," "dislike of a medication," "influences," and "process of cessation." RESULTS Overall, participants/surrogates (N = 177) agreed with 63% (883 total medications) of the study clinician's deprescribing recommendations. Thematic analysis revealed that "appropriateness" of a medication was the most common barrier (88.2%) and enabler (67.3%) to deprescribing. Other deprescribing enablers were in the following domains: "influences" (22.7%), "process" (22.5%), "pragmatic" (19.4%), and "dislike" (5.3%). DISCUSSION AND IMPLICATIONS Use of a semistructured deprescribing interview conversation tool allowed study clinicians to elicit individual barriers and enablers to deprescribing from the patient's perspective. Participants in this study expressed more agreement than disagreement with study clinicians' deprescribing recommendations. These results should inform future implementation efforts that incorporate a patient-centered framework during deprescribing conversations. CLINICAL TRIALS REGISTRATION NUMBER NCT02979353.
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Affiliation(s)
- Jennifer L Kim
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Kanah M Lewallen
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Emily K Hollingsworth
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Avantika S Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education, & Clinical Center (GRECC), VA Tennessee Healthcare System, Nashville, Tennessee, USA
| | - Eduard E Vasilevskis
- Geriatric Research, Education, & Clinical Center (GRECC), VA Tennessee Healthcare System, Nashville, Tennessee, USA
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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Ortiz-Zuñiga AM, Rojano Toimil A, Rahnama K, Lainez E, Raguer N, Simó-Servat O, Hernández C, Simó R, Ciudin A. Retinal sensitivity and gaze fixation evaluated by microperimetry in subjects with type 2 diabetes: two independent parameters that explore different neuronal circuits. J Endocrinol Invest 2023:10.1007/s40618-023-02046-y. [PMID: 36870015 PMCID: PMC10371889 DOI: 10.1007/s40618-023-02046-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND AIMS Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperimetry are useful and complementary tools for identifying mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D). The hypothesis is that RS and GF examine different neural circuits: RS depends only on the visual pathway while GF reflects white matter complex connectivity networks. The aim of the study is to shed light to this issue by examining the relationship of these two parameters with visual evoked potentials (VEP), the current gold standard to examine the visual pathway. MATERIALS AND METHODS Consecutive T2D patients > 65 years were recruited from the outpatient clinic. Retinal microperimetry (MAIA 3rd generation) and visual evoked potentials (VEP) (Nicolet Viking ED). RS (dB), GF (BCEA63%, BCEA95%) (MAIA) and VEP (Latency P100ms, Amplitude75-100 uV) were analyzed. RESULTS Thirty three patients (45% women, 72.1 ± 4.6 years) were included. VEP parameters significantly correlated with RS but not with GF. CONCLUSIONS These results confirm that RS but not GF depends on the visual pathway, reinforcing the concept that they are complementary diagnostic tools. Used together can further increase the value of microperimetry as screening test for identifying T2D population with cognitive impairment.
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Affiliation(s)
- A M Ortiz-Zuñiga
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - A Rojano Toimil
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - K Rahnama
- Department of Clinical Neurophysiology, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - E Lainez
- Department of Clinical Neurophysiology, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - N Raguer
- Department of Clinical Neurophysiology, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - O Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain
| | - C Hernández
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain
| | - R Simó
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain.
| | - A Ciudin
- Department of Endocrinology and Nutrition, Hospital Universitari Vall Hebron, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5.Pabellón 11, 28029, Madrid, Spain.
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16
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Benefits vs risks: SGLT-2 inhibitors in older adults living with frailty: a retrospective study from a university hospital. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-023-01175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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17
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Christiaens A, Henrard S, Boland B, Sinclair AJ. Overtreatment of older people with type 2 diabetes-a high impact frequent occurrence in need of a new definition. Diabet Med 2023; 40:e14994. [PMID: 36300647 DOI: 10.1111/dme.14994] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/19/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Diabetes overtreatment is a frequent and major issue in older people with type 2 diabetes but its definition is often inconsistent and may be misleading. This critical review has aimed at examining the definitions of diabetes overtreatment in older people used in research studies. METHODS Studies addressing diabetes overtreatment in people aged 65 or older were identified by searching the PubMed database according to an extensive search equation. RESULTS Twenty-two research studies providing a definition of diabetes overtreatment in people aged were found. Overall, 12 different definitions of diabetes overtreatment were used. All studies defined overtreatment according to a HbA1c threshold (varying from <42 mmol/mol [<6.0%] to <64 mmol/mol [<8%]). Amongst them, 2 definitions had no consideration about glucose-lowering (GL) treatment, 6 required the prescribing of ≥1 GL agent(s), and 4 the prescribing of ≥1 GL agent(s) inducing the high risk of hypoglycaemia (i.e., sulfonylurea(s) or insulin(s)). Only 4 definitions (four studies) were individualised, using varying HbA1c thresholds according to patients' age or health status. CONCLUSIONS Definitions of diabetes overtreatment are heterogeneous across research studies, which is confusing. A standardised definition, based on the individual risk of hypoglycaemia and/or its complications must be promoted in order to bring clarity and greater insight into this field, as well as to improve the quality of management of diabetes in older patients.
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Affiliation(s)
- Antoine Christiaens
- Fund for Scientific Research - FNRS, Brussels, Belgium
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Brussels, Belgium
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université, Paris, France
| | - Séverine Henrard
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Brussels, Belgium
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Benoit Boland
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
- Geriatric medicine, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People (fDROP), London, UK
- King's College, London, UK
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18
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Zhang Y, Yu C, Chen S, Tu Z, Zheng M, Lv J, Wang G, Liu Y, Yu J, Guo Y, Yang L, Chen Y, Guo K, Yang K, Yang H, Zhou Y, Jiang Y, Zhang X, He M, Liu G, Chen Z, Wu T, Wu S, Li L, Pan A. Ideal cardiovascular health and mortality: pooled results of three prospective cohorts in Chinese adults. Chin Med J (Engl) 2023; 136:141-149. [PMID: 36727769 PMCID: PMC10106258 DOI: 10.1097/cm9.0000000000002379] [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: 08/22/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Evidence on the relations of the American Heart Association's ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps. METHODS A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis. RESULTS During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed. CONCLUSIONS ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.
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Affiliation(s)
- Yanbo Zhang
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University Health Science Center, Beijing 100191, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Zhouzheng Tu
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Mengyi Zheng
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University Health Science Center, Beijing 100191, China
| | - Guodong Wang
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Yan Liu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Jiaxin Yu
- Department of Cardiology, Tangshan Worker's Hospital, Tangshan, Hebei 063000, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing 100191, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Kunquan Guo
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442001, China
| | - Kun Yang
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442001, China
| | - Handong Yang
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei 442001, China
| | - Yanfeng Zhou
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yiwen Jiang
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiaomin Zhang
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Meian He
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Gang Liu
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Tangchun Wu
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University Health Science Center, Beijing 100191, China
- Chinese Academy of Medical Sciences, Beijing 100191, China
| | - An Pan
- Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Weng SC, Lin CF, Hsu CY, Lin SY. Effect of frailty, physical performance, and chronic kidney disease on mortality in older patients with diabetes : a retrospective longitudinal cohort study. Diabetol Metab Syndr 2023; 15:7. [PMID: 36650566 PMCID: PMC9843852 DOI: 10.1186/s13098-022-00972-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/24/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Declined renal function is associated with physical function impairment and frailty in a graded fashion. This study aimed to examine the relationship between renal function, frailty and physical performance with mortality in older patients with diabetes, while also determining their combined effects on patient outcome. METHODS A retrospective longitudinal study was conducted in elderly patients with diabetes. Kidney disease staging was based on clinical practice guidelines of the International Society of Nephrology, and chronic kiney disease (CKD) was defined as urinary albumin to creatinine ratio (UACR) > 30 mg/g, persistent reduction in estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2 or both. The modified Rockwood frailty index (RFI) was composed of cumulative health deficits, and physical function was determined by handgrip strength (HGS). Additionally, a timed up and go (TUG) test was assessed at baseline. Kaplan-Meier survival and Cox proportional hazard analyses were used to analyze the association between CKD, frailty, physical function and mortality. RESULTS For the 921 enrolled patients, their mean age was 82.0 ± 6.7 years. After a median 2.92 (interquartile range [IQR] 1.06-4.43) year follow-up, the survival rate was 67.6% and 85.5% in patients with and without CKD, respectively. The mortality hazard ratio (crude HR) with CKD was 5.92 for those with an RFI higher than 0.313 (95% CI 3.44-10.18), 2.50 for a TUG time longer than 21 s (95% CI 1.22-5.13), and 2.67 for an HGS lower than 10.57 kg in females or 20.4 kg in males (95% CI 1.12-6.37). After multivariate adjustment, the mortality hazard ratio for an RFI ≥ 0.313 was 5.34 (95% CI 2.23-12.80) in CKD patients, but not in patients without CKD. In subgroup analysis, patients experiencing CKD and frailty, or physical function impairment, had the lowest survival proportion followed by only frailty/declined physical function, only CKD, without CKD, and non-frailty/non-physical impairment. CONCLUSION CKD, frailty and physical function impairment were all associated with an increased mortality risk in older patients with diabetes, while the combined effects of these 3 factors were seen on patient outcome.
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Affiliation(s)
- Shuo-Chun Weng
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Fu Lin
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Yi Lin
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Center for Geriatrics and Gerontology, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
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20
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Ko C, Wu C, Huang W, Lo YM, Lin S, Wu JS, Huang W, Shen S. Alleviative effects of α‐lipoic acid on muscle atrophy via the modulation of
TNF
‐α/
JNK
and
PI3K
/
AKT
pathways in high‐fat diet and streptozotocin‐induced type 2 diabetic rats. Food Sci Nutr 2023; 11:1931-1939. [PMID: 37051351 PMCID: PMC10084977 DOI: 10.1002/fsn3.3227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023] Open
Abstract
Diabetes mellitus (DM) is often accompanied by clinical complications such as sarcopenia. Previous studies have indicated that oxidative stress and insulin resistance (IR) are highly associated with the pathogenesis of diabetic myopathy. α-lipoic acid (ALA), a potent biological antioxidant, exists abundantly in a variety of plants and vegetables. This study aimed to investigate the ameliorative effect of ALA on muscle atrophy in type 2 diabetic rats induced by high-fat diet feeding (HFD) plus streptozotocin (STZ) injection. The HFD/STZ-induced diabetic rats were orally administered 50, 100, or 200 mg/kg body weight ALA once a day for 13 weeks. The results showed that ALA at the tested concentrations significantly increased the soleus muscle mass and muscle fibers in diabetic rats. Proinflammatory cytokines, such as tumor necrosis factor (TNF)-α, were found to decrease in both the serum and muscle of ALA-treated diabetic rats. ALA significantly reduced the protein-expression levels of phosphorylated c-Jun N-terminal kinase (pJNK)/JNK, forkhead box O3 (FOXO3), and muscle ring-finger protein-1 (Murf1); whereas, it enhanced the protein-expression levels of phosphoinositide 3-kinase (PI3K), phosphorylated protein kinase B (pAKT)/AKT, myogenin determination gene D (MyoD), the mechanistic target of rapamycin (mTOR), and myosin heavy chain (MyHC) in the soleus muscle of diabetic rats. The results from this study suggested that ALA treatment may preserve soleus muscle mass, alleviate muscle atrophy by suppressing the TNF-α/JNK pathway, and ameliorate the PI3K/AKT pathway in HFD/STZ-induced type 2 diabetic rats.
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Affiliation(s)
- Chih‐Yuan Ko
- Department of Clinical Nutrition The Second Affiliated Hospital of Fujian Medical University Quanzhou China
- School of Public Health Fujian Medical University Fuzhou China
- School of Medical Technology and Engineering Fujian Medical University Fuzhou China
| | - Chi‐Hao Wu
- Graduate Program of Nutrition Science National Taiwan Normal University Taipei Taiwan
| | - Wen‐Jian Huang
- School of Public Health Fujian Medical University Fuzhou China
| | | | - Shih‐Xiang Lin
- Graduate Program of Nutrition Science National Taiwan Normal University Taipei Taiwan
| | - James Swi‐Bea Wu
- Graduate Institute of Food Science and Technology National Taiwan University Taipei Taiwan
| | - Wen‐Chung Huang
- Graduate Institute of Health Industry Technology Chang Gung University of Science and Technology Taoyuan Taiwan
| | - Szu‐Chuan Shen
- Graduate Program of Nutrition Science National Taiwan Normal University Taipei Taiwan
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21
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Yang B, Han L, Wang Y, Cheng K. Effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections on glycaemic control among older adults with type 2 diabetes: protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e063161. [PMID: 36631237 PMCID: PMC9835874 DOI: 10.1136/bmjopen-2022-063161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Insulin therapy plays an irreplaceable role in glycaemic control among older adults with type 2 diabetes mellitus (T2DM) and can be administered by either multiple daily injections (MDI) of insulin or by a continuous subcutaneous insulin infusion (CSII) pump. Many clinical trials have compared the effects of CSII pumps and MDI in various diabetic populations, but there has been no systematic review and meta-analysis focusing on older adults with T2DM. This study aims to determine whether the CSII pump is associated with better glycaemic control relative to the MDI in older adults with T2DM. METHODS AND ANALYSIS PubMed, Medline, Cochrane Library, Web of Science core collection, China National Knowledge Infrastructure (CNKI), Wan Fang Database, Chinese Science and Technology Journal Database (VIP) and Chinese Biomedical Literature Database (SinoMed) will be searched from inception to December 2021. Only randomised controlled trials will be included, and the language of the selected studies will be restricted to English and Chinese. Two researchers will independently screen the studies, extract data, assess the risk of bias and evaluate the quality of evidence. Any disagreement will be resolved by consensus or by a third researcher. Data analysis and synthesis will be conducted using RevMan V.5.3. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed, as necessary. ETHICS AND DISSEMINATION As this study will not contain personal information, ethical approval will not be required. The results of the study will be published in a peer-reviewed journal or at relevant conference. PROSPERO REGISTRATION NUMBER CRD42021283729.
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Affiliation(s)
- Bei Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Han
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yin Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kangyao Cheng
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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22
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Nair R, Mody R, Yu M, Cowburn S, Konig M, Prewitt T. Real-World Treatment Patterns of Glucose-Lowering Agents Among Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease or At Risk for Cardiovascular Disease: An Observational, Cross-Sectional, Retrospective Study. Diabetes Ther 2022; 13:1921-1932. [PMID: 36131064 PMCID: PMC9663782 DOI: 10.1007/s13300-022-01320-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There is limited published literature on longitudinal utilization of glucose-lowering agents (GLAs) among patients with type 2 diabetes (T2D) and cardiovascular disease (CVD or risk of CVD). This retrospective, observational study aimed to provide updated evidence on patient characteristics and utilization of GLAs among patients with T2D and CVD or risk of CVD in the United States. METHODS This was a cross-sectional evaluation of patients with T2D aged 50-89 years with annual continuous enrolment in a Medicare Advantage and Prescription Drug plan, identified from administrative claims data (Humana Research Database). Patients with T2D and atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) (CVD cohort), or T2D and an additional CVD risk factor without pre-existing CVD (CVD risk cohort) were identified from 2015 to 2019. Patients were followed from their first observed ASCVD/HF diagnosis or CVD risk factor for each year they were continuously enrolled or until occurrence of a CVD diagnosis (CVD risk cohort only). Use of GLA classes were reported by year, cohort, and age groups (50-64 years and ≥ 65 years). RESULTS The percentage of patients on sodium-glucose co-transporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and GLP-1 RAs with proven cardiovascular benefit, respectively, increased from 2015 to 2019 among ≥ 65 years (CVD cohort: 1.1-3.4%, 1.6-4.0%, and 1.2-3.8%; CVD risk cohort: 1.4-3.7%, 2.0-4.3%, and 1.5-4.1%); and among 50-64 years (CVD cohort: 2.6-7.3%, 4.3-10.1%, and 3.4-9.4%; CVD risk cohort: 3.3-6.8%, 4.6-9.6%, and 3.5-8.9%). CONCLUSIONS Although use of SGLT-2is and GLP-1 RAs increased over time, overall utilization of these agents in patients with T2D and ASCVD/HF or at risk for ASCVD/HF remained low, especially for those aged ≥ 65 years.
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Affiliation(s)
- Radhika Nair
- Humana Healthcare Research, Inc., Louisville, KY, USA
| | - Reema Mody
- Eli Lilly and Company, Indianapolis, IN, USA.
| | - Maria Yu
- Eli Lilly and Company, Indianapolis, IN, USA
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23
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Zhang YB, Pan XF, Lu Q, Wang YX, Geng TT, Zhou YF, Liao LM, Tu ZZ, Chen JX, Xia PF, Wang Y, Wan ZZ, Guo KQ, Yang K, Yang HD, Chen SH, Wang GD, Han X, Wang YX, Yu D, He MA, Zhang XM, Liu LG, Wu T, Wu SL, Liu G, Pan A. Associations of combined healthy lifestyles with cancer morbidity and mortality among individuals with diabetes: results from five cohort studies in the USA, the UK and China. Diabetologia 2022; 65:2044-2055. [PMID: 36102938 PMCID: PMC9633429 DOI: 10.1007/s00125-022-05754-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/30/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Cancer has contributed to an increasing proportion of diabetes-related deaths, while lifestyle management is the cornerstone of both diabetes care and cancer prevention. We aimed to evaluate the associations of combined healthy lifestyles with total and site-specific cancer risks among individuals with diabetes. METHODS We included 92,239 individuals with diabetes but without cancer at baseline from five population-based cohorts in the USA (National Health and Nutrition Examination Survey and National Institutes of Health [NIH]-AARP Diet and Health Study), the UK (UK Biobank study) and China (Dongfeng-Tongji cohort and Kailuan study). Healthy lifestyle scores (range 0-5) were constructed based on current nonsmoking, low-to-moderate alcohol drinking, adequate physical activity, healthy diet and optimal bodyweight. Cox regressions were used to calculate HRs for cancer morbidity and mortality, adjusting for sociodemographic, medical and diabetes-related factors. RESULTS During 376,354 person-years of follow-up from UK Biobank and the two Chinese cohorts, 3229 incident cancer cases were documented, and 6682 cancer deaths were documented during 1,089,987 person-years of follow-up in the five cohorts. The pooled multivariable-adjusted HRs (95% CIs) comparing participants with 4-5 vs 0-1 healthy lifestyle factors were 0.73 (0.61, 0.88) for incident cancer and 0.55 (0.46, 0.67) for cancer mortality, and ranged between 0.41 and 0.63 for oesophagus, lung, liver, colorectum, breast and kidney cancers. Findings remained consistent across different cohorts and subgroups. CONCLUSIONS/INTERPRETATION This international cohort study found that adherence to combined healthy lifestyles was associated with lower risks of total cancer morbidity and mortality as well as several subtypes (oesophagus, lung, liver, colorectum, breast and kidney cancers) among individuals with diabetes.
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Affiliation(s)
- Yan-Bo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong-Fei Pan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Centre, Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Qi Lu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Xiu Wang
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Ting-Ting Geng
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linda M Liao
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zhou-Zheng Tu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun-Xiang Chen
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng-Fei Xia
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen-Zhen Wan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun-Quan Guo
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Kun Yang
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Han-Dong Yang
- Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Shuo-Hua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Guo-Dong Wang
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Xu Han
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yi-Xin Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Centre, Vanderbilt University Medical Centre, Nashville, TN, USA
| | - Mei-An He
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Min Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lie-Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shou-Ling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Ma N, Yu X, Yang T, Zhao Y, Li H. A Hypoglycemia Early Alarm Method for Patients with Type 1 Diabetes Based on Multi-dimensional Sequential Pattern Mining. Heliyon 2022; 8:e11372. [PMID: 36387535 PMCID: PMC9647441 DOI: 10.1016/j.heliyon.2022.e11372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/12/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Hypoglycemia is a limiting factor for blood glucose management. Serious symptoms such as seizures, and coma may occur during severe hypoglycemia, and nocturnal hypoglycemia is particularly dangerous for patients with type 1 diabetes (T1D). An effective early alarm method is essential for hypoglycemia prevention but challenging, as blood glucose is affected by many factors and the hypoglycemia sequence patterns vary from person to person. In this paper, we proposed a hypoglycemia early alarm method for mining the hidden information in blood glucose based on multi-dimensional sequential pattern mining. The blood glucose, meal, and insulin time series information were used to construct a multi-dimensional database, then the UniSeq algorithm was used to extract multi-dimensional hypoglycemia sequence patterns. Hypoglycemia early alarm was realized through pattern matching with real-time blood glucose. The public OhioT1DM dataset was used for performance evaluation. The experiment results were: 75.76% Sensitivity, 75% Precision, 75.38% F1 score, and 25.17 minutes early alarm time. The result verified that multi-dimensional sequential pattern mining can extract more hidden information and demonstrate more potential significance in providing comprehensive diagnosis support for personalized treatment. Furthermore, early alarms for potential hypoglycemia can also reserve sufficient time for blood glucose management.
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25
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Bolli GB, Cheng AYY, Owens DR. Insulin: evolution of insulin formulations and their application in clinical practice over 100 years. Acta Diabetol 2022; 59:1129-1144. [PMID: 35854185 PMCID: PMC9296014 DOI: 10.1007/s00592-022-01938-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
The first preparation of insulin extracted from a pancreas and made suitable for use in humans after purification was achieved 100 years ago in Toronto, an epoch-making achievement, which has ultimately provided a life-giving treatment for millions of people worldwide. The earliest animal-derived formulations were short-acting and contained many impurities that caused adverse reactions, thereby limiting their therapeutic potential. However, since then, insulin production and purification improved with enhanced technologies, along with a full understanding of the insulin molecule structure. The availability of radio-immunoassays contributed to the unravelling of the physiology of glucose homeostasis, ultimately leading to the adoption of rational models of insulin replacement. The introduction of recombinant DNA technologies has since resulted in the era of both rapid- and long-acting human insulin analogues administered via the subcutaneous route which better mimic the physiology of insulin secretion, leading to the modern basal-bolus regimen. These advances, in combination with improved education and technologies for glucose monitoring, enable people with diabetes to better meet individual glycaemic goals with a lower risk of hypoglycaemia. While the prevalence of diabetes continues to rise globally, it is important to recognise the scientific endeavour that has led to insulin remaining the cornerstone of diabetes management, on the centenary of its first successful use in humans.
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Lunati ME, Cimino V, Gandolfi A, Trevisan M, Montefusco L, Pastore I, Pace C, Betella N, Favacchio G, Bulgheroni M, Bucciarelli L, Massari G, Mascardi C, Girelli A, Morpurgo PS, Folli F, Luzi L, Mirani M, Pintaudi B, Bertuzzi F, Berra C, Fiorina P. SGLT2-inhibitors are effective and safe in the elderly: The SOLD study. Pharmacol Res 2022; 183:106396. [PMID: 35970329 DOI: 10.1016/j.phrs.2022.106396] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND AND AIMS Sodium-glucose co-transporter-2 inhibitors (SGLT2i) may have important benefits for the elderly with type 2 diabetes (T2D), however some safety concerns still limit their use in patients over 70 years of age. The SOLD study (SGLT2i in Older Diabetic patients) is a multicenter study, aimed to evaluate the effectiveness and safety of SGLT2i in the older diabetic patients in a real-life setting. MATERIALS AND METHODS We analyzed a population of 739 adults (mean age 75.4 ± 3.9 years, M/F 420/319) with T2D, which started a SGLT2i-based treatment after the age of 70, with at least one year of follow-up. Data were collected at baseline, at 6 and 12 months of follow-up. RESULTS SGLT2i (37.5% Empagliflozin, 35.7% Dapagliflozin, 26.1% Canagliflozin, 0.7% Ertugliflozin) were an add-on therapy to Metformin in 88.6%, to basal insulin in 36.1% and to other antidiabetic drugs in 29.6% of cases. 565 subjects completed the follow up, while 174 (23.5%) discontinued treatment due to adverse events which were SGLT2i related. A statistically significant reduction of glycated hemoglobin (baseline vs 12 months: 7.8 ± 1.1 vs 7.1 ± 0.8%, p < 0.001) and body mass index values (baseline vs 12 months: 29.2 ± 4.7 vs 28.1 ± 4.5 kg/m2, p < 0.001) were evident during follow-up. Overall, estimated glomerular filtration rate remained stable over time, with significant reduction of urinary albumin excretion. In the subgroup of patients which were ≥ 80 years, a significant improvement in glycated hemoglobin values without renal function alterations was evident. Overall discontinuation rate during the follow-up period was different across age groups, being urinary tract infections and worsening of renal function the most common cause. CONCLUSION SGLT2i are well-tolerated and safe in the elderly and appear as an effective therapeutic option, though some caution is also suggested, especially in more fragile subjects.
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Affiliation(s)
| | - Vincenzo Cimino
- Department of Biomedical and Clinical Sciences L. Sacco Endocrinology and Diabetology, Pio Albergo Trivulzio, Milan, Italy
| | | | | | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ida Pastore
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Franco Folli
- Endocrinology and Metabolism, Department of Health Science, Università di Milano, ASST Santi Paolo e Carlo, Milan, Italy
| | - Livio Luzi
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marco Mirani
- IRCCS Humanitas Research Hospital, Milano, Italy
| | | | | | - Cesare Berra
- IRCCS MultiMedica Sesto San Giovanni, Milano, Italy
| | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy; Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Italy.
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27
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Hamrick I, Goblirsch MJ, Tuan WJ, Beckham F. Transitioning from insulin to dipeptidyl-peptidase 4 (DPP-4) inhibitors for type 2 diabetes. Geriatr Nurs 2022; 46:86-89. [DOI: 10.1016/j.gerinurse.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/04/2022]
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28
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Effect of different antidiabetic medications on atherosclerotic cardiovascular disease (ASCVD) risk score among patients with type-2 diabetes mellitus: A multicenter non-interventional observational study. PLoS One 2022; 17:e0270143. [PMID: 35763504 PMCID: PMC9239438 DOI: 10.1371/journal.pone.0270143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The aim of this study was to compare the clinical outcomes associated with different combinations of oral diabetic drugs among patients with type 2 diabetes mellitus.
Method
A prospective multicenter longitudinal, noninterventional observation study design was applied. At baseline (0 month), clinical parameters including glucose profile, renal function, lipid profile and risk assessment for cardiovascular risks were calculated. Mean Weighted difference (MWD) with heterogeneity and effect z was calculated to determine the risk reduction at the end of the study.
Results
A total of 1,657 were enrolled to different cohorts with response rate of 75.5%. The distribution of patients was based on prescribed drug. A total of 513 (30.9%) in G1 (metformin alone), 217 (13.09%) in G2 (metformin with Glimepiride), 231 (12.85%) in G3 (Metformin with Gliclazide), 384 (23.17%) in G4 (metformin with Sitagliptin) and 312 (18.89%) in G5 (Metformin with Saxagliptin). There was no significant different in all clinical and social variables at baseline. The Intergroup analysis showed significant differences with all the primary outcome variables except BMI (p = 0.217) and eGFR (p = 0.782) among patients using sulphonylurea (SU) combination (G2 & G3). Findings also showed significant high frequency of emergency visit and hospitalization in G1 (78.16% & 30.8%) as compared to SU (70.1% & 28.3%, p = 0.001) and DPP-4 (56.6% & 20.4%, p = 0.001). The overall reported effect was z = 2.58, p = 0.001 for ASCVD risk reduction assessment.
Conclusion
The study concluded that significant effect of Dipeptidyl peptidase-4 inhibitor on reduction of hospitalization, lipid profile and also ASCVD risk score of type-II diabetes mellitus patients regardless of clinical comorbidities. Also, sulfonylurea combinations have showed significant reduction in LDL and triglycerides values.
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Yang H, Li J, Liu S, Yang X, Liu J. Predicting Risk of Hypoglycemia in Patients With Type 2 Diabetes by Electronic Health Record-Based Machine Learning: Development and Validation. JMIR Med Inform 2022; 10:e36958. [PMID: 35708754 PMCID: PMC9247813 DOI: 10.2196/36958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/08/2022] [Accepted: 05/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hypoglycemia is a common adverse event in the treatment of diabetes. To efficiently cope with hypoglycemia, effective hypoglycemia prediction models need to be developed. OBJECTIVE The aim of this study was to develop and validate machine learning models to predict the risk of hypoglycemia in adult patients with type 2 diabetes. METHODS We used the electronic health records of all adult patients with type 2 diabetes admitted to West China Hospital between November 2019 and December 2021. The prediction model was developed based on XGBoost and natural language processing. F1 score, area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA) were used as the main criteria to evaluate model performance. RESULTS We included 29,843 patients with type 2 diabetes, of whom 2804 patients (9.4%) developed hypoglycemia. In this study, the embedding machine learning model (XGBoost3) showed the best performance among all the models. The AUC and the accuracy of XGBoost are 0.82 and 0.93, respectively. The XGboost3 was also superior to other models in DCA. CONCLUSIONS The Paragraph Vector-Distributed Memory model can effectively extract features and improve the performance of the XGBoost model, which can then effectively predict hypoglycemia in patients with type 2 diabetes.
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Affiliation(s)
- Hao Yang
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaxi Li
- Department of Clinical Laboratory Medicine, Jinniu Maternity and Child Health Hospital of Chengdu, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Xiaoling Yang
- West China School of Nursing, Endocrinology and Metabolism Department, West China Hospital, Sichuan University, Chengdu, China
| | - Jialin Liu
- Information Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Medical Informatics, West China Medical School, Chengdu, China
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Bellia C, Lombardo M, Meloni M, Della-Morte D, Bellia A, Lauro D. Diabetes and cognitive decline. Adv Clin Chem 2022; 108:37-71. [PMID: 35659061 DOI: 10.1016/bs.acc.2021.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Epidemiologic studies have documented an association between diabetes and increased risk of cognitive decline in the elderly. Based on animal model studies, several mechanisms have been proposed to explain such an association, including central insulin signaling, neurodegeneration, brain amyloidosis, and neuroinflammation. Nevertheless, the exact mechanisms in humans remain poorly defined. It is reasonable, however, that many pathways may be involved in these patients leading to cognitive impairment. A major aim of clinicians is identifying early onset of neurologic signs and symptoms in elderly diabetics to improve quality of life of those with cognitive impairment and reduce costs associated with long-term complications. Several biomarkers have been proposed to identify diabetics at higher risk of developing dementia and diagnose early stage dementia. Although biomarkers of brain amyloidosis, neurodegeneration and synaptic plasticity are commonly used to diagnose dementia, especially Alzheimer disease, their role in diabetes remains unclear. The aim of this review is to explore the molecular mechanisms linking diabetes with cognitive decline and present the most important findings on the clinical use of biomarkers for diagnosing and predicting early cognitive decline in diabetics.
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Affiliation(s)
- Chiara Bellia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy.
| | - Mauro Lombardo
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Rome, Italy
| | - Marco Meloni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - David Della-Morte
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Narindrarangkura P, Boren SA, Khan U, Day M, Simoes EJ, Kim MS. SEE-Diabetes, a patient-centered diabetes self-management education and support for older adults: Findings and information needs from patients' perspectives. Prim Care Diabetes 2022; 16:395-403. [PMID: 35227635 PMCID: PMC9133060 DOI: 10.1016/j.pcd.2022.02.008] [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: 12/02/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
Abstract
AIMS This study identified the information needs of people with diabetes aged 65 and older through surveys and focus groups to inform the development of a patient-centered educational decision aid for diabetes care, SEE-Diabetes (Support-Engage-Empower-Diabetes). METHODS We conducted survey (N = 37) and three focus groups (N = 9). The survey collected demographics, diabetes duration, insulin usage, and clinic notes accessibility through a patient portal. In focus groups, participants evaluated the Assessment and Plan section of three selected deidentified clinic notes to assess readability and helpfulness for diabetes care. RESULTS The mean age of participants was 66 (24-82, SD = 12), and 22 were female (60%). The mean diabetes duration was 20.9 years (1-63, SD=15). Most participants (80%) read their clinical notes via patient portal. In the focus groups, the readability of clinic notes was noted as a primary concern because of medical abbreviations and poor formatting. Participants found the helpfulness of clinic notes was negatively impacted by vague or insufficient self-care information. CONCLUSIONS We found the high use of patient portal for reading clinic notes, which offers a use case opportunity for the proposed SEE-Diabetes educational aid. Feedback about the readability and helpfulness of clinic notes will be considered during the design process.
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Affiliation(s)
- Ploypun Narindrarangkura
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Suzanne A Boren
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Uzma Khan
- Cosmopolitan International Diabetes and Endocrinology Center, University of Missouri, Columbia, 3315 Berrywood Dr, Suite 201, Columbia, MO 65201, United States; Department of Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Margaret Day
- Department of Family and Community Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Eduardo J Simoes
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Min Soon Kim
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
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Ambrož M, de Vries ST, Hoogenberg K, Denig P. Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients With Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020. Front Pharmacol 2022; 13:883103. [PMID: 35645811 PMCID: PMC9133603 DOI: 10.3389/fphar.2022.883103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
Aims: We aimed to assess trends in glycosylated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) thresholds at initiation of glucose- and blood pressure-lowering medication among patients with type 2 diabetes and assess the influence of age and sex on these trends. Materials and Methods: We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients initiating a first non-insulin glucose-lowering or any blood pressure-lowering medication between 2015 and 2020 with an HbA1c or SBP measurement in the 120 days before initiation were included. We used multilevel regression analyses adjusted for potential confounders to assess the influence of calendar year, age or sex, and the interaction between calendar year and age or sex on trends in HbA1c and SBP thresholds at initiation of medication. Results: We included 2,671 and 2,128 patients in the analyses of HbA1c and SBP thresholds, respectively. The overall mean HbA1c threshold at initiation of glucose-lowering medication significantly increased from 7.4% in 2015 to 8.0% in 2020 (p < 0.001), and particularly in the younger age groups. Compared to patients ≥80 years, patients aged 60–69 years initiated medication at lower levels mainly in the early years. Patients <60 years and between 70–79 years initiated medication at similar levels as patients ≥80 years. Females initiated medication at lower levels than males throughout the study period (p < 0.001). The mean SBP threshold at initiation of blood pressure-lowering medication varied from 145 to 149 mmHg without a clear trend (p = 0.676). There were no differences in SBP thresholds between patients of different ages or sex. Conclusion: The rising trend in the HbA1c threshold for initiating glucose-lowering medication in the lower age groups was unexpected and requires further investigation. Males appear to receive less timely initiation of glucose-lowering medication than females. The lack of higher thresholds for the oldest age group or lower thresholds for the youngest age group in recent years is not in line with the age-related recommendations for personalized diabetes care and calls for health systems interventions.
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Affiliation(s)
- Martina Ambrož
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sieta T. de Vries
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Klaas Hoogenberg
- Department of Internal Medicine, Martini Hospital, Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Petra Denig,
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Chang LH, Chu CH, Huang CC, Lin LY. Fibroblast Growth Factor 21 Levels Exhibit the Association With Renal Outcomes in Subjects With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:846018. [PMID: 35528011 PMCID: PMC9069677 DOI: 10.3389/fendo.2022.846018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Whether microalbuminuria predicts renal outcomes in patients with type 2 diabetes mellitus (T2DM) is argued. Fibroblast growth factor 21 (FGF-21) levels were elevated by the pathogenic process of diabetic kidney disease. The purpose of the study was to evaluate the associations of FGF-21 and renal outcomes in subjects with T2DM. Methods Chinese patients with T2DM were enrolled and then observed prospectively, and FGF-21 levels at baseline were measured. The associations of FGF-21 levels and renal composite events, defined by a drop > 30% of eGFR or worsening category of albuminuria, were evaluated using Cox analysis. The appropriate cut-off value of FGF-21 was mapped by the receiver operating characteristic (ROC) curve. Results Among 312 subjects, higher FGF-21 levels were associated with higher risks of renal events in Cox analysis. The area under the curve of FGF-21 levels in the ROC curve was optimal (0.67, p < 0.001), and the cut-off value of 1.40 pg/dl exhibited the best sensitivity (76.2%) and specificity (53.5%). The frequency of renal composite events was higher in subjects with FGF-21 ≥ 1.40 pg/dl than in others (30% vs. 10%, p<0.001 by the log-rank test). The worse renal outcomes predicted by FGF-21 ≥ 1.40 pg/dl were confirmed using the adjustments of Cox sequential models (hazard ratio 2.28, 95% confidence interval 1.23-4.24, p=0.009) and consistent across subjects with different status of baseline characteristics and renal risks. Conclusion FGF-21 levels were proportional to the risks of renal events in broad- spectrum Chinese T2DM subjects, making it a potential biomarker to predict the renal outcomes of T2DM.
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Affiliation(s)
- Li-Hsin Chang
- Division of Endocrinology and Metabolism, Department of Medicine, Yeezen General Hospital, Taoyuan, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Chia-Huei Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei, Taiwan
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Jude EB, Malecki MT, Gomez Huelgas R, Prazny M, Snoek F, Tankova T, Giugliano D, Khunti K. Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes. Diabetes Ther 2022; 13:619-634. [PMID: 35274219 PMCID: PMC8913205 DOI: 10.1007/s13300-022-01222-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/02/2022] [Indexed: 11/03/2022] Open
Abstract
Given the progressive nature of type 2 diabetes (T2D), most individuals with the disease will ultimately undergo treatment intensification. This usually involves the stepwise addition of a new glucose-lowering agent or switching to a more complex insulin regimen. However, complex treatment regimens can result in an increased risk of hypoglycaemia and high treatment burden, which may impact negatively on both therapeutic adherence and overall quality of life. Individuals with good glycaemic control may also be overtreated with unnecessarily complex regimens. Treatment simplification aims to reduce individual treatment burden, without compromising therapeutic effectiveness or safety. Despite data showing that simplifying therapy can achieve good glycaemic control without negatively impacting on treatment efficacy or safety, it is not always implemented in clinical practice. Current clinical guidelines focus on treatment intensification, rather than simplification. Where simplification is recommended, clear guidance is lacking and mostly focused on treatment of the elderly. An expert, multidisciplinary panel evaluated the current treatment landscape with respect to guidance, published evidence, recommendations and approaches regarding simplification of complex insulin regimens. This article outlines the benefits of treatment simplification and provides practical recommendations on simplifying complex insulin treatment strategies in people with T2D using illustrative cases.
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Affiliation(s)
- Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
- University of Manchester, Manchester, UK
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Ricardo Gomez Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Martin Prazny
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Frank Snoek
- Department of Medical Psychology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Dario Giugliano
- Division of Endocrinology and Metabolic Diseases, University Hospital, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.
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Yang Y, Zhao JJ, Yu XF. Expert Consensus on Cognitive Dysfunction in Diabetes. Curr Med Sci 2022; 42:286-303. [PMID: 35290601 DOI: 10.1007/s11596-022-2549-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/02/2022] [Indexed: 12/14/2022]
Abstract
The incidence of diabetes is gradually increasing in China, and diabetes and associated complications, such as cognitive dysfunction have gained much attention in recent time. However, the concepts, clinical treatment, and prevention of cognitive dysfunction in patients with diabetes remain unclear. The Chinese Society of Endocrinology investigated the current national and overseas situation of cognitive dysfunction associated with diabetes. Based on research both in China and other countries worldwide, the Expert Consensus on Cognitive Dysfunction in Diabetes was established to guide physicians in the comprehensive standardized management of cognitive dysfunction in diabetes and to improve clinical outcomes in Chinese patients. This consensus presents an overview, definition and classification, epidemiology and pathogenesis, risk factors, screening, diagnosis, differential diagnosis, treatment, and prevention of cognitive dysfunction in patients with diabetes.
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Affiliation(s)
- Yan Yang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jia-Jun Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 25000, China.
| | - Xue-Feng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Lane W, Favaro E, Jódar E, Kelkar P, Oviedo A, Sivarathinasami R, Senior PA, Sesti G, Franek E. Effective Overall Glycaemic Control with Fast-Acting Insulin Aspart Across Patients with Different Baseline Characteristics: A Post Hoc Analysis of the Onset 9 Trial. Diabetes Ther 2022; 13:761-774. [PMID: 35290624 PMCID: PMC8991309 DOI: 10.1007/s13300-022-01213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/27/2022] [Indexed: 11/03/2022] Open
Abstract
AIMS To investigate the efficacy and safety of fast-acting insulin aspart (faster aspart) compared with insulin aspart (IAsp) in participants with type 2 diabetes (T2D) across different subgroups. METHODS We report on a post hoc analysis of onset 9, a 16-week trial of participants with T2D randomised to faster aspart (n = 546) or IAsp (n = 545). Participants were grouped by baseline HbA1c (< 7.0%, ≥ 7.0%), meal test bolus insulin dose (≤ 10 units [U], > 10 U to ≤ 20 U, > 20 U), body mass index (< 30 kg/m2, ≥ 30 to < 35 kg/m2, ≥ 35 kg/m2), and age (< 65 years, ≥ 65 years). Outcomes assessed were change from baseline in HbA1c and in 1-h postprandial glucose (PPG) increment, and severe or blood glucose (BG)-confirmed hypoglycaemia. RESULTS Faster aspart provided reductions in HbA1c comparable to IAsp across all subgroups, with improved 1-h PPG control compared with IAsp in several subgroups. Faster aspart had comparable or improved rates of severe or BG-confirmed hypoglycaemia versus IAsp, particularly in participants with good glycaemic control (HbA1c < 7.0%), the elderly (≥ 65 years old), and those with insulin resistance (> 20 U meal test bolus insulin dose). CONCLUSIONS Faster aspart provides effective overall glycaemic control, with improved early PPG control compared with IAsp across a range of patient characteristics. CLINICAL TRIAL REGISTRATION NCT03268005.
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Affiliation(s)
- Wendy Lane
- Mountain Diabetes and Endocrine Centre, 1998 Hendersonville Rd, Bldg. 31, Asheville, NC, 28803, USA.
| | | | - Esteban Jódar
- University Hospital Quirón Salud Madrid, Universidad Europea, Madrid, Spain
| | | | - Alejandra Oviedo
- Santojanni Hospital and Cenudiab, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Centralny Szpital Kliniczny MSWiA, Warsaw, Poland
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Shao P, Xu H, Sheng X, Qin R, Ma J, Luo Y, Lee A, Shi L, Huang L, Cheng Y, Zhao H, Xu Y. Lobar Cerebral Microbleeds Are Associated With Cognitive Decline in Patients With Type 2 Diabetes Mellitus. Front Neurol 2022; 13:843260. [PMID: 35401417 PMCID: PMC8990891 DOI: 10.3389/fneur.2022.843260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Combined the number, volume, and location of cerebral microbleeds (CMBs), this study aimed to explore the different features of CMBs and their correlation with cognitive ability in patients with type 2 diabetes mellitus (T2DM). Methods This study recruited 95 patients with T2DM and 80 healthy control (HC) individuals. AccuBrain®, an automated tool, was used to obtain the number and volume of CMBs. The scores on global cognition and five cognitive domains were derived from a battery of cognitive tests. The logistic regression and multivariate linear regression were conducted to determine the relationship between the CMBs (number, volume, and location) and cognitive ability in patients with T2DM. Results After adjusting for several variables, the total volume of CMBs (OR = 0.332, 95%CI: 0.133–0.825, and p = 0.018) was independent risk factor for cognitive impairment, whereas the total number of CMBs was not (OR = 0933, 95%CI: 0.794–1.097, and p = 0.400). Furthermore, the volume of CMBs in lobar regions was independently associated with working memory (β = −0.239, 95%CI: −0.565 to −0.035, and p = 0.027). However, no significant correlation between the number of CMBs (both lobar and deep/infratentorium) and any cognitive domains was observed. Conclusions Lobar CMBs was related with cognitive impairment in patients with T2DM and might be a potential early warning signal. Compared with the counting analysis, the quantitative method offered a more sensitive and objective measurement for studying imaging features of CMBs.
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Affiliation(s)
- Pengfei Shao
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
| | - Hengheng Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
| | - Xiaoning Sheng
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
| | - Junyi Ma
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
| | - Yishan Luo
- BrainNow Research Institute, Shenzhen, China
| | - Allan Lee
- BrainNow Research Institute, Shenzhen, China
| | - Lin Shi
- BrainNow Research Institute, Shenzhen, China
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Lili Huang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
| | - Yue Cheng
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Hui Zhao
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
- *Correspondence: Hui Zhao
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
- Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China
- Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China
- Yun Xu
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Evaluation of knowledge, barriers, and attitudes in the management of type 2 diabetes in elderly patients: A Delphi study on primary and hospital care. Rev Clin Esp 2022; 222:385-392. [PMID: 35300934 DOI: 10.1016/j.rceng.2021.11.007] [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: 05/21/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This work aims to explore attitudes regarding the management of elderly or frail patients with type 2 diabetes mellitus in the routine clinical practice of a multidisciplinary group of physicians in Spain. METHODS A mixed survey was used that included both Delphi and opinion, attitude, and behaviour (OAB) questions. Perceptions in primary care (n = 211) and hospital care (n = 80) were compared. RESULTS Consensus was obtained on all statements. Eighty-seven percent of participants considered that severe psychiatric disorders conditioned antidiabetic treatment and 72% that a psychocognitive assessment is as relevant as the assessment of other comorbidities. Hospital care physicians more frequently considered that comorbidity affects self-care (95.0% vs. 82.9%), that a lack of de-intensification is a form of therapeutic inertia (88.8% vs. 76.3%), that classifying older adults as frail is fundamental to choosing targets (96.3% vs. 87.7%), that de-intensification of antidiabetic treatment and control of cardiovascular risk factors should be considered in those over 80 years of age (90.0% vs. 78.7%), and that type 2 diabetes mellitus predisposes patients to sarcopenia (86.3% vs. 71.6%). The usefulness of clinical guidelines was more highly valued among primary care participants (79.1% vs. 72.5%). CONCLUSIONS There is room for improvement on several aspects of managing elderly or frail patients with type 2 diabetes mellitus, including inertia in treatment de-intensification, conducting a psychocognitive assessment, or the identification of frailty and sarcopenia.
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Shang Y, Wu W, Dove A, Guo J, Welmer AK, Rizzuto D, Fratiglioni L, Xu W. Healthy behaviours, leisure activities, and social network prolong disability-free survival in older adults with diabetes. J Gerontol A Biol Sci Med Sci 2022; 77:2093-2101. [PMID: 35239961 PMCID: PMC9536441 DOI: 10.1093/gerona/glac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background Diabetes has been related to disability and excess mortality. We estimated the extent to which diabetes shortens disability-free survival and identified modifiable factors that may prolong disability-free survival in older adults with diabetes. Methods Disability-free older adults (n = 2 216, mean age: 71 years, female: 61%) were followed for up to 15 years. Diabetes was ascertained through medical examinations, medication use, or glycated hemoglobin ≥6.5% (48 mmol/mol). Disability-free survival was defined as survival until the occurrence of disability. A favorable (vs unfavorable) lifestyle profile was defined as the presence of at least 1 of the following: healthy (vs unhealthy) behaviors, active (vs inactive) engagement in leisure activities, or moderate-to-rich (vs poor) social network. Data were analyzed using Cox regression and Laplace regression. Results During the follow-up, 1 345 (60.7%) participants developed disability or died. Diabetes, but not prediabetes, was related to the outcome (hazard ratio [HR] 1.29, 95% CI 1.06–1.57), and 2.15 (1.02–3.27) years shorter median disability-free survival. In joint exposure analysis, disability-free survival was shortened by 3.29 (1.21–5.36), 3.92 (2.08–5.76), and 1.66 (0.06–3.28) years for participants with diabetes plus unhealthy behaviors, inactive engagement in leisure activities, or poor social network. Among participants with diabetes, a favorable profile led to a nonsignificant HR of 1.19 (0.93–1.56) for disability/death and prolonged disability-free survival by 3.26 (2.33–4.18) years compared to those with an unfavorable profile. Conclusions A healthy and socially active lifestyle may attenuate the risk of diabetes on disability or death and prolong disability-free survival among people with diabetes.
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Affiliation(s)
- Ying Shang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Wei Wu
- School of Laboratory Medicine, Hubei University of Chinese Medicine, 16 Huangjia Lake West Road, Wuhan, China
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jie Guo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Garduno AC, LaCroix AZ, LaMonte MJ, Dunstan DW, Evenson KR, Wang G, Di C, Schumacher BT, Bellettiere J. Associations of Daily Steps and Step Intensity With Incident Diabetes in a Prospective Cohort Study of Older Women: The OPACH Study. Diabetes Care 2022; 45:339-347. [PMID: 35050362 PMCID: PMC8914434 DOI: 10.2337/dc21-1202] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The primary aim was to assess associations between total steps per day and incident diabetes, whereas the secondary aim was to assess whether the intensity and/or cadence of steps is associated with incident diabetes. RESEARCH DESIGN AND METHODS Women without physician-diagnosed diabetes (n = 4,838; mean [SD] age 78.9 [6.7] years) were followed up to 6.9 years; 395 developed diabetes. Hip-worn ActiGraph GT3X+ accelerometers worn for 1 week enabled measures of total, light-intensity, and moderate- to vigorous-intensity (MV-intensity) steps per day. Using Cox proportional hazards analysis we modeled adjusted change in the hazard rate for incident diabetes associated with total, light-intensity, and MV-intensity steps per day. We further estimated the proportion of the steps-diabetes association mediated by BMI. RESULTS On average, participants took 3,729 (SD 2,114) steps/day, of which 1,875 (791) were light-intensity steps and 1,854 ± 1,762 were MV-intensity. More steps per day were associated with a lower hazard rate for incident diabetes. Confounder-adjusted models for a 2,000 steps/day increment yielded hazard ratio (HR) 0.88 (95% CI 0.78-1.00; P = 0.046). After further adjustment for BMI, HR was 0.90 (95% CI 0.80-1.02; P = 0.11). BMI did not significantly mediate the steps-diabetes association (proportion mediated = 17.7% [95% CI -55.0 to 142.0]; P = 0.09]). The relationship between MV-intensity steps per day (HR 0.86 [95% CI 0.74-1.00]; P = 0.04) and incident diabetes was stronger than for light-intensity steps per day (HR 0.97 [95% CI 0.73-1.29]; P = 0.84). CONCLUSIONS These findings suggest that for older adults, more steps per day are associated with lower incident diabetes and MV-intensity steps are most strongly associated with a lower hazard of diabetes. This evidence supports that regular stepping is an important risk factor for type 2 diabetes prevention in older adults.
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Affiliation(s)
- Alexis C Garduno
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA.,Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Guangxing Wang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chongzhi Di
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Benjamin T Schumacher
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA.,Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA
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Doni K, Bühn S, Weise A, Mann NK, Hess S, Sönnichsen A, Pieper D, Thürmann P, Mathes T. Safety of dipeptidyl peptidase-4 inhibitors in older adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Ther Adv Drug Saf 2022; 13:20420986211072383. [PMID: 35111291 PMCID: PMC8785305 DOI: 10.1177/20420986211072383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Registration: PROSPERO: CRD42020210645 Introduction: We aimed to assess the safety of dipeptidyl peptidase-4 (DPP-4) inhibitors in older patients with type 2 diabetes with inadequate glycaemic control. Methods: We included randomized controlled trials (RCTs) in older (⩾65 years) patients with type 2 diabetes. The intervention group was randomized to treatment with any DPP-4 inhibitors. A systematic search in MEDLINE and Embase was performed in December 2020. For assessing the risk of bias, RoB 2 tool was applied. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We pooled outcomes using random effects meta-analyses. Results: We identified 16 RCTs that included 19,317 patients with a mean age of greater than 70 years. The mean HbA1c level ranged between 7.1 and 10.0 g/dl. Adding DPP-4 inhibitors to standard care alone may increase mortality slightly [risk ratio (RR) 1.04; 95% confidence interval (CI) 0.89–1.21]. Adding DPP-4 inhibitors to standard care increases the risk for hypoglycaemia (RR 1.08; 95% CI 1.01–1.16), but difference in overall adverse events is negligible. DPP-4 inhibitors added to standard care may reduce mortality compared with sulfonylureas (RR 0.88; 95% CI 0.75–1.04). DPP-4 inhibitors probably reduce the risk for hypoglycaemia compared with sulfonylureas (magnitude of effect not quantifiable because of heterogeneity) but difference in overall adverse events is negligible. There is insufficient evidence on hospitalizations, falls, fractures, renal impairment and pancreatitis. Conclusion: There is no evidence that DPP-4 inhibitors in addition to standard care decrease mortality but DPP-4 inhibitors increase hypoglycaemia risk. Second-line therapy in older patients should be considered cautiously even in drugs with a good safety profile such as DPP-4 inhibitors. In case second-line treatment is necessary, DPP-4 inhibitors appear to be preferable to sulfonylureas. Plain language summary Safety of dipeptidyl peptidase-4 inhibitors in older adults with type 2 diabetes Introduction: We performed the review to assess the safety of dipeptidyl peptidase-4 (DPP-4) inhibitors in older type 2 diabetes patients with blood sugar outside the normal level. Methods: To answer the question, we searched various electronic databases. We included studies in older (⩾65 years) patients with type 2 diabetes that assessed the safety of DPP-4 inhibitors. The data from the different studies were quantitatively summarized using statistical methods. We assessed the quality of the data to judge the certainty of the findings. Results: We identified 16 studies that included 19,317 patients with a mean age greater than 70 years. The average blood sugar level of patients in the included studies was slightly or moderately increased. Adding DPP-4 inhibitors to standard care alone may increase mortality slightly. Adding DPP-4 inhibitors to standard care increases the risk for hypoglycaemia, but difference in overall adverse events is negligible. DPP-4 inhibitors added to standard care may reduce mortality compared with sulfonylureas. DPP-4s probably reduce the risk of hypoglycaemia compared with sulfonylureas (magnitude of effect not quantifiable because of heterogeneity) but difference in overall adverse events is negligible. There is insufficient evidence on hospitalizations, falls, fractures, renal impairment and pancreatitis. Conclusion: There is no evidence that DPP-4 inhibitors in addition to standard care decrease mortality but DPP-4 inhibitors increase the risk that blood sugar falls below normal. Adding DPP-4 inhibitorss to standard care in older patients should be considered cautiously even in drugs with a good safety profile such as DPP-4 inhibitors. In case additional treatment is necessary, DPP-4 inhibitors appear to be preferable to sulfonylureas.
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Affiliation(s)
- Katharina Doni
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Alina Weise
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Nina-Kristin Mann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Dawid Pieper
- Institute for Research in Operative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Institute for Health Services and Health System Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Petra Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Tim Mathes
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal Germany
- Institute for Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
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42
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Secnik J, Xu H, Schwertner E, Hammar N, Alvarsson M, Winblad B, Eriksdotter M, Garcia-Ptacek S, Religa D. Glucose-Lowering Medications and Post-Dementia Survival in Patients with Diabetes and Dementia. J Alzheimers Dis 2022; 86:245-257. [PMID: 35034902 PMCID: PMC9028644 DOI: 10.3233/jad-215337] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: The effectiveness of glucose-lowering drugs (GLDs) is unknown among patients with dementia. Objective: To analyze all-cause mortality among users of six GLDs in dementia and dementia-free subjects, respectively. Methods: This was a longitudinal open-cohort registry-based study using data from the Swedish Dementia Registry, Total Population Register, and four supplemental registers providing data on dementia status, drug usage, confounders, and mortality. The cohort comprised 132,402 subjects with diabetes at baseline, of which 11,401 (8.6%) had dementia and 121,001 (91.4%) were dementia-free. Subsequently, comparable dementia – dementia-free pairs were sampled. Then, as-treated and intention-to-treat exposures to metformin, insulin, sulfonylurea, dipeptidyl-peptidase-4 inhibitors, glucagon-like peptide-1 analogues (GLP-1a), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) were analyzed in the parallel dementia and dementia-free cohorts. Confounding was addressed using inverse-probability weighting and propensity-score matching, and flexible parametric survival models were used to produce hazard ratios (HR) and 95% confidence intervals (CI) of the association between GLDs and all-cause mortality. Results: In the as-treated models, increased mortality was observed among insulin users with dementia (HR 1.34 [95%CI 1.24–1.45]) as well as in dementia-free subjects (1.54 [1.10–1.55]). Conversely, sulfonylurea was associated with higher mortality only in dementia subjects (1.19 [1.01–1.42]). GLP-1a (0.44 [0.25–0.78]) and SGLT-2i users with dementia (0.43 [0.23–0.80]) experienced lower mortality compared to non-users. Conclusion: Insulin and sulfonylurea carried higher mortality risk among dementia patients, while GLP-1a and SGLT-2i were associated with lower risk. GLD-associated mortality varied between dementia and comparable dementia-free subjects. Further studies are needed to optimize GLD use in dementia patients.
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Affiliation(s)
- Juraj Secnik
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Neurology, Charles University, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Hong Xu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Schwertner
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Niklas Hammar
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael Alvarsson
- Growth and Metabolism, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Dorota Religa
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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43
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Sabbagh MN, Perez A, Holland TM, Boustani M, Peabody SR, Yaffe K, Bruno M, Paulsen R, O'Brien K, Wahid N, Tanzi RE. Primary prevention recommendations to reduce the risk of cognitive decline. Alzheimers Dement 2022; 18:1569-1579. [PMID: 35026040 PMCID: PMC9545398 DOI: 10.1002/alz.12535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022]
Abstract
Introduction Few resources address steps clinicians can take to help patients reduce their risk of dementia, despite growing recognition that brain health can be optimized and that risk reduction for cognitive decline can be accomplished by lifestyle modifications. Methods To address this gap, UsAgainstAlzheimer's convened a risk reduction workgroup (RRWG) to review existing evidence and develop recommendations for primary care clinicians discussing cognitive decline and risk reduction with their patients. Results The RRWG produced 11 consensus‐based recommendations and implementation strategies across six topics: neurovascular risk management, physical activity, sleep, nutrition, social isolation, and cognitive stimulation. Discussion These recommendations are a first step for clinicians to address brain health with patients and potentially help them prevent cognitive decline. To ensure there is routine care for brain health, proper incentives and policies must be instituted and more education for consumers should be provided.
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Affiliation(s)
- Marwan N Sabbagh
- Barrow Neurological Institute, Dignity Health/St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Adriana Perez
- Leonard Davis Institute of Health Economics at the University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Malaz Boustani
- Indiana University Center for Health Innovation and Implementation Science, School of Medicine, Indianapolis, Indiana, USA
| | | | - Kristine Yaffe
- University of California San Francisco, San Francisco, California, USA
| | | | | | - Kelly O'Brien
- UsAgainstAlzheimer's, Washington, District of Columbia, USA
| | - Naila Wahid
- Avalere Health, Washington, District of Columbia, USA
| | - Rudolph E Tanzi
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA USA, Boston, Massachusetts, USA
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Emery KA, Robins J, Salyer J, Thurby-Hay L, Djira G. Type 2 Diabetes Self-Management Variables and Predictors. Clin Nurs Res 2021; 31:1250-1262. [PMID: 34961341 DOI: 10.1177/10547738211067322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Guided by the Self and Family-Management framework, relationships between diabetes distress, self-efficacy, resilience and outcomes of A1c, quality of life and health status were explored. A cross sectional descriptive design was used. 78 individuals were enrolled from US clinics. Data were analyzed to test for associations, main effects and interactions and predictors of self-management. Results indicated low diabetes distress (M = 20.53), high self-efficacy (M = 7.32), moderate resilience (M = 80.27), and mean A1c 7.35%/56.88 mmol/mol. 76% scored above the mental health norm, 46% scored above the physical health norm. Average weighted quality of life = -1.74. Diabetes distress was negatively associated with self-efficacy, resilience, physical health, mental health, and quality of life. Self-efficacy was positively associated with resilience, physical health and quality of life. Resilience was positively associated with physical health, mental health and quality of life. Positive associations were found between quality of life, physical and mental health. No associations were found between A1c and variables in the study. Multiple significant interactions were found with A1c, mental health and quality of life outcomes. Terms in the model included treatment regimen, years since diagnosis, provider collaboration and history of diabetes self-management education. Distress was a significant predictor of health status and quality of life. The results confirm self-management facilitators self-efficacy and resilience and barrier diabetes distress and their relationships with outcomes in the framework. This study contributes to the understanding of the emotional aspect of diabetes. Continuing this work will allow researchers to better understand self-management, support self-management efforts and better outcomes.
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Affiliation(s)
| | - Jo Robins
- Virginia Commonwealth University, Richmond, VA, USA
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López-Rubio C, Koponen M, Lampela P, Taipale H, Tanskanen A, Bell JS, Tolppanen AM, Hartikainen S. Changes in the use of diabetes drugs among community-dwelling people with Alzheimer's disease. BMC Geriatr 2021; 21:701. [PMID: 34911481 PMCID: PMC8672592 DOI: 10.1186/s12877-021-02694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Type 2 diabetes is common in persons with Alzheimer’s disease (AD). Management of diabetes in persons with AD is challenging due to changing goals of care and susceptibility to adverse drug events including hypoglycemia. The aim of this study was to investigate the prevalence of diabetes drug use from 5 years before to 5 years after the time of AD diagnosis among persons with and without AD. Methods This was a nationwide register-based study of persons with and without AD and diabetes in Finland. We analyzed data from the Medication Use and Alzheimer’s disease (MEDALZ) study that included 70,718 community-dwelling people diagnosed with AD from 2005 to 2011. The study population included 8418 persons with AD and 6666 matched persons without AD who were diagnosed with diabetes 5 years before AD diagnosis (index date). We defined the prevalence of diabetes drug use in three-month evaluation periods from 5 years before until 5 years after the index date. Results Nearly all people with diabetes (94% in both cohorts) used one or more diabetes drugs on the index date. The most prevalent drug metformin was used by 60.9% of people with AD and 59.1% of people without AD. The next most prevalent drugs were sulfonylureas and insulin. The prevalence of diabetes drug use was similar in people with and without AD but began to decline 1 year after AD diagnosis in the AD cohort compared to non-AD cohort. Conclusions The decline in diabetes drug use after AD diagnosis may be attributed to clinicians and patients seeking to avoid serious adverse drug events including hypoglycemia. In addition, the findings may reflect personalized glycemic control and unintentional weight loss in persons with AD reducing the need for diabetes drugs. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02694-w.
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Affiliation(s)
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Pasi Lampela
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - J Simon Bell
- School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. .,School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.
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Secnik J, Xu H, Schwertner E, Hammar N, Alvarsson M, Winblad B, Eriksdotter M, Garcia-Ptacek S, Religa D. The association of antidiabetic medications and Mini-Mental State Examination scores in patients with diabetes and dementia. Alzheimers Res Ther 2021; 13:197. [PMID: 34857046 PMCID: PMC8641148 DOI: 10.1186/s13195-021-00934-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/09/2021] [Indexed: 02/06/2023]
Abstract
Background The effect of antidiabetic medication on cognitive function is unclear. We analyzed the association between five antidiabetic drugs and change in Mini-Mental State Examination (MMSE) scores in patients with diabetes and dementia. Methods Using the Swedish Dementia Registry and four supplementary Swedish registers/databases, we identified 1873 patients (4732 observations) with diagnosis of type 2 diabetes (diabetes) and Alzheimer’s disease or mixed-pathology dementia who were followed up at least once after dementia diagnosis. Use of metformin, insulin, sulfonylurea, thiazolidinediones (TZD), and dipeptidyl-peptidase-4 inhibitors (DPP-4i) was identified at baseline. Prevalent-user, incident-user, and drug-drug cohorts were sampled, and propensity-score matching was used to analyze comparable subjects. Beta coefficients with 95% confidence intervals (CI) from the random intercept and slope linear mixed-effects models determined the association between the use of antidiabetic medications and decline in MMSE score points between the follow-ups. Inverse-probability weighting was used to account for patient dropout. Results Compared to non-users, prevalent users of metformin (beta 0.89, 95% CI 0.44; 1.33) and DPP-4i (0.72, 0.06; 1.37) experienced a slower cognitive decline with time. Secondly, compared to DPP-4i, the use of insulin (−1.00, −1.95; −0.04) and sulfonylureas (−1.19; −2.33; −0.04) was associated with larger point-wise decrements in MMSE with annual intervals. Conclusions In this large cohort of patients with diabetes and dementia, the use of metformin and DPP-4i was associated with a slower decline in MMSE scores. Further examination of the cognitive effects of metformin and incretin-based medications is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00934-0.
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Affiliation(s)
- Juraj Secnik
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Neo, Blickagången 16, 14152, Huddinge, Sweden. .,Department of Neurology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic.
| | - Hong Xu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Neo, Blickagången 16, 14152, Huddinge, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Schwertner
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Neo, Blickagången 16, 14152, Huddinge, Sweden
| | - Niklas Hammar
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael Alvarsson
- Growth and Metabolism, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Neo, Blickagången 16, 14152, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Neo, Blickagången 16, 14152, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Dorota Religa
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Neo, Blickagången 16, 14152, Huddinge, Sweden.,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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Scuteri A. Characteristics that influence the diagnosis and treatment of diabetes in geriatric patients over 75. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Piro S, Purrello F. Acute diabetes complications. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pedone C. Lipid control in geriatric DM patients. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mannucci E. Prescribing, monitoring, and deprescribing drugs in geriatric DM patients. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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