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Asbaghi O, Naeini F, Ashtary-Larky D, Kaviani M, Rezaei Kelishadi M, Eslampour E, Moradi S, Mirzadeh E, Clark CCT, Naeini AA. Effects of chromium supplementation on blood pressure, body mass index, liver function enzymes and malondialdehyde in patients with type 2 diabetes: A systematic review and dose-response meta-analysis of randomized controlled trials. Complement Ther Med 2021; 60:102755. [PMID: 34237387 DOI: 10.1016/j.ctim.2021.102755] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several studies reported beneficial effects of chromium supplementation for management of type 2 diabetes mellitus (T2DM). The present study aimed to provide a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the effects of chromium supplementation on blood pressure, body mass index (BMI), liver function enzymes and malondialdehyde (MDA) in patients with T2DM. METHODS PubMed, Scopus, and Embase were searched up to 15 November 2020 with no language and time restriction. RCTs that reported the effects of chromium supplementation on blood pressure, BMI, liver function enzymes and MDA in patients with T2DM were included. A random-effects model was used to compute weighted mean differences (WMDs) with 95 % confidence intervals (CIs). Between-study heterogeneity was assessed by Cochran's Q test and quantified by I2 statistic. RESULTS Of 3586 publications, 15 RCTs were included for the meta-analysis. Pooled effect sizes indicated that chromium significantly reduced diastolic blood pressure (DBP) (WMD): -2.36 mmHg, 95 % CI: -4.14, -0.60; P = 0.008), and MDA (WMD: -0.55 umol/l, 95 % CI: -0.96, -0.14; P = 0.008). However, chromium supplementation did not significantly affect BMI, systolic blood pressure (SBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST). Meta-regression analysis did not show significant linear relationship between dose of chromium and change in BMI (p = 0.412), SBP (p = 0. 319), DBP (p = 0.102), ALT (p = 0.923), AST (p = 0.986) and MDA (p = 0.055). CONCLUSION The present systematic review and meta-analysis shows that supplementation with chromium at dose of 200-1000 μg/day may reduce DBP and MDA in T2DM patients.
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Affiliation(s)
- Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Naeini
- Department of Clinical Nutrition, School of Nutritional Science, Tehran University of Medical Science, Tehran, Iran.
| | - Damoon Ashtary-Larky
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mojtaba Kaviani
- Faculty of Pure & Applied Science, School of Nutrition and Dietetics, Acadia University, Wolfville, NS, Canada.
| | - Mahnaz Rezaei Kelishadi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Elham Eslampour
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Sajjad Moradi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Elahe Mirzadeh
- Department of Physical Education and Sports Science, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK.
| | - Amirmansour Alavi Naeini
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Morris E, Jebb SA, Oke J, Nickless A, Ahern A, Boyland E, Caterson ID, Halford J, Hauner H, Aveyard P. Effect of weight loss on cardiometabolic risk: observational analysis of two randomised controlled trials of community weight-loss programmes. Br J Gen Pract 2021; 71:e312-e319. [PMID: 33685923 PMCID: PMC7959667 DOI: 10.3399/bjgp20x714113] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines recommend that clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, we lack individual level data quantifying the benefits of weight change for individuals to guide consultations in primary care. AIM To examine how weight change affects cardiometabolic risk factors, and to facilitate shared decision making between patients and clinicians regarding weight loss. DESIGN AND SETTING Observational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight-loss groups. METHOD Linear mixed effects regression modelling examining the association between weight change and change in systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, glycated haemoglobin (HbA1c), and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes, and hyperlipidaemia. RESULTS In total, 2041 participants had a mean (standard deviation) age of 50 (SD 13.5) years, mean baseline weight of 90.6 (14.8) kg and mean body mass index (BMI) of 32.7 (SD 4.1) kg/m2. Mean (SD) weight change was -4.3 (SD 6.0) kg. All outcome measures showed statistically significant improvements. Each 1 kg weight loss was associated with 0.4 mmHg reduction in SBP and 0.3 mmHg reduction in DBP, or 0.5 mmHg and 0.4 mmHg/kg respectively in people with hypertension. Each 1 kg weight loss was associated with 0.2 mmol/mol reduction in HbA1c, or 0.6 mmol/mol in people with diabetes. Effects on plasma lipids were negligible. CONCLUSION Weight loss achieved through referral to community weight-loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in BP and glucose regulation, especially in those at highest risk.
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Affiliation(s)
- Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford; Exploristics Ltd., Belfast, UK
| | - Amy Ahern
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Emma Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ian D Caterson
- SoLES, University of Sydney, Boden Collaboration, Charles Perkins Centre, University of Sydney, Australia
| | - Jason Halford
- Psychology, University of Leeds, Leeds, UK; president of the European Association for the Study of Obesity
| | - Hans Hauner
- Chair of nutritional medicine and director of the Else Kröner-Fresenius-Centre of Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK
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Mori H, Takahashi H, Mine K, Higashimoto K, Inoue K, Kojima M, Kuroki S, Eguchi T, Ono Y, Inuzuka S, Soejima H, Nagafuchi S, Anzai K. TYK2 Promoter Variant Is Associated with Impaired Insulin Secretion and Lower Insulin Resistance in Japanese Type 2 Diabetes Patients. Genes (Basel) 2021; 12:400. [PMID: 33799705 PMCID: PMC7999758 DOI: 10.3390/genes12030400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
Accumulating evidence has suggested that viral infection causes type 1 diabetes due to direct β-cell damage and the triggering of autoimmune reactivity to β cells. Here, we elucidated that the tyrosine kinase 2 (Tyk2) gene, encoding an interferon receptor signaling molecule, is responsible for virus-induced diabetes in mice, and its promoter variant confers a risk of type 1 diabetes in humans. This study investigated the relationship between a TYK2 promoter variant (TYK2PV) and insulin secretion in type 2 diabetes patients. TYK2PV status was determined using direct DNA sequencing and its associations with fasting insulin, C-peptide, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated in type 2 diabetes patients without sulfonylurea or insulin medication. Of the 172 patients assessed, 18 (10.5%) showed TYK2PV-positivity. Their body mass index (BMI) was significantly lower than in those without the variant (23.4 vs. 25.4 kg/m2, p = 0.025). Fasting insulin (3.9 vs. 6.2 μIU/mL, p = 0.007), C-peptide (1.37 vs. 1.76 ng/mL, p = 0.008), and HOMA-IR (1.39 vs. 2.05, p = 0.006) were lower in those with than in those without the variant. Multivariable analysis identified that TYK2PV was associated with fasting insulin ≤ 5 μIU/mL (odds ratio (OR) 3.63, p = 0.025) and C-peptide ≤ 1.0 ng/mL (OR 3.61, p = 0.028), and also lower insulin resistance (HOMA-IR ≤ 2.5; OR 8.60, p = 0.042). TYK2PV is associated with impaired insulin secretion and low insulin resistance in type 2 diabetes. Type 2 diabetes patients with TYK2PV should be carefully followed in order to receive the appropriate treatment including insulin injections.
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Affiliation(s)
- Hitoe Mori
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.M.); (K.M.); (K.I.); (M.K.); (S.N.); (K.A.)
| | - Hirokazu Takahashi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.M.); (K.M.); (K.I.); (M.K.); (S.N.); (K.A.)
- Liver Center, Faculty of Medicine, Saga University Hospital, Saga University, Saga 849-8501, Japan
| | - Keiichiro Mine
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.M.); (K.M.); (K.I.); (M.K.); (S.N.); (K.A.)
- Division of Host Defense, Medical Institute of Bioregulation, Kyushu University, Fukuoka 812-8582, Japan
| | - Ken Higashimoto
- Divison of Molecular Genetics & Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga 849-8501, Japan; (K.H.); (H.S.)
| | - Kanako Inoue
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.M.); (K.M.); (K.I.); (M.K.); (S.N.); (K.A.)
| | - Motoyasu Kojima
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.M.); (K.M.); (K.I.); (M.K.); (S.N.); (K.A.)
- Saiseikai Karatsu Hospital, Saga 847-0852, Japan
| | | | | | - Yasuhiro Ono
- Department of Internal Medicine, Kouhokai Takagi Hospital, Fukuoka 831-0016, Japan;
| | | | - Hidenobu Soejima
- Divison of Molecular Genetics & Epigenetics, Department of Biomolecular Sciences, Faculty of Medicine, Saga 849-8501, Japan; (K.H.); (H.S.)
| | - Seiho Nagafuchi
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.M.); (K.M.); (K.I.); (M.K.); (S.N.); (K.A.)
| | - Keizo Anzai
- Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 849-8501, Japan; (H.M.); (K.M.); (K.I.); (M.K.); (S.N.); (K.A.)
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Bacha F, El ghormli L, Arslanian S, Zeitler P, Laffel LM, Levitt Katz LE, Gandica R, Chang NT, Sprague JE, Macleish SA. Predictors of response to insulin therapy in youth with poorly-controlled type 2 diabetes in the TODAY trial. Pediatr Diabetes 2019; 20:871-879. [PMID: 31418516 PMCID: PMC6953481 DOI: 10.1111/pedi.12906] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To understand the factors associated with glycemic control after starting insulin in youth with type 2 diabetes following glycemic failure (persistent HbA1c ≥8%) with metformin alone, metformin + rosiglitazone or metformin + lifestyle in the TODAY study. METHODS Change in HbA1c after add-on insulin therapy and the factors predictive of glycemic response were evaluated. At 1-year postinsulin initiation, 253 youth had a mean of 3.9 ± 1.0 visits since the time of insulin initiation. Participants were divided into three groups according to glycemic control: consistent decrease in HbA1c by ≥0.5%, change <0.5%, or consistent increase in HbA1c ≥0.5%, at 75% or more of the visits. RESULTS Within 1-year postinsulin initiation, 33.2% of participants had a consistent HbA1c decrease of ≥0.5%, 46.2% changed HbA1c <0.5%, and 20.6% had an increase ≥0.5%. At randomization into TODAY and at time of insulin initiation, the three glycemia groups were similar in age, sex, race-ethnicity, pubertal stage, BMI z-score, diabetes duration, and insulin secretion indices. Consistent HbA1c improvement was associated with higher insulin sensitivity (1/fasting insulin) at randomization and at time of failure, higher adiponectin at randomization, and was not associated with indices of β-cell function. CONCLUSIONS Response to add-on insulin was highly variable among youth in TODAY. Greater insulin sensitivity and higher adiponectin concentrations at randomization were associated with improved glycemic control after initiation of insulin. Due to limited information on adherence to insulin injections, the roles of adherence to the prescribed insulin regimen or psychosocial factors are unknown.
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Affiliation(s)
- Fida Bacha
- Children’s Nutrition Research Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Laure El ghormli
- Biostatistics Center, George Washington University, Rockville, MD
| | | | - Philip Zeitler
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
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Toselli S, Gualdi-Russo E, Mazzuca P, Campa F. Ethnic differences in body composition, sociodemographic characteristics and lifestyle in people with type 2 diabetes mellitus living in Italy. Endocrine 2019; 65:558-568. [PMID: 31368082 DOI: 10.1007/s12020-019-02031-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/19/2019] [Indexed: 01/02/2023]
Abstract
This study aimed to compare immigrants and Italian natives with type 2 diabetes mellitus (DM2) in terms of anthropometric parameters and lifestyle-related characteristics and to investigate the relationship between ethnicity and glycemic control in men and women with DM2 living in Italy. The sample included 100 immigrants (55 Albanians and 45 Africans) and 100 Italians, followed by the Public Health Clinics of Rimini. The association of ethnicity with sex, socioeconomic status, anthropometric and hematological characteristics, and lifestyle were examined. In addition, differences among groups in glycemic control were evaluated. Among males, African participants presented significantly lower values than other groups in adiposity parameters and triglycerides. The highest percentage of obesity and of normal weight was found in Italians and in Africans, respectively. Among females, there were scanty differences, but Italians presented higher WHR values than the other groups. No statistical differences appeared in hematological parameters among groups. There were no significant differences in glycemic control among groups and sexes. Also considering the differences between subjects with optimal (L) or nonoptimal (H) glycemic control, the differences in lifestyle, anthropometric, and hematological variables remained scarce. Among all groups, significantly higher values of glucose were detected in H than in L. A similar condition appeared for triglycerides in males. Immigrant and native Italian diabetics did not present any difference in their clinical characteristics, but Italians generally presented worst lifestyle habits. The percentage of subjects with poor metabolic control of diabetes was not low, but similar in immigrants and natives.
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Affiliation(s)
- Stefania Toselli
- Departments of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Emanuela Gualdi-Russo
- Department of Biomedical Sciences and Surgical Specialties, University of Ferrara, Ferrara, Italy
| | - Paolo Mazzuca
- Unit of Internal Medicine, Diabetes and Metabolic Disease Center, Romagna Health District, Rimini, Italy
| | - Francesco Campa
- Departments of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Basu A, Sukumar N, Ryder RE. Young Asian men with diabetes have the highest risk for acute coronary events: retrospective cohort analyses. JRSM Open 2018; 9:2054270417732699. [PMID: 29344402 PMCID: PMC5761920 DOI: 10.1177/2054270417732699] [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] [Indexed: 11/27/2022] Open
Abstract
Objective To understand the ethnic differences in coronary heart disease risk among inpatients with diabetes following acute coronary syndrome. Design Single-centre retrospective cohort-analysis of patients with type II diabetes over a six-year period receiving standard care. Setting Birmingham, UK. Participants One thousand and one hundred and five patients with type II diabetes from a multi-ethnic background. Main outcome measures Odds ratios of coronary heart disease events among three ethnic groups. Results The prevalence of coronary heart disease events was 20.7% in Asian, 13.2% in Caucasian and 7.7% in Afro-Caribbean patients. Asian patients were younger at diagnosis of diabetes (−5.1 years p < 0.001 versus Afro-Caribbeans and −7.1 years p < 0.001 versus Caucasians). The mean number of events was highest amongst Asian (1.2) compared to Caucasian (1.1) and Afro-Caribbean (1.0) patients (p = 0.04). The mean age at first event was 61.3 years for Asians, 62.5 years and 65.8 for Afro-Caribbeans and Caucasians, respectively (analysis of variance F[2,131] = 2.36 p = 0.09). Un-adjusted odds ratios for at least one coronary heart disease event were highest among Asian men (OR 5.04; 95% CI 2.31–11.01; p < 0.0001) with Afro-Caribbean women as baseline (OR 1.0). The odds ratios remain largely unchanged (1.0 Afro-Caribbeans [baseline], 1.27 [p = 0.56] Caucasians and 3.2 [p = 0.001] for Asians) when corrected for age, gender, duration of diabetes, insulin dependency, mean low-density lipoprotein-cholesterol, triglycerides and high-density lipoprotein-cholesterol, mean glycated haemoglobin, mean systolic and diastolic blood pressure (logistic regression; ROC: 79% AUC). Afro-Caribbean patients had the highest mean high-density lipoprotein-cholesterol (1.6 mmol/L) and the lowest risk for coronary heart disease events. Conclusions Asian patients were younger at their first event and diagnosed earlier with diabetes. Asian men had the highest risk of coronary heart disease event which correlated with the lowest levels of high-density lipoprotein-cholesterol.
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Affiliation(s)
- Ansu Basu
- Department of Diabetes, Endocrinology and Lipid Metabolism, City Hospital, Birmingham B18 7QH, UK.,The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Nithya Sukumar
- Department of Diabetes, Endocrinology and Lipid Metabolism, City Hospital, Birmingham B18 7QH, UK.,3University of Warwick, Coventry CV4 7AL, UK
| | - Robert Ej Ryder
- Department of Diabetes, Endocrinology and Lipid Metabolism, City Hospital, Birmingham B18 7QH, UK.,The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Abstract
South Asians have a higher prevalence of diabetes, coronary heart disease and cardiovascular death. Their predisposition to insulin resistance partly explains this excess risk. After immigration, the adoption of a western diet allied to increased sedentary behaviour leads to weight gain, hypertension and hyperlipidaemia, factors which in turn combine to amplify the chances of getting heart disease. Further contributory factors are increased sub-clinical inflammation, increased thrombogenic tendency and higher serum homocysteine levels. South Asians with diabetes might do as well as White people with respect to intensive glycaemic and blood pressure control. However, there is little evidence for measures to reduce cardiovascular risk as South Asians have not been included as a subgroup in most large trials. Future prospective studies, including studies on the prevention of diabetes and cardiovascular disease in this high-risk population, are therefore urgently required.
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Affiliation(s)
| | - Naveed Sattar
- Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
| | - Miles Fisher
- Department of Diabetes, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK
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Drake TC, Hsu FC, Hire D, Chen SH, Cohen RM, McDuffie R, Nylen E, O'Connor P, Rehman S, Seaquist ER. Factors associated with failure to achieve a glycated haemoglobin target of <8.0% in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Obes Metab 2016; 18:92-5. [PMID: 26435375 PMCID: PMC6241305 DOI: 10.1111/dom.12569] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 07/26/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
Abstract
The aim of this study was to identify the clinical features of participants in the standard therapy arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) glycaemia trial who failed to reach the glycated haemoglobin (HbA1c) target. We analysed 4685 participants in the standard therapy arm, comparing participants who reached the HbA1c target of <8.0% with those whose HbA1c level was ≥8.0% 12 months after randomization. Baseline and 12-month clinical characteristics were compared. At 12 months after randomization, 3194 participants had HbA1c <8.0% and 1491 had HbA1c ≥8.0%. Black race [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.61-0.89; p = 0.002], severe hypoglycaemia (OR 0.57, CI 0.37-0.89; p = 0.014) and insulin use (OR 0.51, CI 0.40-0.65; p < 0.001) were associated with failure to reach HbA1c goal at 12 months in the adjusted model. Even with free medications, free visits with clinicians and aggressive titration of medications, >30% of participants in the standard arm of the ACCORD trial had an HbA1c ≥8.0% at 1 year. Participants who were black, had severe hypoglycaemia and were on insulin were more likely to have an above-target HbA1c concentration after 12 months on the standard protocol.
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Affiliation(s)
- T C Drake
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - F-C Hsu
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D Hire
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S-H Chen
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R M Cohen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Cincinnati and Medical Service, Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - R McDuffie
- Clinical Translational Unit, Department of Medicine, Tulane University, New Orleans, LA, USA
| | - E Nylen
- Division of Endocrinology, Department of Medicine, VAMC, Washington, DC, USA
| | - P O'Connor
- Center for Chronic Care Innovation, HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - S Rehman
- Department of Medicine, Phoenix VA Healthcare Systems, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - E R Seaquist
- Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Krishnadath ISK, Nahar-van Venrooij LM, Jaddoe VWV, Toelsie JR. Ethnic differences in prediabetes and diabetes in the Suriname Health Study. BMJ Open Diabetes Res Care 2016; 4:e000186. [PMID: 27403324 PMCID: PMC4932318 DOI: 10.1136/bmjdrc-2015-000186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/30/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is increasing worldwide, and information on risk factors to develop targeted interventions is limited. Therefore, we analyzed data of the Suriname Health Study to estimate the prevalence of prediabetes and diabetes. We also explored whether ethnic differences in prediabetes or diabetes risk could be explained by biological, demographic, lifestyle, anthropometric, and metabolic risk factors. METHOD The study was designed according to the WHO Steps guidelines. Fasting blood glucose levels were measured in 3393 respondents, aged 15-65 years, from an Amerindian, Creole, Hindustani, Javanese, Maroon or Mixed ethnic background. Prediabetes was defined by fasting blood glucose levels between 6.1 and 7.0 mmol/L and diabetes by fasting blood glucose levels ≥7.0 mmol/L or 'self-reported diabetes medication use.' For all ethnicities, we analyzed sex, age, marital status, educational level, income status, employment, smoking status, residence, physical activity, body mass index, waist circumference, hypertension, and the levels of triglyceride, total cholesterol, high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol. RESULTS The prevalence of prediabetes was 7.4%, while that of diabetes was 13 0%. From these diabetes cases, 39.6% were not diagnosed previously. No ethnic differences were observed in the prevalence of prediabetes. For diabetes, Hindustanis (23.3%) had twice the prevalence compared to other ethnic groups (4.7-14.2%). The associations of the risk factors with prediabetes or diabetes varied among the ethnic groups. The differences in the associations of ethnic groups with prediabetes or diabetes were partly explained by these risk factors. CONCLUSIONS The prevalence of diabetes in Suriname is high and most elevated in Hindustanis. The observed variations in risk factors among ethnic groups might explain the ethnic differences between these groups, but follow-up studies are needed to explore this in more depth.
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Affiliation(s)
- Ingrid S K Krishnadath
- Department of Public Health, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Lenny M Nahar-van Venrooij
- Department of Public Health, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jerry R Toelsie
- Department of Physiology, Faculty of Medical Sciences , Anton de Kom University of Suriname , Paramaribo , Suriname
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Kondo Y, Harada N, Hamasaki A, Kaneko S, Yasuda K, Ogawa E, Harashima SI, Yoneda H, Fujita Y, Kitano N, Nakamura Y, Matsuo F, Shinji M, Hinotsu S, Nakayama T, Inagaki N. Sitagliptin monotherapy has better effect on insulinogenic index than glimepiride monotherapy in Japanese patients with type 2 diabetes mellitus: a 52-week, multicenter, parallel-group randomized controlled trial. Diabetol Metab Syndr 2016; 8:15. [PMID: 26925169 PMCID: PMC4769515 DOI: 10.1186/s13098-016-0131-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/08/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The 52-week monotherapy with the dipeptidyl peptidase-4 inhibitor sitagliptin and the sulphonylurea glimepiride on early-phase insulin secretion in Japanese patients with type 2 diabetes mellitus (T2DM) is not known. METHODS A randomized, parallel-group, open-label trial was conducted at 18 centers between February, 2011 and March, 2013. 171 outpatients with T2DM were recruited and randomly assigned to glimepiride or sitagliptin by minimization. Doses of glimepiride (0.25-1.0 mg/day) and sitagliptin (25-100 mg/day) were adjusted for hemoglobin A1c (HbA1c) > 6.9 %. Analyses were performed on full analysis set (FAS) of randomized subjects taking medications as allocated, and underwent 75 g oral glucose tolerance test (OGTTs) before and after treatment. The primary outcome was insulinogenic index to quantify early-phase insulin secretion after treatment, which was evaluated by analysis of covariance (ANCOVA). RESULTS Of 171 enrolled subjects, 68 in the sitagliptin group and 65 in the glimepiride group were included in the FAS (mean age, 64 years; baseline (HbA1c), 7.4 %). The primary outcome revealed a significantly higher insulinogenic index in the sitagliptin group than that in the glimepiride group (p = 0.036). Sitagliptin also reduced plasma glucose levels at 60 and 120 min during OGTT compared with glimepiride, while achieving a similar improvement in HbA1c during treatment. Body weight did not change in either of the two groups, and one case of hypoglycemia was observed in the glimepiride group. CONCLUSIONS Sitagliptin shows better effects on insulinogenic index after 52-week treatment compared with glimepiride in Japanese patients with T2DM. Trial registration University hospital Medical Information Network (UMIN) Clinical Trials Registry, No.00004791.
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Affiliation(s)
- Yaeko Kondo
- />Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
- />Department of Internal Medicine, Kyoto Kizugawa Hospital, Joyo, Japan
| | - Norio Harada
- />Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
- />Nagisa Clinic, Hirakata, Japan
| | - Akihiro Hamasaki
- />Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Shizuka Kaneko
- />Division of Diabetes/Endocrinology/Lifestyle-related Disease, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Koichiro Yasuda
- />Department of Diabetology and Endocrinology, Osaka Saiseikai Noe Hospital, Osaka, Japan
| | - Eiichi Ogawa
- />Department of Diabetes and Endocrinology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Shin-ichi Harashima
- />Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Hiroko Yoneda
- />Department of Diabetes Mellitus, The Japan Baptist Medical Foundation, The Japan Baptist Hospital, Kyoto, Japan
| | - Yoshihito Fujita
- />Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
- />Nishio Clinic, Uji, Japan
| | - Norikazu Kitano
- />Department of Internal Medicine, Hyogo Prefectural Tsukaguchi Hospital, Amagasaki, Japan
| | - Yoshio Nakamura
- />Division of Diabetes and Endocrinology, Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | | | | | - Shiro Hinotsu
- />Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Takeo Nakayama
- />Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- />Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 Japan
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Tan EDD, Davis WA, Davis TME. Changes in characteristics and management of Asian and Anglo-Celts with type 2 diabetes over a 15-year period in an urban Australian community: The Fremantle Diabetes Study. J Diabetes 2016; 8:139-47. [PMID: 25581285 DOI: 10.1111/1753-0407.12267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/29/2014] [Accepted: 01/04/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of the present study was to determine temporal changes in characteristics and management of Asians with type 2 diabetes (T2D) compared with those of the majority Anglo-Celt (AC) patients in an urban Australian community. METHODS Cross-sectional data from the observational Fremantle Diabetes Study (FDS) collected in 1993-96 (Phase I; FDS1) and 2008-11 (Phase II; FDS2) were analyzed for patients classified as Asian (n = 44 and 65 in FDS1 and FDS2, respectively) or AC (n = 796 and 793, respectively). Between-group differences in changes in key variables between FDS phases were analyzed by generalized linear modeling with adjustment for age and gender. RESULTS Asians patients were significantly younger at diagnosis and recruitment and had a lower body mass index and smaller waist circumference than the AC participants in both FDS phases. They were also less likely to be treated for hypertension. Cardiovascular risk factors and their management and macrovascular complications were similar in the two groups over time. A greater propensity to retinopathy with Asian ethnicity in FDS1 (27.3% vs 13.5%; P = 0.23) was attenuated in FDS2 (23.7% vs 19.0%; P = 0.39). Asians had a significantly lower prevalence of peripheral sensory neuropathy in FDS2 (33.8% vs 63.3%; P < 0.001; adjusted P = 0.011 for between-group temporal change). CONCLUSIONS There were persistent differences between the phenotypic features of Asian migrants with T2D versus AC patients in an Australian urban community over 15 years of follow-up, but management of diabetes and non-glycemic risk factors remained comparable. Ethnicity-specific differences in susceptibility to microvascular complications should be considered in clinical management.
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Affiliation(s)
- Eva D D Tan
- School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia
| | - Wendy A Davis
- School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia
| | - Timothy M E Davis
- School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia
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Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial. Br J Gen Pract 2015; 64:e208-16. [PMID: 24686885 PMCID: PMC3964458 DOI: 10.3399/bjgp14x677833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory. Aim To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status. Design and setting Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands. Method A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years. Results The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable. Conclusion Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
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Di Bartolomeo F, Van den Ende W. Fructose and Fructans: Opposite Effects on Health? PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2015; 70:227-37. [PMID: 25904233 DOI: 10.1007/s11130-015-0485-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Fructans are fructose-based oligo-and polysaccharides of natural origin. Fructan and fructose species are sometimes confused by the great public, although they clearly have different biochemical and physiological properties. This review discusses aspects of the use of fructose and fructans in foods in the context of human health, with possible differential effects on cellular autophagy in cells of the human body. Although there are uncertainties on the daily levels of ingested fructose to be considered harmful to human health, there is an emerging consensus on the benefits of the use of fructans in functional foods, sustaining health via direct immunomodulatory and antioxidant effects or through indirect, prebiotic mechanisms.
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Affiliation(s)
- Francesca Di Bartolomeo
- Institute of Biochemistry, Graz University of Technology, Petersgasse 12/2, 8010, Graz, Austria
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Rawshani A, Svensson AM, Rosengren A, Zethelius B, Eliasson B, Gudbjörnsdottir S. Impact of ethnicity on progress of glycaemic control in 131,935 newly diagnosed patients with type 2 diabetes: a nationwide observational study from the Swedish National Diabetes Register. BMJ Open 2015; 5:e007599. [PMID: 26048210 PMCID: PMC4458585 DOI: 10.1136/bmjopen-2015-007599] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Studies on ethnic disparities in glycaemic control have been contradictory, and compromised by excessively broad categories of ethnicity and inadequate adjustment for socioeconomic differences. We aimed to study the effect of ethnicity on glycaemic control in a large cohort of patients with type 2 diabetes. SETTING We used nationwide data (mainly from primary care) from the Swedish National Diabetes Register (2002-2011) to identify patients with newly diagnosed (within 12 months) type 2 diabetes. PARTICIPANTS We included 131,935 patients (with 713,495 appointments), representing 10 ethnic groups, who were followed up to 10 years. PRIMARY AND SECONDARY OUTCOME MEASURES Progress of glycated haemoglobin (HbA1c) for up to 10 years was examined. Mixed models were used to correlate ethnicity with HbA1c (mmol/mol). The effect of glycaemic disparities was examined by assessing the risk of developing albuminuria. The impact of ethnicity was compared to that of income, education and physical activity. RESULTS Immigrants, particularly those of non-Western origin, received glucose-lowering therapy earlier, had 30% more appointments but displayed poorer glycaemic control (2-5 mmol/mol higher HbA1c than native Swedes). Probability of therapy failure was 28-111% higher for non-Western groups than for native Swedes. High-income Western groups remained below the target-level of HbA1c for 4-5 years, whereas non-Western populations never reached the target level. These disparities translated into 51-92% higher risk of developing albuminuria. The impact of ethnicity was greater than the effect of income and education, and equal to the effect of physical activity. CONCLUSIONS Despite earlier pharmacological treatment and more frequent appointments, immigrants of non-Western origin display poorer glycaemic control and this is mirrored in a higher risk of developing albuminuria.
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Affiliation(s)
- Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn Zethelius
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
- Medical Products Agency, Epidemiology, Uppsala, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers, Gothenburg, Sweden
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Tanisawa K, Ito T, Sun X, Ise R, Oshima S, Cao ZB, Sakamoto S, Tanaka M, Higuchi M. High cardiorespiratory fitness can reduce glycated hemoglobin levels regardless of polygenic risk for Type 2 diabetes mellitus in nondiabetic Japanese men. Physiol Genomics 2014; 46:497-504. [PMID: 24824210 DOI: 10.1152/physiolgenomics.00027.2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
High cardiorespiratory fitness (CRF) is associated with a reduced risk of Type 2 diabetes mellitus (T2DM) and improved β-cell function; genetic factors also determine these risks. This cross-sectional study investigated whether CRF modifies the association of polygenic risk of T2DM with glucose metabolism in nondiabetic Japanese men. Fasting plasma glucose, insulin, and glycated hemoglobin (HbA1c) levels were measured in 174 Japanese men (age: 20-79 yr). β-Cell function and insulin resistance were evaluated by calculating HOMA-β and HOMA-IR, respectively. CRF was assessed by measuring maximal oxygen uptake (V̇o2max). Subjects were divided into the low and high CRF groups within each age group according to the median V̇o2max. Eleven single nucleotide polymorphisms (SNPs) associated with T2DM were analyzed and used to calculate genetic risk score (GRS); subjects were divided into the low, middle, and high GRS groups. The high GRS group had higher HbA1c levels than the low GRS group in both the low and high CRF groups (P < 0.05). Furthermore, the individuals with a high GRS had a lower HOMA-β than those with a low GRS regardless of CRF (P < 0.05). In multiple linear regression analysis, although GRS was a significant predictor of HbA1c (β = 0.153, P = 0.025), V̇o2max was also associated with HbA1c (β = -0.240, P = 0.041) independent of GRS. These results suggest that CRF is associated with HbA1c levels independent of GRS derived from T2DM-related SNPs; however, it does not modify the association of GRS with increased HbA1c or impaired β-cell function.
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Affiliation(s)
- Kumpei Tanisawa
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan; Department of Genomics for Longevity and Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
| | - Tomoko Ito
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Xiaomin Sun
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Ryuken Ise
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Satomi Oshima
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan; and
| | - Zhen-Bo Cao
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan; and
| | - Shizuo Sakamoto
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan; and Institute of Advanced Active Aging Research, Waseda University, Tokorozawa, Saitama, Japan
| | - Masashi Tanaka
- Department of Genomics for Longevity and Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
| | - Mitsuru Higuchi
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan; and Institute of Advanced Active Aging Research, Waseda University, Tokorozawa, Saitama, Japan
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Shimodaira M, Niwa T, Nakajima K, Kobayashi M, Hanyu N, Nakayama T. Serum Triglyceride Levels Correlated with the Rate of Change in Insulin Secretion Over Two Years in Prediabetic Subjects. ANNALS OF NUTRITION AND METABOLISM 2014; 64:38-43. [DOI: 10.1159/000360012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/26/2014] [Indexed: 11/19/2022]
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Jain V, Shivkumar S, Gupta O. Health-related quality of life (hr-qol) in patients with type 2 diabetes mellitus. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:96-101. [PMID: 24696831 PMCID: PMC3968572 DOI: 10.4103/1947-2714.127752] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Quality of life is an important aspect in diabetes because poor quality of life leads to diminished self-care, which in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming in both the short run and the long run. AIMS The aim of our study is to examine the health-related quality of life of diabetic patients in rural India. MATERIALS AND METHODS This case-control study was done among type 2 diabetes mellitus patients attending Medicine Outpatient department of a 780-bedded rural medical college located in central India. We used the World Health Organization Quality of Life Questionnaire - short version (WHOQOL-BREF) to assess quality of life. RESULTS The HRQOL among diabetics and non-diabetic controls is comparable to each other with bad physical health, bad psychological health, deteriorating social relationships, and bad environmental conditions affecting the HRQOL of both the groups equally. The overall HRQOL of the total study population (cases and controls) was poor. CONCLUSION The finding of this study will help in health promotion in rural medical practice in India. It would beckon the much awaited avenue of holistic care of a diabetic patient with equal importance to the mental wellbeing and quality of life, as compared to physical well being.
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Affiliation(s)
- Vishakha Jain
- Department of Medicine, Mahatma Gandhi Institute of medical sciences, Sevagram, Wardha, Maharashtra, India
| | - Saumya Shivkumar
- Department of Medicine, Mahatma Gandhi Institute of medical sciences, Sevagram, Wardha, Maharashtra, India
| | - Omprakash Gupta
- Department of Medicine, Mahatma Gandhi Institute of medical sciences, Sevagram, Wardha, Maharashtra, India
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18
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Davis TME, Coleman RL, Holman RR. Ethnicity and long-term vascular outcomes in Type 2 diabetes: a prospective observational study (UKPDS 83). Diabet Med 2014; 31:200-7. [PMID: 24267048 DOI: 10.1111/dme.12353] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/20/2013] [Accepted: 10/26/2013] [Indexed: 01/12/2023]
Abstract
AIMS Evidence of ethnic differences in vascular complications of diabetes has been inconsistent. The aim of this study was to examine the relationship between ethnicity and long-term outcome in a large sample of individuals with newly diagnosed Type 2 diabetes. METHODS In a prospective observational study of 4273 UK Prospective Diabetes Study participants followed for a median of 18 years, 3543 (83%) were White Caucasian, 312 (7%) Afro-Caribbean and 418 (10%) Asian Indian. Relative risks for predefined outcomes were assessed comparing Afro-Caribbean and Asian Indian with White Caucasian using accelerated failure time models, with adjustment for cardiovascular risk factors and other potentially confounding variables. RESULTS During follow-up, 2468 (58%) participants had any diabetes-related end point, 1037 (24%) a myocardial infarction and 401 (9%) a stroke, and 1782 (42%) died. Asian Indian were at greater risk (relative risk, 95% confidence interval) for any diabetes-related end point (1.18, 1.07-1.29), but at lower risk of all-cause mortality (0.89, 0.80-0.97) and peripheral vascular disease (0.43, 0.23-0.82), vs. White Caucasian. Afro-Caribbean participants were at lower risk for all-cause mortality (0.84, 0.76-0.93), diabetes-related death (0.75, 0.64-0.88), myocardial infarction (0.55, 0.43-0.71) and peripheral vascular disease (0.55, 0.33-0.93) vs. White Caucasian. No ethnicity-related associations were found for stroke or microangiopathy. CONCLUSIONS Asian Indian ethnicity is associated with the greatest burden of disease, but not with an increased risk of major vascular complications or death. Afro-Caribbean ethnicity is associated with reduced risk of all-cause and diabetes-related death, myocardial infarction and peripheral vascular disease, suggesting an ethnicity-specific protective mechanism.
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Affiliation(s)
- T M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, WA, Australia
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Morimoto A, Tatsumi Y, Deura K, Mizuno S, Ohno Y, Miyamatsu N, Watanabe S. Impact of impaired insulin secretion and insulin resistance on the incidence of type 2 diabetes mellitus in a Japanese population: the Saku study. Diabetologia 2013; 56:1671-9. [PMID: 23680915 DOI: 10.1007/s00125-013-2932-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS To assess the impact of impaired insulin secretion (IIS) and insulin resistance (IR) on type 2 diabetes incidence in a Japanese population. METHODS This 4 year cohort study included 3,059 participants aged 30-69 without diabetes at baseline who underwent comprehensive medical check-ups between April 2006 and March 2007 at Saku Central Hospital. Based on their insulinogenic index and HOMA-IR values, participants were classified by the criteria of the Japan Diabetes Society into four categories: normal; isolated IIS (i-IIS); isolated IR (i-IR); and IIS plus IR. They were followed up until March 2011. The incidence of type 2 diabetes was determined from fasting and 2 h post-load plasma glucose concentrations and from receiving medical treatment for diabetes. RESULTS At baseline, 1,550 individuals (50.7%) were classified as normal, 900 (29.4%) i-IIS, 505 (16.5%) i-IR, and 104 (3.4%) IIS plus IR. During 10,553 person-years of follow-up, 219 individuals developed type 2 diabetes, with 126 (57.5%) having i-IIS at baseline. Relative to the normal group, the multivariable-adjusted HRs for type 2 diabetes in the i-IIS, i-IR and IIS plus IR groups were 8.27 (95% CI 5.33, 12.83), 4.90 (95% CI 2.94, 8.17) and 16.93 (95% CI 9.80, 29.25), respectively. The population-attributable fractions of type 2 diabetes onset due to i-IIS, i-IR, and IIS plus IR were 50.6% (95% CI 46.7%, 53.0%), 14.2% (95% CI 11.8%, 15.6%) and 12.9% (95% CI 12.3%, 13.2%), respectively. CONCLUSIONS/INTERPRETATION Compared with IR, IIS had a greater impact on the incidence of type 2 diabetes in a Japanese population.
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Affiliation(s)
- Akiko Morimoto
- Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan.
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Dhanaraj E, Raval AD, Yadav R, Bhansali A, Tiwari P. Prescribing pattern of antidiabetic drugs and achievement of glycemic control in T2DM patients tertiary care hospital in North India. Int J Diabetes Dev Ctries 2013. [DOI: 10.1007/s13410-013-0123-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Yu SH, Kang JG, Hwang YC, Ahn KJ, Yoo HJ, Ahn HY, Park SW, Park CY. Increasing achievement of the target goals for glycemic, blood pressure and lipid control for adults with diagnosed diabetes in Korea. J Diabetes Investig 2013; 4:460-5. [PMID: 24843696 PMCID: PMC4025104 DOI: 10.1111/jdi.12077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/17/2013] [Accepted: 02/17/2013] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction We investigated the prevalence, treatment and control of diagnosed diabetes in Korean adults from 1998 to 2010. Materials and Methods The Korean Ministry of Health and Welfare carried out the Korean National Health and Nutrition Examination Survey (KNHANES) in the years 1998 (I), 2001 (II), 2005 (III), 2007–2009 (IV) and 2010 (V). We estimated the prevalence of diagnosed diabetes in Korean adults and the proportions of well‐controlled diabetes, as defined by having glycosylated hemoglobin <7.0%, blood pressure <130/80 mmHg and low density lipoprotein (LDL) cholesterol <100 mg/dL according to the American Diabetes Association. Results The prevalence of diagnosed diabetes increased significantly from 3.2% in 1998 to 6.4% in 2010 (P < 0.0001). The prevalence of adults with diagnosed diabetes achieving blood pressure and LDL cholesterol target levels increased from 23.8% to 54.2% (P < 0.0001), and 25.7% to 47.7% (P<0.0001), respectively. However, the percentage of patients achieving glycemic goals did not increase significantly from 42.5% to 49.1% (P = 0.3034). Furthermore, there were significant increases in the proportions of individuals achieving all three target levels, from 2.7% in 2005 to 8.7% in 2010 (P < 0.0001). Conclusions The prevalence of diagnosed diabetes in Korea increased significantly from 1998 to 2010. The percentages of those achieving all recommendations of the American Diabetes Association have increased, but are still not satisfactory.
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Affiliation(s)
- Sung Hoon Yu
- Division of Endocrinology and Metabolism Department of Internal Medicine Hallym University College of Medicine Seoul Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism Department of Internal Medicine Hallym University College of Medicine Seoul Korea
| | - Yoo-Cheol Hwang
- Division of Endocrinology and Metabolism Department of Medicine Kyung Hee University Hospital at Gangdong Kyung Hee University School of Medicine Seoul Korea
| | - Kyu Jeung Ahn
- Division of Endocrinology and Metabolism Department of Medicine Kyung Hee University Hospital at Gangdong Kyung Hee University School of Medicine Seoul Korea
| | - Hyung Joon Yoo
- Division of Endocrinology and Metabolism Department of Internal Medicine Hallym University College of Medicine Seoul Korea
| | - Hong Yup Ahn
- Department of Statistics Dongguk University-Seoul Seoul Korea
| | - Sung Woo Park
- Division of Endocrinology and Metabolism Department of Internal Medicine School of Medicine Sungkyunkwan University Seoul Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism Department of Internal Medicine School of Medicine Sungkyunkwan University Seoul Korea
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Okamoto K, Iwasaki N, Doi K, Noiri E, Iwamoto Y, Uchigata Y, Fujita T, Tokunaga K. Inhibition of glucose-stimulated insulin secretion by KCNJ15, a newly identified susceptibility gene for type 2 diabetes. Diabetes 2012; 61:1734-41. [PMID: 22566534 PMCID: PMC3379671 DOI: 10.2337/db11-1201] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Potassium inwardly rectifying channel, subfamily J, member 15 (KCNJ15) is a type 2 diabetes-associated risk gene, and Kcnj15 overexpression suppresses insulin secretion in rat insulinoma (INS1) cells. The aim of the current study was to characterize the role of Kcnj15 by knockdown of this gene in vitro and in vivo. Human islet cells were used to determine the expression of KCNJ15. Expression of KCNJ15 mRNA in islets was higher in subjects with type 2 diabetes. In INS1 cells, Kcnj15 expression was induced by high glucose-containing medium. Regulation of Kcnj15 by glucose and its effect on insulin secretion were analyzed in INS1 cells and in normal mice and diabetic mice by the inactivation of Kcnj15 using small interfering RNA. Knockdown of Kcnj15 increased the insulin secretion in vitro and in vivo. KCNJ15 and Ca(2+)-sensing receptor (CsR) interact in the kidney. Binding of Kcnj15 with CsR was also detected in INS1 cells. In conclusion, downregulation of Kcnj15 leads to increased insulin secretion in vitro and in vivo. The mechanism to regulate insulin secretion involves KCNJ15 and CsR.
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Affiliation(s)
- Koji Okamoto
- Department of Human Genetics, Graduate School of Tokyo University, Tokyo, Japan
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoko Iwasaki
- Diabetes Center, Tokyo Women’s Medical University, Tokyo, Japan
- Institute of Integrated Medical Science, Tokyo Women’s Medical University, Tokyo, Japan
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
- Corresponding authors: Katsushi Tokunaga, , and Naoko Iwasaki,
| | - Kent Doi
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Yasuko Uchigata
- Diabetes Center, Tokyo Women’s Medical University, Tokyo, Japan
| | - Toshiro Fujita
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Tokyo University, Tokyo, Japan
- Corresponding authors: Katsushi Tokunaga, , and Naoko Iwasaki,
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Patel JV, Hughes EA, Lip GYH, Gill PS. Diabetes Health, Residence & Metabolism in Asians: the DHRMA study, research into foods from the Indian subcontinent - a blinded, randomised, placebo controlled trial. BMC Cardiovasc Disord 2011; 11:70. [PMID: 22136261 PMCID: PMC3259037 DOI: 10.1186/1471-2261-11-70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 12/02/2011] [Indexed: 01/13/2023] Open
Abstract
Background Coronary heart disease (CHD) is highly prevalent amongst the South Asian communities in Britain. The reasons for this excess CHD risk are multifactorial, but in part relate to a susceptibility to diabetes mellitus - where the aberrant metabolism of non-esterified fatty acids (NEFA) and glucose are likely to underpin vascular disease in this population. Dietary intervention is an important and first line approach to manage increased CHD risk. However, there is limited information on the impact of the South Asian diet on CHD risk. Methods/Design The Diabetes Health, Residence & Metabolism in Asians (DHRMA) study is a blinded, randomised, placebo controlled trial that analyses the efficacy of reduced glycaemic index (GI) staples of the South Asian diet, in relation to cardio-metabolic risk factors that are commonly perturbed amongst South Asian populations - primarily glucose, fatty acid and lipoprotein metabolism and central adiposity. Using a 10-week dietary intervention study, 50 healthy South Asians will be randomised to receive either a DHRMA (reduced GI) supply of chapatti (bread), stone ground, high protein wheat flour and white basmati rice (high bran, unpolished) or commercially available (leading brand) versions chapatti wheat flour and basmati rice. Volunteers will be asked to complete a 75g oral glucose tolerance test at baseline and at 10-weeks follow-up, where blood metabolites and hormones, blood pressure and anthropometry will also be assessed in a standardised manner. Discussion It is anticipated that the information collected from this study help develop healthy diet options specific (but not exclusive) for South Asian ethnic communities. Trial registration Current Controlled Trials ISRCTN02839188
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Affiliation(s)
- Jeetesh V Patel
- Metabolic Medicine, Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Lyndon, West Bromwich, Lyndon (B71 4HJ), UK
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Davidson JA, Lacaya LB, Jiang H, Heilmann CR, Scism-Bacon JL, Gates JR, Jackson JA. Impact of race/ethnicity on the efficacy and safety of commonly used insulin regimens: a post hoc analysis of clinical trials in type 2 diabetes mellitus. Endocr Pract 2011; 16:818-28. [PMID: 20439249 DOI: 10.4158/ep09285.or] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the impact of race/ethnicity on the efficacy and safety of commonly used insulin regimens in patients with type 2 diabetes mellitus. METHODS In this post hoc analysis, pooled data from 11 multinational clinical trials involving 1455 patients with type 2 diabetes were used to compare specific insulin treatments in Latino/Hispanic, Asian, African-descent, and Caucasian patients. Insulin treatments included once daily insulin glargine or neutral protamine Hagedorn (BASAL), insulin lispro mix 75/25 twice daily (LMBID), or insulin lispro mix 50/50 three times daily (LMTID). RESULTS Race/ethnicity was associated with significant outcome differences for each of the insulin regimens. BASAL therapy was associated with greater improvement in several measures of glycemic control among Latino/Hispanic patients compared with Caucasian patients (lower end point hemoglobin A1c, greater reduction in hemoglobin A1c from baseline, and a larger proportion of patients achieving hemoglobin A1c level <7%). In contrast, LMBID therapy was associated with higher end point hemoglobin A1c and a smaller decrease in hemoglobin A1c from baseline in Latino/Hispanic and Asian patients than in Caucasian patients. Furthermore, fewer Asian patients attained a hemoglobin A1c level <7% than did Caucasians patients. For LMTID therapy, hemoglobin A1c outcomes were comparable across patient groups. Fasting blood glucose and glycemic excursions varied among racial/ethnic groups for the 3 insulin regimens. Weight change was comparable among racial/ethnic groups in each insulin regimen. During treatment with LMTID, Asian patients experienced higher incidence and rate of severe hypoglycemia than Caucasian patients. CONCLUSIONS Latino/Hispanic, Asian, and African-descent patients with type 2 diabetes show different metabolic responses to insulin therapy, dependent in part on insulin type and regimen intensity.
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Affiliation(s)
- Jaime A Davidson
- Department of Medicine, University of Texas Southwestern Medical School, Dallas, Texas 75248, USA.
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Davies MJ, Kela R, Khunti K. Liraglutide - overview of the preclinical and clinical data and its role in the treatment of type 2 diabetes. Diabetes Obes Metab 2011; 13:207-20. [PMID: 21205109 DOI: 10.1111/j.1463-1326.2010.01330.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Type 2 diabetes is characterized by a progressive decline in glycaemic control. Many standard diabetes treatments, however, fail to achieve or maintain glycaemic control, and are often associated with an increased risk of hypoglycaemia and weight gain. Recently developed incretin-based therapies are a promising addition to the current armamentarium of diabetes treatments. Two types of incretin-based therapies are currently available: glucagon-like peptide (GLP)-1 receptor agonists (liraglutide and exenatide) and dipeptidyl peptidase-4 inhibitors (sitaglipin, vildagliptin and saxagliptin). This review aims to summarize the key efficacy and safety data of liraglutide, a once-daily human GLP-1 analogue. Extensive phase III clinical trials have shown liraglutide to improve glycaemic control with additional benefits on body weight, blood pressure and β-cell function. Liraglutide is also generally well tolerated with a low risk of hypoglycaemia. Liraglutide has recently been approved for marketing in Europe, Japan and the USA.
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Affiliation(s)
- M J Davies
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
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Ricci-Cabello I, Ruiz-Pérez I, Olry de Labry-Lima A, Márquez-Calderón S. Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:572-587. [PMID: 21040063 DOI: 10.1111/j.1365-2524.2010.00960.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.
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Affiliation(s)
- I Ricci-Cabello
- Andalusian School of Public Health, Regional Health Ministry, Andalusia, Spain
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Abstract
Blacks have a lower prevalence of metabolic syndrome (MetS) that can be partly ascribed to the lower prevalent rates of some major components of MetS, namely the lower serum triglycerides and higher high-density lipoprotein cholesterol levels in blacks when compared with whites. Blacks manifest greater insulin resistance, the pivotal lesion underpinning MetS than whites. However, the relationships among insulin resistance and cardiovascular disease (CVD) risk factors are weaker in blacks than whites. The international bodies have recommended the use of European-based cutoff points for MetS for blacks. However, with the emerging inconsistencies in the association of insulin resistance and CVD risk factors in blacks, the use of these definitions and the cutoff points for MetS have become problematic. Therefore, it is important to review the limitations in the use of the current criteria and cutoff points of MetS in blacks to lessen the CVD risk burden in blacks.
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Affiliation(s)
- Kwame Osei
- Division, Endocrinology, Diabetes and Metabolism, The Ohio State University Medical Center, 495 McCampbell Hall, Columbus, OH 43210, USA.
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Okamoto K, Iwasaki N, Nishimura C, Doi K, Noiri E, Nakamura S, Takizawa M, Ogata M, Fujimaki R, Grarup N, Pisinger C, Borch-Johnsen K, Lauritzen T, Sandbaek A, Hansen T, Yasuda K, Osawa H, Nanjo K, Kadowaki T, Kasuga M, Pedersen O, Fujita T, Kamatani N, Iwamoto Y, Tokunaga K. Identification of KCNJ15 as a susceptibility gene in Asian patients with type 2 diabetes mellitus. Am J Hum Genet 2010; 86:54-64. [PMID: 20085713 PMCID: PMC2801752 DOI: 10.1016/j.ajhg.2009.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 11/07/2009] [Accepted: 12/04/2009] [Indexed: 11/29/2022] Open
Abstract
Recent advances in genome research have enabled the identification of new genomic variations that are associated with type 2 diabetes mellitus (T2DM). Via fine mapping of SNPs in a candidate region of chromosome 21q, the current study identifies potassium inwardly-rectifying channel, subfamily J, member 15 (KCNJ15) as a new T2DM susceptibility gene. KCNJ15 is expressed in the beta cell of the pancreas, and a synonymous SNP, rs3746876, in exon 4 (C566T) of this gene, with T allele frequency among control subjects of 3.1%, showed a significant association with T2DM affecting lean individuals in three independent Japanese sample sets (p = 2.5 x 10(-7), odds ratio [OR] = 2.54, 95% confidence interval [CI] = 1.76-3.67) and with unstratified T2DM (p = 6.7 x 10(-6), OR = 1.76, 95% CI = 1.37-2.25). The diabetes risk allele frequency was, however, very low among Europeans in whom no association between this variant and T2DM could be shown. Functional analysis in human embryonic kidney 293 cells demonstrated that the risk allele of the synonymous SNP in exon 4 increased KCNJ15 expression via increased mRNA stability, which resulted in the higher expression of protein as compared to that of the nonrisk allele. We also showed that KCNJ15 is expressed in human pancreatic beta cells. In conclusion, we demonstrated a significant association between a synonymous variant in KCNJ15 and T2DM in lean Japanese patients with T2DM, suggesting that KCNJ15 is a previously unreported susceptibility gene for T2DM among Asians.
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Affiliation(s)
- Koji Okamoto
- Department of Human Genetics, Graduate School of Tokyo University, Tokyo 113-0033, Japan
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan
| | - Naoko Iwasaki
- Diabetes Center, Tokyo Women's Medical University, Tokyo 162-8666, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo 162-8666, Japan
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Chisa Nishimura
- Department of Human Genetics, Graduate School of Tokyo University, Tokyo 113-0033, Japan
| | - Kent Doi
- Department of Human Genetics, Graduate School of Tokyo University, Tokyo 113-0033, Japan
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan
| | - Shinko Nakamura
- Diabetes Center, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Miho Takizawa
- Diabetes Center, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Makiko Ogata
- Diabetes Center, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Risa Fujimaki
- Diabetes Center, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Niels Grarup
- Hagedorn Research Institute, 2820 Gentofte, Copenhagen, Denmark
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Glostrup University Hospital, 2600 Glostrup, Denmark
| | - Knut Borch-Johnsen
- Steno Diabetes Center, 2820 Gentofte, Copenhagen, Denmark
- Faculty of Health Sciences, University of Aarhus, 8000 Aarhus, Denmark
| | - Torsten Lauritzen
- Department of General Practice, University of Aarhus, 8000 Aarhus, Denmark
| | - Annelli Sandbaek
- Department of General Practice, University of Aarhus, 8000 Aarhus, Denmark
| | - Torben Hansen
- Hagedorn Research Institute, 2820 Gentofte, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Kazuki Yasuda
- Department of Metabolic Disorder, Research Institute, International Medical Center of Japan, Tokyo 162-8655, Japan
| | - Haruhiko Osawa
- Department of Molecular and Genetic Medicine, Ehime University Graduate School of Medicine, Ehime 790-8577, Japan
| | - Kishio Nanjo
- First Department of Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Takashi Kadowaki
- Department of Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan
| | - Masato Kasuga
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Oluf Pedersen
- Hagedorn Research Institute, 2820 Gentofte, Copenhagen, Denmark
- Faculty of Health Sciences, University of Aarhus, 8000 Aarhus, Denmark
- Institute of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Toshiro Fujita
- Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan
| | - Naoyuki Kamatani
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yasuhiko Iwamoto
- Diabetes Center, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Tokyo University, Tokyo 113-0033, Japan
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Montanya E, Sesti G. A review of efficacy and safety data regarding the use of liraglutide, a once-daily human glucagon-like peptide 1 analogue, in the treatment of type 2 diabetes mellitus. Clin Ther 2009; 31:2472-88. [PMID: 20109994 DOI: 10.1016/j.clinthera.2009.11.034] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Eduard Montanya
- Endocrine Unit, University Hospital of Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.
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Nomura S, Shouzu A, Omoto S, Nishikawa M, Fukuhara S, Iwasaka T. Effect of valsartan on monocyte/endothelial cell activation markers and adiponectin in hypertensive patients with type 2 diabetes mellitus. Thromb Res 2009; 117:385-92. [PMID: 15896827 DOI: 10.1016/j.thromres.2005.04.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Revised: 04/03/2005] [Accepted: 04/07/2005] [Indexed: 01/18/2023]
Abstract
Angiotensin II receptor blockade has been shown to have a beneficial effect on the angiopathies of hypertension and hyperglycemia in patients with type 2 diabetes. However, the effect of angiotensin II receptor blockade on monocyte and endothelial cell adhesion markers in type 2 diabetes is poorly understood. We investigated the effects of valsartan on these markers in 53 hypertensive patients with and without type 2 diabetes mellitus. Levels of monocyte activation markers (soluble CD14: 2.1+/-0.9 vs. 3.3+/-1.4 microg/ml, p<0.01; monocyte chemotactic peptide: 392+/-94 vs. 489+/-114 pg/ml, p<0.05; and monocyte-derived microparticles: 264+/-98 vs. 511+/-128/microL, p<0.01) and endothelial cell activation markers (soluble E-selectin: 41+/-11 vs. 61+/-20 ng/ml, p<0.001; and soluble vascular cell adhesion molecule-1: 478+/-82 vs. 584+/-101 ng/ml, p<0.01) were significantly increased in hypertensive patients with type 2 diabetes compared to normotensive controls. In addition, the concentrations of adiponectin were significantly decreased in patients with type 2 diabetes (8.1+/-3.1 vs. 5.2+/-2.5 microg/ml, p<0.01). Regardless of the presence of diabetic complications, both systolic and diastolic blood pressures significantly decreased after valsartan administration (valsartan 80 mg/day for 8 weeks). Monocyte and endothelial cell activation markers were decreased significantly in patients with type 2 diabetes after valsartan treatment, but not in non-type 2 diabetic patients. In addition, valsartan alleviated hypoadiponectinemia in hypertensive patients with diabetes (before vs. after: 5.2+/-2.5 vs. 7.6+/-2.7 microg/ml, p<0.001) but did not increase adiponectin levels in the non-diabetic hypertensive group, for which the average adiponectin level was normal prior to treatment. These results suggest angiotensin II receptor blockade (valsartan) may be beneficial as an anti-atherosclerotic therapy in patients with type 2 diabetes in addition to its anti-hypertensive action.
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Affiliation(s)
- Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, Japan.
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McEwen LN, Bilik D, Johnson SL, Halter JB, Karter AJ, Mangione CM, Subramanian U, Waitzfelder B, Crosson JC, Herman WH. Predictors and impact of intensification of antihyperglycemic therapy in type 2 diabetes: translating research into action for diabetes (TRIAD). Diabetes Care 2009; 32:971-6. [PMID: 19228862 PMCID: PMC2681018 DOI: 10.2337/dc08-1911] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the predictors of intensification of antihyperglycemic therapy in patients with type 2 diabetes; its impact on A1C, body weight, symptoms of anxiety/depression, and health status; and patient characteristics associated with improvement in A1C. RESEARCH DESIGN AND METHODS We analyzed survey, medical record, and health plan administrative data collected in Translating Research into Action for Diabetes (TRIAD). We examined patients who were using diet/exercise or oral antihyperglycemic medications at baseline, had A1C >7.2%, and stayed with the same therapy or intensified therapy (initiated or increased the number of classes of oral antihyperglycemic medications or began insulin) over 18 months. RESULTS Of 1,093 patients, 520 intensified therapy with oral medications or insulin. Patients intensifying therapy were aged 58 +/- 12 years, had diabetes duration of 11 +/- 9 years, and had A1C of 9.1 +/- 1.5%. Younger age and higher A1C were associated with therapy intensification. Compared with patients who did not intensify therapy, those who intensified therapy experienced a 0.49% reduction in A1C (P < 0.0001), a 3-pound increase in weight (P = 0.003), and no change in anxiety/depression (P = 0.5) or health status (P = 0.2). Among those who intensified therapy, improvement in A1C was associated with higher baseline A1C, older age, black race/ethnicity, lower income, and more physician visits. CONCLUSIONS Treatment intensification improved glycemic control with no worsening of anxiety/depression or health status, especially in elderly, lower-income, and minority patients with type 2 diabetes. Interventions are needed to overcome clinical inertia when patients might benefit from treatment intensification and improved glycemic control.
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Affiliation(s)
- Laura N McEwen
- Department of Internal Medicine/Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA.
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Sone H, Yamada N. [Progress in clinical care of cardiovascular diseases complicated with diabetes mellitus]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2009; 98:794-801. [PMID: 19472542 DOI: 10.2169/naika.98.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Agban H, Elley CR, Kenealy T, Robinson E. Trends in the management of risk of diabetes complications in different ethnic groups in New Zealand primary care. Prim Care Diabetes 2008; 2:181-186. [PMID: 18829410 DOI: 10.1016/j.pcd.2008.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 03/27/2008] [Accepted: 08/07/2008] [Indexed: 11/17/2022]
Abstract
AIMS To assess changes over two years in the health status and management of a cohort of people with Type 2 diabetes from different ethnic groups within a primary care diabetes annual review programme in New Zealand. METHODS The study evaluated changes in clinical measures and proportions achieving guideline targets for 7782 people who had data recorded at baseline in 2002-2003 and at follow-up two years later within the diabetes programme. RESULTS A large proportion of Maori (47%) and Pacific (69%) patients had poor glycaemic control at baseline and only small improvements were made over the two years. Significant improvements were made in all the ethnic groups in blood pressure and lipid management at two-year follow-up. By the two-year follow-up, over 75% of Maori and Pacific patients received appropriate treatment with anti-hypertensive and lipid lowering medication and many of the ethnic disparities in risk factors for complications were reduced. CONCLUSIONS Participation in the annual review programme may have contributed to improvements in clinical management and reduced disparities in a cohort with Type 2 diabetes. However, the removal of restrictions on statin use in 2002, and introduction of diabetes management guidelines in 2003 may also have improved management standards.
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Affiliation(s)
- Hosnah Agban
- School of Population Health, University of Auckland, Auckland, New Zealand
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Hermansen K, Mortensen LS, Hermansen ML. Combining insulins with oral antidiabetic agents: effect on hyperglycemic control, markers of cardiovascular risk and disease. Vasc Health Risk Manag 2008; 4:561-74. [PMID: 18827907 PMCID: PMC2515417 DOI: 10.2147/vhrm.s1815] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular disease (CVD). Unfortunately, several potential barriers exist for CVD risk management in diabetes, including the need for significant lifestyle changes, potential problems with hypoglycemia, weight gain, injection tolerability, treatment complexity with current diabetes therapies and other, unmodifiable factors. Improving glycemic control may impact CVD risk. Treatment of T2DM usually starts with lifestyle changes such as diet and exercise. When these become insufficient, pharmacotherapy is required. Various oral antidiabetic drugs (OADs) are available that reduce hyperglycemia. The first line of therapy is usually metformin, since it does not increase weight and seems to have a beneficial effect on CVD mortality and risk factors. As T2DM progresses, insulin treatment becomes necessary for the majority of patients. The last few years have seen the development of long-acting, rapid-acting, and premixed insulin analog formulations. The treat-to-target algorithms of recent studies combining OADs plus insulin analogs have demonstrated that patients can reach glycemic treatment targets with low risk of hypoglycemia, greater convenience, and – with some analogs – limited weight gain vs conventional insulins. These factors may possibly have a positive influence on CVD risk. Future studies will hopefully elucidate the benefits of this approach.
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Affiliation(s)
- Kjeld Hermansen
- Department of Endocrinology and Metabolism C, Aarhus University Hospital DK-8000 Aarhus, Denmark.
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Choudhury S, Brophy S, Fareedi MA, Zaman B, Ahmed P, Williams DRR. Intervention, recruitment and evaluation challenges in the Bangladeshi community: experience from a peer lead educational course. BMC Med Res Methodol 2008; 8:64. [PMID: 18844992 PMCID: PMC2571097 DOI: 10.1186/1471-2288-8-64] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 10/09/2008] [Indexed: 11/17/2022] Open
Abstract
Background The incidence of Type 2 diabetes is increasing worldwide and diabetes is four times more common among ethnic minority groups than among the general Caucasian population. This study reflects on the specific issues of engaging people and evaluating interventions through written questionnaires within older ethnic minority groups. Methods The original protocol set out to evaluate an adapted version of the X-PERT® patient program using questionnaires and interviews. Results Questionnaires, even verbally completed, were unsuccessful and difficult to administer as participants found the questionnaire structure and design difficult to follow and did not perceive any benefit to completing the questionnaires. The benefits of attending the course were also poorly understood by participants and in many cases people participated in coming to the course as a favour to the researcher. Engaging participants required word of mouth and the involvement of active members of the community. Conclusion Peer led courses and their evaluation in older ethnic minority communities needs a very different approach for that in younger Caucasian patients. A structured approached to evaluation (favoured by western educational system) is inappropriate. Engaging participants is difficult and the employment of local well known people is essential.
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Affiliation(s)
- Sm Choudhury
- School of Medicine, Swansea University, Wales, UK.
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Abstract
BACKGROUND AND METHODS The present review assesses published data relating to the main ethnic groups in the UK Prospective Diabetes Study (UKPDS), namely White Caucasians (WC; 82% of the cohort), Indian-Asians (IA; 10%) and Afro-Caribbeans (AC; 8%). RESULTS At entry, the IA patients were younger than WC and AC patients, had a greater waist-hip ratio and more sedentary lifestyle, but had the lowest prevalence of hypertension and current smoking. The AC patients had the poorest glycaemic control but the most favourable lipid profile. The differences in modifiable vascular risk factors did not change over 9 years of follow-up. Consistent with UKPDS exclusion criteria, few patients had complications at baseline and there were no between-group differences. An interim analysis of incident fatal/non-fatal myocardial infarction (median follow-up 8.7 years) showed that the AC patients had a 70% lower risk than WC after adjustment for explanatory variables and that IA patients had a similar risk to WC. An analysis of complete albuminuria and renal failure data (median follow-up 15 years) showed that IA ethnicity was independently associated with an increased risk. CONCLUSIONS There are sustained ethnic differences in the nature of diabetes, including vascular risk factors. AC patients had a substantially reduced risk of myocardial infarction that was not explained by their more favourable lipid profile, while IA patients were more likely to develop nephropathy than WC and IA patients. Longer follow-up is needed to determine whether the increased macrovascular risk observed in IA patients in other studies is replicated in the UKPDS cohort.
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Affiliation(s)
- T M E Davis
- University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Australia.
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Munoko TN, Hermans MP. Phenotypic characterization of first generation Maghrebian migrants with type 2 diabetes. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2008. [DOI: 10.1016/j.dsx.2008.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boden-Albala B, Cammack S, Chong J, Wang C, Wright C, Rundek T, Elkind MSV, Paik MC, Sacco RL. Diabetes, fasting glucose levels, and risk of ischemic stroke and vascular events: findings from the Northern Manhattan Study (NOMAS). Diabetes Care 2008; 31:1132-7. [PMID: 18339972 DOI: 10.2337/dc07-0797] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is insufficient randomized trial data to support evidence-based recommendations for tight control of fasting blood glucose (FBG) among diabetic subjects in primary stroke prevention. We explored the relationship between FBG among diabetic subjects and risk of ischemic stroke in a multiethnic prospective cohort. RESEARCH DESIGN AND METHODS Medical and social data and FBG values were collected for 3,298 stroke-free community residents: mean age +/- SD was 69 +/-10 years; 63% were women, 21% were white, 24% were black, and 53% were Hispanic; and follow-up was 6.5 years. Baseline FBG levels were categorized: 1) elevated FBG: history of diabetes and FBG >or=126 mg/dl (7.0 mmol/l); 2) target FBG: history of diabetes and FBG <126 mg/dl (7.0 mmol/l); or 3) no diabetes/reference group. Cox models were used to calculate hazard ratios (HRs) and 95% CI for ischemic stroke and vascular events. RESULTS In the Northern Manhattan Study, 572 participants reported a history of diabetes and 59% (n = 338) had elevated FBG. Elevated FBG among diabetic subjects was associated with female sex (P < 0.04), Medicaid (P = 0.01), or no insurance (P = 0.03). We detected 190 ischemic strokes and 585 vascular events. Diabetic subjects with elevated FBG (HR 2.7 [95% CI 2.0-3.8]) were at increased risk of stroke, but those with target FBG levels (1.2 [0.7-2.1]) were not, even after adjustment. A similar relationship existed for vascular events: elevated FBG (2.0 [1.6-2.5]) and target FBG (1.3 [0.9-1.8]. CONCLUSIONS This prospective cohort study provides evidence for the benefits of tighter glucose control for primary stroke prevention.
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Affiliation(s)
- Bernadette Boden-Albala
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Fagour C, Sorel G, Inamo J, Couffinhal T. [The prevalence of abnormal glucose regulation after myocardial infarction: Comparative study in two French ethnic groups]. ANNALES D'ENDOCRINOLOGIE 2008; 69:433-9. [PMID: 18466875 DOI: 10.1016/j.ando.2008.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 02/17/2008] [Accepted: 03/12/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to compare the prevalence of abnormal glucose tolerance in patients stemming from two French ethnic groups and admitted for acute coronary syndrome (ACS) to intensive coronary care unit. MATERIALS AND METHODS During a period of six months, 53 and 60 consecutive patients were enrolled at Fort-de-France (Martinique, French West Indies, Afrocaribbeans, group F) and at Bordeaux (France, Europeans, group B), respectively. Glucometabolic state was classified according to medical history and fasting glycemia measured from the fourth day after ACS. RESULTS At baseline, 36% of the patients of group F and 20% of the patients of group B had previously known diabetes (p=0.06). Prevalence of hypertension was higher in Afrocaribbeans than in Europeans (60 versus 40%, p<0.05). According to fasting glycemia, newly detected diabetes were found in six Afrocaribbeans and only one was found in Europeans; two patients in group F and three patients in group B displayed impaired fasting glycemia. As a whole, 51% of Afrocaribbeans and 27% of Europeans showed abnormal glucose tolerance (p<0.05). Furthermore, Afrocaribbeans displayed lower levels of triglycerides and higher levels of HDL cholesterol than Europeans (p<0.05). CONCLUSION Our study suggested a higher prevalence of impaired glucose metabolism in French Afrocaribbeans than in European counterparts after ACS. Furthermore, French Afrocaribbeans displayed a more favorable lipoprotein profile. These characteristics look like that of the American and British Afrocaribbeans, maybe because of a common genetic origin.
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Affiliation(s)
- C Fagour
- Service d'endocrinologie et de diabétologie, CHU de Bordeaux, hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac, France.
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Lichtenstein AH, Rasmussen H, Yu WW, Epstein SR, Russell RM. Modified MyPyramid for Older Adults. J Nutr 2008; 138:5-11. [PMID: 18156396 DOI: 10.1093/jn/138.1.5] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 1999 we proposed a Modified Food Guide Pyramid for adults aged 70+ y. It has been extensively used in a variety of settings and formats to highlight the unique dietary challenges of older adults. We now propose a Modified MyPyramid for Older Adults in a format consistent with the MyPyramid graphic. It is not intended to substitute for MyPyramid, which is a multifunctional Internet-based program allowing for the calculation of individualized food-based dietary guidance and providing supplemental information on food choices and preparation. Pedagogic issues related to computer availability, Web access, and Internet literacy of older adults suggests a graphic version of MyPyramid is needed. Emphasized are whole grains and variety within the grains group; variety and nutrient density, with specific emphasis on different forms particularly suited to older adults' needs (e.g. frozen) in the vegetables and fruits groups; low-fat and non-fat forms of dairy products including reduced lactose alternatives in the milk group; low saturated fat and trans fat choices in the oils group; and low saturated fat and vegetable choices in the meat and beans group. Underlying themes stress nutrient- and fiber-rich foods within each group and food sources of nutrients rather than supplements. Fluid and physical activity icons serve as the foundation of MyPyramid for Older Adults. A flag to maintain an awareness of the potential need to consider supplemental forms of calcium, and vitamins D and B-12 is placed at the top of the pyramid. Discussed are newer concerns about potential overnutrition in the current food landscape available to older adults.
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Affiliation(s)
- Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
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Nishimura T, Nakajima K, Kusuoka H, Yamashina A, Nishimura S. Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study. Eur J Nucl Med Mol Imaging 2007; 35:319-28. [DOI: 10.1007/s00259-007-0608-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 09/15/2007] [Indexed: 10/22/2022]
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Kristensen JK, Bak JF, Wittrup I, Lauritzen T. Diabetes prevalence and quality of diabetes care among Lebanese or Turkish immigrants compared to a native Danish population. Prim Care Diabetes 2007; 1:159-165. [PMID: 18632038 DOI: 10.1016/j.pcd.2007.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 05/14/2007] [Accepted: 07/14/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To describe Type 2 diabetes prevalence and care among Turkish (T) and Lebanese (L) immigrants as compared to native Danes (DK) in the county of Aarhus. METHOD Data from The National Health Service Registry, The Regional Laboratory Database and The Danish National Hospital Registry were collected from 2000 through 2003 to identify and describe known diabetes in a background population of 244.426 citizens in the age group of 40-70 years living in the County of Aarhus. RESULTS The age-standardised prevalence of Type 2 diabetes was 3.6% (DK), 18.9% (L) and 19.8% (T). In 2003, HbA1c was measured at least once in 84% (DK), 87% (L) and 83% (T) of the patients. In 2003, 72% (DK), 53% (L) and 51% (T) had an HbA1c <8% (p<0.05) and less than 50% of all groups had a total-cholesterol <5.0 mmol/l. In 39% (DK), 35% (L) and 37% (T) of the patients, no examination for retinopathy was registered during the period of 2000-2003. A cardiovascular diagnosis was registered in 27% (DK), 32% (L) and 33% (T) of the patients (p=NS). CONCLUSION Compared to native Danes, Lebanese and Turkish immigrants had a much higher prevalence of Type 2 diabetes and worse glycaemic regulation. The routine monitoring of diabetes care for native Danes, Lebanese or Turkish immigrants were similar. Overall, diabetes care is not satisfactory neither for native Danes, nor Lebanese or Turkish immigrants.
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Millett C, Gray J, Saxena S, Netuveli G, Khunti K, Majeed A. Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study. PLoS Med 2007; 4:e191. [PMID: 17564486 PMCID: PMC1891316 DOI: 10.1371/journal.pmed.0040191] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 04/11/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004. METHODS AND FINDINGS We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c < or = 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57-0.97) and BP control (AOR 0.65, 95% CI 0.53-0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005. CONCLUSIONS Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.
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MESH Headings
- Adult
- Africa/ethnology
- Aged
- Aged, 80 and over
- Bangladesh/ethnology
- Blood Pressure
- Caribbean Region/ethnology
- Cholesterol/blood
- Contracts
- Diabetes Mellitus/blood
- Diabetes Mellitus/economics
- Diabetes Mellitus/ethnology
- Diabetes Mellitus/therapy
- Disease Management
- Ethnicity
- Family Practice/economics
- Family Practice/organization & administration
- Female
- Glycated Hemoglobin/analysis
- Goals
- Health Policy
- Humans
- India/ethnology
- London
- Male
- Medical Records Systems, Computerized/statistics & numerical data
- Middle Aged
- National Health Programs/economics
- National Health Programs/standards
- Outcome Assessment, Health Care/economics
- Outcome Assessment, Health Care/standards
- Pakistan/ethnology
- Physician Incentive Plans/economics
- Physicians, Family/economics
- Practice Management, Medical/economics
- Prejudice
- Prospective Studies
- Quality Indicators, Health Care/economics
- Quality Indicators, Health Care/standards
- Reimbursement, Incentive/economics
- Reimbursement, Incentive/organization & administration
- Treatment Outcome
- United Kingdom/epidemiology
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Affiliation(s)
- Christopher Millett
- Wandsworth Primary Care Research Centre, Wandsworth Primary Care Trust, London, United Kingdom.
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Gulliford MC, Ashworth M, Robotham D, Mohiddin A. Achievement of metabolic targets for diabetes by English primary care practices under a new system of incentives. Diabet Med 2007; 24:505-11. [PMID: 17381507 DOI: 10.1111/j.1464-5491.2007.02090.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse achievement of metabolic targets by English general practices following the introduction of a new system of incentives. METHODS Clinical data were abstracted from the records of 2099 patients at 26 general practices in South London. Cross-sectional data for 2005 were obtained for all general practices in England, including characteristics of registered populations, practice organizational characteristics and 'Quality and Outcomes Framework' (QOF) metabolic targets. RESULTS Among 26 practices in South London, the median practice-specific proportion of patients achieving HbA(1c) < or = 7.4% each year increased: 2000, 22%; 2001, 32%; 2002, 37%; 2003, 38% and in 2005 from QOF, 57%. In 8484 general practices in England in 2005, the median proportion of diabetic patients with HbA(1c) < or = 7.4% was 59.0%; the highest and lowest centiles ranged from 27.7 to 89.8% among general practices, from 46.9 to 71.0% among 303 primary care trusts and from 49.9 to 67.1.% among 28 health authorities. Comparing the highest and lowest tertiles of deprivation, the per cent achieving HbA(1c) < or = 7.4% was 2.96% (95% confidence interval 2.23-3.69%) lower in the most deprived areas. In areas with the highest proportion of ethnic minorities, the per cent achieving HbA(1c) < or = 7.4% was 2.73% (1.85-3.61%) lower than where there were few ethnic minorities. Practices with the highest total QOF organization scores had more patients achieving the HbA(1c) target (difference 5.03%, 4.43-5.64%). CONCLUSIONS Intermediate outcomes are improving but deprived areas with less organized services achieve worse glycaemic control. Financial incentives may contribute to improved services and better clinical outcomes.
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Affiliation(s)
- M C Gulliford
- Division of Health and Social Care Research, King's College London, UK.
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Chittari MV, Bush K, Bellary S, Kumar S, Barnett AH, O' Hare JP. Microvascular and cardiovascular disease in South Asians: the emerging challenge. ACTA ACUST UNITED AC 2007. [DOI: 10.1002/pdi.1134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Oladele CRW, Barnett E. Racial/Ethnic and social class differences in preventive care practices among persons with diabetes. BMC Public Health 2006; 6:259. [PMID: 17052356 PMCID: PMC1629017 DOI: 10.1186/1471-2458-6-259] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 10/19/2006] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Diabetes is the sixth leading cause of death in the United States. Persons with diabetes are at increased risk for serious complications including CVD, stroke, retinopathy, amputation, and nephropathy. Minorities have the highest incidence and prevalence of diabetes and related complications compared to other racial groups. Preventive care practices such as smoking cessation, eye examinations, feet examinations, and yearly checkups can prevent or delay the incidence and progression of diabetes related complications. The purpose of this study was to examine racial/ethnic differences in diabetes preventive care practices by several socio-demographic characteristics including social class. METHODS Data from the Behavioral Risk Factor Surveillance Survey for 1998-2001 were used for analyses. The study population consisted of persons who indicated having diabetes on the BRFSS, 35 yrs and older, and Non-Hispanic Black, non-Hispanic White, or Hispanic persons. Logistic regression was used in analyses. RESULTS Contrary to our hypotheses, Blacks and Hispanics engaged in preventive care more frequently than Whites. Whites were less likely to have seen a doctor in the previous year, less likely to have had a foot exam, more likely to smoke, and less likely to have attempted smoking cessation. Persons of lower social class were at greatest risk for not receiving preventive care regardless of race/ethnicity. Persons with no health care coverage were twice as likely to have not visited the doctor in the previous year and twice as likely to have not had an eye exam, 1.5 times more likely to have not had a foot exam or attempted smoking cessation. CONCLUSION This study showed that persons of lower social class and persons with no health insurance are at greatest risk for not receiving preventive services.
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Affiliation(s)
- Carol R Williams Oladele
- University of South Florida, College of Public Health, Department of Epidemiology and Biostatistics, 13201 Bruce B. Downs Blvd. MDC 56, Tampa FL 33612 USA
| | - Elizabeth Barnett
- University of South Florida, College of Public Health, Department of Epidemiology and Biostatistics, 13201 Bruce B. Downs Blvd. MDC 56, Tampa FL 33612 USA
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Baradaran HR, Jamieson J, Gardee R, Knill-Jones RP. Scottish survey of diabetes services for minority ethnic groups. BMC Health Serv Res 2006; 6:130. [PMID: 17029641 PMCID: PMC1630428 DOI: 10.1186/1472-6963-6-130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 10/09/2006] [Indexed: 11/23/2022] Open
Abstract
Background In the UK, all ethnic minority groups have higher rates of diabetes than the general population. Although there have been a number of projects to assess diabetic care amongst minority ethnic groups in the United Kingdom, little is known about the extent to which the needs of ethnic minority groups are actually met by the National Health Service (NHS) Scotland. Therefore we conducted this study to understand of the current situation for diabetes care available to minority ethnic groups in Scotland. Methods We conducted this cross-sectional study in all health boards in Scotland. A questionnaire was designed based on expert comments. It was completed by Local Health Care Cooperatives (LHCC) managers, chairs, diabetes specialist nurses and public health practitioners. Results 57 of questionnaires were returned (response rate = 69.5%). Of these LHCCs, 71% responded that diabetes was part of their LHCC plan. However 69% answered that ethnic group was not recorded by community services and GPs, and 80% of LHCCs did not monitor trends of complications of diabetes by ethnic group. Conclusion Improvement is needed in quality, completeness, and availability of minority ethnic group data for diabetes at a national level, particularly if NHS Primary Care Organisations are to be responsible for providing diabetes care as laid out in the Scottish Diabetes Framework.
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Affiliation(s)
- Hamid R Baradaran
- Public Health and Health Policy Section, University of Glasgow, Glasgow G12 8RZ, UK.
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Stur M, Egger S, Haas A, Kieselbach G, Mennel S, Michl R, Roden M, Stolba U, Wedrich A. Diagnose, Therapie und Verlaufskontrolle der diabetischen Augenerkrankung. SPEKTRUM DER AUGENHEILKUNDE 2006. [DOI: 10.1007/bf03163807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barnett AH, Dixon AN, Bellary S, Hanif MW, O'hare JP, Raymond NT, Kumar S. Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia 2006; 49:2234-46. [PMID: 16847701 DOI: 10.1007/s00125-006-0325-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022]
Abstract
A popular hypothesis for the greater prevalence of type 2 diabetes and cardiovascular disease in UK south Asians is that they have an increased susceptibility of developing insulin resistance in response to certain environmental factors, including obesity and adoption of a sedentary lifestyle. Insulin resistance is postulated as a central feature of the metabolic syndrome, culminating in type 2 diabetes, atherosclerotic vascular disease and CHD; a pathway potentially accelerated by migration/urbanisation. We describe and compare the prevalence of type 2 diabetes, cardiovascular disease and their associated risk factors in UK south Asian and white Caucasian populations to determine possible reasons for the increased preponderance of these diseases in south Asians, and highlight key evidence for optimal risk factor management. Finally, we describe a UK community-based programme that attempts to reduce the morbidity and mortality from type 2 diabetes and cardiovascular disease in south Asians through a new approach to management.
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